Day 1
Thursday, January 20, 2005

8:00 – 9:00 a.m.
Registration and Continental Breakfast

9:00 – 10:15 a.m.
Fee Schedule Secrets to Increase Your Reimbursement
Frank Cohen, Senior Analyst, Medical Information Technologies, Clearwater, Fla.

Fee schedules are typically kept under lock and key by private payers. And no wonder. Since private payers offer different fees to different providers – often even in the same geographical area – they don’t really want physician practices finding out what each other is getting. That’s where this session makes a difference. We’ll give you actual fee schedules for selected procedures and compare them with the Medicare allowable and also with national and state average charges. Next, you will examine additional benchmarking tools, such as RBRVS, utilization per thousand and market dynamics. Then Frank Cohen, perhaps the leading health care statistical analyst in the country, will show you how to read, interpret and use this information to see if your own charges (and reimbursement) are appropriate, high or low. Armed with this technique, you’ll go back to your office extremely well prepared to negotiate reimbursement with your payers.

10:15 – 10:30 a.m.
Break

10:30 – 11:45 a.m.
Refund Requests: What to Do… and What Not to Do
Lisa Clark, health care attorney, Duane Morris, Philadelphia, Pa.

You send in clean claims, you get paid on time and you move on. But your private payers don’t. One, two or maybe three years later you get a request from them for a refund, often for their own mistakes! Find out from Lisa Clark, who successfully assisted a major health system in a dispute with a payer over millions of dollars in claims, just how to make sure your paid claims stay that way – and what you can do to ensure future claim payments don’t get yanked out of your pocket. Find out how to fight against retrospective reviews that reverse prior payer authorizations, long range audits that seek to reverse paid claims more than a year old, partial recoupments and much more. A not-to-be-missed session.

11:45 a.m. – 1:00 p.m.
Lunch

1:00 – 2:15 p.m.
Prompt Payment: Solutions to Make Sure Your Reimbursement Arrives on Time
Jo Ann Steigerwald, President, Medical Business Specialists, Baraboo, Wis.

It can seem like forever. You wait… and wait… and wait for your private payers to adjudicate, process and sometimes even acknowledge your already-clean claims. It’s not right… but it happens. Jo Ann Steigerwald has the solutions you need. Listen as she tells you how to use state and federal rules to ensure your payers reimburse you on time. Hear lessons about providers who successfully used prompt pay laws to arm twist their payers into cutting checks, how to stop “pending” notices that put your claims on hold, what documentation you should keep to make your case, how states differ in applying laws, what procedures are most likely to get stalled by payers and much more.

2:15 – 3:30 p.m.
Partial Payments, Silent PPOs and More: Turn the Tables on Private Payers that Mishandle Your Fees
Debbie Redd, President/CEO, Capital Women’s Care, Rockville, Md.

You have to be vigilant with how private payers handle your fees. For instance, the next time you receive a payment for an out-of-network claim, check the amount and read the fine print. If the payment is for less than the full amount of the claim, there may be a disclaimer saying that if you cash the check, no further payment will be given. Here’s another example: There are private payers who sell their provider networks – including the lower payments you already accept – behind your back to other payers (“silent PPOs”), thereby causing your reimbursement to drop without your knowledge. Debbie Redd, who runs a 54-doctor physician practice, has been there with these and other payment challenges. She shares with you how to recognize what private payers may be doing with your fees… and how to protect what you’re entitled to.

3:30 – 3:45 p.m.
Break

3:45 – 5:00 p.m.
How to Get Your HIPAA-Compliant Electronic Claims Paid
Rachel Foerster, CEO, Rachel Foerster & Associates, Chicago, Ill.

All the confusion and requirements over the HIPAA electronic transactions and code sets rule really come down to one thing: will you still get your claims paid? The answer, as Rachel Foerster tells you, is “yes, but...” If claims are not filed correctly… or if electronic clearinghouses or payers do not have their HIPAA programs in sync, the result may be unnecessarily-delayed or, worse, denied claims. Find out from her just what you need to do to make sure your clean claims do not become victim to the HIPAA transition. Also find out: new data requirements beyond medical codes, solutions to challenges in using your HIPAA-mandated medical codes, and the key role of your practice management/patient accounting system.

