RACs, MACs, MICs, QICs, ZPICs:

Know What They Mean and Limit Your Financial Risk

About the Webinar Program Objectives Webinar Will Answer These Questions Speakers Who Should Attend Purchase Options Continuing Education Questions

Attend from your desktop or conference room. Invite your whole team to attend at one low price of $329 per location. Each registration comes with access to the archived version of the program and the materials until December 31, 2012. Continuing Education: This program is approved for 1.5 contact hours for nurses, certified case managers, disability management specialists, licensed Mental Health counselors/certified counselors, psychologists and social workers.

Navigating the federal auditing bodies – or what seems like a large cup of alphabet soup – is enough to make your head spin.

But these federal auditing bodies can have a tremendous impact on your organization. Many reports have paid mind to the millions of dollars that the new recovery audit contractors (RACs) have taken from providing organizations. Fewer reports have spent time on the fistful of other auditing bodies that are out there and keeping hospital executives up at night.

In the face of these auditing bodies, case managers stand at the brink of a tremendous opportunity. Case management departments have an opportunity to make a huge impact within their organization by knowing more about these new and changing entities and knowing the value in understanding what they are looking at and the financial risk they pose to their organizations.

To learn about how to navigate the myriad auditing bodies of the federal government, gather your team on February 29, 2012, from 12:00-1:30pm EST to learn from an esteemed faculty who will share essential background information in addition to working tactics, tips and tools that have proved successful in limiting financial risk.

By attending this training session you will learn:

• The breadth and roles of federal auditing contractors.
• How to improve your compliance with national regulations.
• Strategies to limit the financial risk of your organization through proactive steps.

Case managers dealing with Medicare and Medicaid programs, especially hospital care managers and the new patient-centered medical home (PCMH) case managers, are among those on the frontlines coordinating care. They are also on the frontlines assessing and confirming medical necessity for appropriate levels of care and reviewing medical records for sufficient documentation.

Therefore, they need to have a clear understanding of Medicare and Medicaid programs, associated statutes, as well as what these new entities are auditing in their charts and how their organizations are dealing with them.

When case managers review patient’s medical management needs, coordinate care, and determine medical necessity, they need to clearly understand the use of the appropriate tools for reviews such as national coverage determination (NCD) and local coverage determination (LCD) guidelines, used by Medicare and Medicaid, as well as, InterQual criteria and Milliman Roberts care guidelines used by commercial payers. Also, they need to continue developing useful job aides that assist with these and many other important efforts that impact their organization’s bottom line.

• Identify federal and state healthcare auditors.
• Understand the risks that auditing bodies pose to your organization.
• Learn how to circumvent these risks through department strategies.
• Understand the key role case management departments play in this endeavor.
• Instill a program-wide gameplan for auditing prevention.
• Underscore the importance of case management’s important role in federal audits for executive leadership.

• What are RACs?
• What are MACs?
• What are MICs?
• What are QICs?
• What are ZPICs?
• How can my department secure our organization against costly audits?
• What is the importance of medical necessity?
• How can I understand the importance of assigning proper levels of care?
• Are there workflow plans that can mitigate the risk of audits?
• Who should take a leadership role when it comes to facing audits?
• Are there any software capabilities for this type of issue?
• How can I put an end to unnecessary payments?

Tina M. Kowlsen, RN, BS, CCM, is the Compliance Manager for Third Party Audits in the Corporate Care Management Department at UPMC in Pittsburgh, Pa.

Linda Sallee, RN, MS, CMAC, ACM, IQCI, has more than 30 years of experience in the healthcare field. She is a Director at Huron Consulting Group in the healthcare practice. With a master’s in Nursing from the University of Southern Mississippi, Linda’s vast career experience includes serving as VP for Case Management of five hospitals, Chief Nurse Executive; Regional Director of Clinical Quality Improvement; Outcome Manager for Quality Improvement for 11 hospitals; Director of Case Management/Case Manager; nurse educator; and staff nurse.  She is passionate about service-focused, cost-effective, quality care.  Linda is currently on the National Board for the American Case Management Association (ACMA) and is President of the Virginia Chapter of ACMA.

Donna Hoare Scanlon, RN, CMC is the director of the Case Management Department at Indiana Regional Medical Center, where she has been employed for over 32 years. Her nursing background includes both critical care and nursing administration. She began working in utilization management in 1991 and has been the director of the department for three years. She manages a staff which includes RN inpatient and Emergency Department care managers, social workers, the denial coordinator and administrative assistant.

Annette Cusimano has been employed at Indiana Regional Medical Center for 28 years. She is a member of the Case Management Department as the Denial Coordinator. Annette manages inpatient denials and appeals for managed care organizations as well as RACs and other audit agencies.

Moderator:  Anne Llewellyn RN-BC, MS, BHSA, CCM, CRRN  Editor in Chief, Case Management Products  Dorland Health, a Division of Access Intelligence

• Live Webcast Registration – $329 (per-site fee)
• Webcast Recording on CD-ROM – $329
• Live Webcast and CD-ROM – $389

Nurses: This program is approved for 1.5 contact hours for nurses by Commonwealth Educational Seminars (CES). As an APA approved provider, CES programs are accepted by the American Nurses Credentialing Center (ANCC). Every state Board of Nursing accepts ANCC approved programs except California and Iowa. However, CES is also an approved Continuing Education Provider by the California Board of Registered Nursing, (Provider Number CEP 15567) which is also accepted by the Iowa Board of Nursing

Certified Case Managers: This program is approved for 1.5 contact hours for case managers through the Commission for Case Manager Certification.

Disability Management Specialists: This program is approved for 1.5 contact hours through the Certification of Disability Management Specialists Commission.

Licensed Mental Health Counselors/Certified Counselors: Commonwealth Educational Services (CES) is recognized by the National Board for Certified Counselors to offer CE credit. (#5596). The program is approved for 1.5 CE hours credit. We adhere to NBCC Continuing Education Guidelines. The following state Counseling Boards accept programs offered by NBCC approved providers as part of license renewal: AL, AK, AR, DE, FL, GA, IL, IN, IA, ID, IL, KY, LA, ME, MA, MT, ND, NE, NH, NM, NC, NV, OK, OR, RI, SD, TN, TX, WA, and WV.

Psychologists: Commonwealth Educational Services (CES) is approved by the American Psychological Association to sponsor continuing education for psychologists. Psychologists attending this program receive 1.5 CE hours credit. CES maintains responsibility for this program.
 
Social Workers: This program is approved for 1.5 CE hours for Social Workers. Commonwealth Educational Seminars (CES) is approved as a provider for Social Work Continuing Education (ACE Provider #1117) by the Association of Social Work Boards (ASWB, 400 South Ridge Parkway, Ste B, Culpepper, VA 22701) www.aswb.org. ASWB Approval Period: 10/6/09-10/5/12.


 

For questions regarding the Webinar or to register by phone, contact Hope Kabik at 301-354-1769.

If you are having any technical difficulties or need assistance meeting these requirements, please contact our Technical Support Center at 1-866-229-3239..

For content questions regarding this Webinar, contact Anne Llewellyn at 954-254-2950 or email allewellyn@dorlandhealth.com.

*Dorland Health does not offer any refunds for the webinar.  All sales are final.

The live audio is delivered to your location over the telephone or your computer speakers. The Power-Point presentations are presented over the Internet and are available to print out before the program. This is like a talk-radio program with visuals on the Web. You and your team will be able to have a live Q&A with all the speakers.

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