1:00 pm -
Kory T. Anderson
Kory T. Anderson, MD
System Physician Advisor and Lead Physician for Denials Management
Intermountain Healthcare

Mohammad Shaheed
Mohammad Shaheed, MD, SFHM, CHCQHM-PHYADV
Medical Director, Physician Advisor Group
Rochester Regional Health

1:15 pm

Addressing the health of patients across the care continuum is increasingly complex and resource intensive. In order to optimize patient flow and ensure care coordination and continuity, leaders must collaborate with health professionals involved in care management and transitions of care.

  • Create better coordination practices to transition patients to the appropriate level of care
  • Discuss the involvement of hospitalists in post-acute care settings such as post-discharge clinics, home health, SNF, LTACS, and high-utilizer clinics
  • Determine an action plan to set up home health approved by the insurance on a timely manner
Rachel Cyrus
Rachel Cyrus, MD, SFHM, FACP
Clinical Director, Division of Hospital Medicine
Northwestern Medical Group

2:00 pm

Health care finance is a language unto itself yet a crucial knowledge physicians must have to navigate through the changes of health care reform. In this session, review the foundation of health care movement to value-based medicine and strategies to position yourself as an essential resource in the revenue cycle for your practice.

  • Uncover the fundamentals of financial pressures on facilities and the revenue streams impacted by physician leaders
  • Define health care finance in a systematic way to help physicians understand how it impacts their department and the health system in a larger scale
  • Promote evolving revenue generation models and empower physicians to drive sustainable change and decrease wasteful practices
Alex Bardakh
Alex Bardakh, MPP
Director, Public Policy and Advocacy
AMDA, The Society for Post-Acute and Long-Term Care Medicine

2:45 pm

Appealing claims is a resource-intensive process that increases the administrative burden of clinicians and physician leaders, especially when dealing with complex pediatrics patients. Physician Advisors involved in claims and denials must establish processes to improve denial rates and effectively justify medical necessity. In this session, evaluate successful strategies providers have embraced to optimize physician workflow and justify medical necessity.

  • Outline the similarities and differences of working on claims and denials of pediatrics and adult patients
  • Uncover best practices to establish a stong peer-to-peer process
  • Discuss internal changes that can better assist physicians in filling claims
  • Create your own medical necessity criteria to augment current criteria and guidelines
Yasser Said
Yasser Said, MD
Physician Advisor; Director, Care Management
Advocate Medical Group

4:00 pm

Denial for authorization can be a costly process in terms of resources for the hospital and also affect the course of treatment of patients. Utilization review is used to not only improve efficiency of care but also protect hospital’s revenue integrity. Explore how physician leaders involved in utilization review can work with case management to efficiently utilize resources and enhance processes for improved patient care, revenue integrity, and compliance.

  • Identify metrics that can be used to ensure compliance in fee-for-service Medicare, Medicare managed care, and commercial payer medical necessity requirements, especially for patients in observation status
  • Promote utilization and case management collaboration to better determine patient status and compliance with Medicare’s Two Midnight Rule
Walter Bohnenblust
Walter Bohnenblust, MD, SFHM
Director, Utilization Management,
UPMC/Tower Health
Medical Director, Utilization Management and Quality Improvement
Tower Health

Sheryl Jones-Henderson
Sheryl Jones-Henderson, MD
Medical Director,
UMPC/Tower Health Physician Advisor and Hospitalist,
Tower Health

4:45 pm

Threats of inappropriate denials can severely impact a hospital’s finances. Physician Advisors and Medical Directors must have a clear understanding of the full spectrum of appeals and denials. Hear what it takes to appeal at different levels, and gain the necessary skills to make the appropriate decision on a case-by-case basis.

  • Analyze current audit structure and the state of Medicare appeals
  • Outline strategies and tools to identify high risk denial targets and avoid the need for ALJ appeal
  • Discuss common denied cases and how to successfully appeal for overturn
Jessica L. Gustafson
Jessica L. Gustafson, Esq.
Founding Shareholder
The Health Law Partners, P.C.

Abby Pendleton
Abby Pendleton, Esq.
Founding Shareholder
The Health Law Partners, P.C.

5:30 pm

NAPA (National Association of Physician Advisors) works with World Congress to organize annual meetings with Physician Advisors and Medical Directors. We are really keen on providing content and meeting place for our community that is relevant and beneficial to you. With that in mind, two NAPA board members will lead an interactive discussion on how NAPA can be your organization of choice to provide the meeting place, resources, and educational content that you need. Some of the questions to be posed to the group included:

  • What kind of content should we provide to those that are new to this role?
  • What are experienced Physician Advisors and Medical Directors looking for when attending a conference?
  • Could we combine a conference for new and experienced Advisors?
  • Is the current duration of annual conference meeting your expectations and needs?
  • What resources are you eager to have at your hands throughout the year?
  • Besides the 2-day annual meeting, how would you like to see us engage you on the other 363 days of the year?
  • Are you looking for a more structured networking idea exchange outside of breaks and cocktail hour?
Aziz Ansari
Aziz Ansari, DO, SFHM, FACP
Associate Chief Medical Officer, Clinical Optimization and Revenue Integrity; Associate Director, Division of Hospital Medicine; Medical Director, Observation Unit, Associate Professor of Medicine
Loyola University Medical Center

Mohammad Shaheed
Mohammad Shaheed, MD, SFHM, CHCQHM-PHYADV
Medical Director, Physician Advisor Group
Rochester Regional Health