Day 2
Friday, January 21, 2005

8:00 – 9:15 a.m.
What the Aetna/Cigna Settlement Means to You
Karen K. Harris, former Aetna Regional General Counsel for the Midwest; health care attorney, Wachler & Associates, Royal Oak, Mich.

It sounds impressive. Aetna and Cigna separately agree to settle a class action lawsuit brought against them and other private payers by organizations representing 700,000 physicians and will pay providers $170 million collectively, plus make a host of other changes to improve communication and give more information to providers. But how will it really work? How much money will physician practices get from the settlement… and, perhaps more importantly, how do you get your share? Karen Harris, who until recently represented Aetna as one of its regional general counsels, shares that knowledge with you. Find out from her not only how to determine if you are entitled to a portion of the settlement, but also how to take advantage of the settlement so you get proper and timely reimbursement in the future.

9:15 – 10:30 a.m.
Solutions to Bundling, Modifier and Downcoding E/M Reimbursement Challenges
Maggie Mac, Consulting Manager, Pershing Yoakley & Associates, Clearwater, Fla.

It’s bad enough going through the E/M hurdles that Medicare sets up. But private payers have their own unique set. At this session, Maggie Mac, who formerly was the practice administrator of an 8-doctor physician practice, tells you how to overcome challenges like: denials for services submitted with modifiers -22, -25, -57, -58, -59, and -80; special handling of hospital E/M services for observation, admission, discharge and consultations; payers who downcode your E/M services; getting paid for E/M services done on the same day as diagnostic testing and other procedures; and annual preventive exams performed at the same time as an E/M service. You’ll leave this session armed with solutions!

Bonus: List of time thresholds for E/M services

10:30 – 10:45 a.m.
Break

10:45 a.m. – 12:00 noon
Special Investigations Units: How Private Payer Cops Tackle Fraud & Abuse
John Morris, Special Investigations Unit Manager, BlueCross/BlueShield of Florida, Jacksonville, Fla.

The government isn’t the only one cracking down on fraud and abuse. Private payers have their own investigative resources – Special Investigations Units (SIUs) – that investigate providers they suspect are committing fraud against them. These SIU teams are often made up of former OIG and other law enforcement agents, and they work closely with their government counterparts. Many cases are, in fact, later referred by the SIUs to the Justice Dept. for prosecution. That said, there are key differences between how the government investigates a case and how a private payer does. Find out from John Morris, who leads an SIU team himself, just what red flags catch SIU eyes, how SIU investigators proceed once they suspect fraud, and just what these private payer investigators can and cannot do. Then learn what you should do so you don’t get caught in the crosshairs.

12:00 noon – 1:15 p.m.
Lunch

1:15 – 2:30 p.m.
When to Renegotiate Your Contract… and When to Threaten Termination
Joey Havens, Director of Physician Services, Horne CPA Group, Jackson, Miss.

If you don’t occasionally swing your private payer contract like a bat, you may be missing a chance to increase your reimbursement. Find out from health care CPA Joey Havens how to get the most from your in-network payers and, more importantly, when to take that big step and drop contracts that are no longer profitable. Learn the formulas private payers use to determine both in- and out-of-network rates and how often they call up contracts for renegotiation; tips to analyze your contract for target areas you should focus on to improve reimbursement or payment terms; when and how to threaten contract termination to drive up reimbursement for key procedures; when to call it quits on your payer’s contract; and renegotiating points every provider should use to walk away with a better-paying fee schedule.

2:30 – 2:45 p.m.
Break

2:45 – 4:00 p.m.
Get the Most from Your Out-of-Network Claims
George Alex, Managing Partner, Iatro, Baltimore, Md.

Someone new to coding and billing might think that out-of-network payers should pay more than in-network payers. After all, there is no contract and no agreed-upon payment discount. Unfortunately, as coders and billers with only a few months on the job know, the reality is all too often different, with the payer frequently trying to push the financial burden onto the patient. George Alex tells you how to avoid this trap and get the payer to reimburse you properly. Find out from him how to fight back when out-of-network payers misuse “usual, customary and reasonable” methodology to pay you less; how to use authoritative sources of coding information to appeal rejections for specific codes that out-of-network payers refuse to pay; and how to use state legislation to stop out-of-network payers from refusing to deal with you directly.

4:00 p.m.
Adjourn