3rd Annual AIHCD Conference
Friday, April 19, 2013
Friday, April 19, 2013 General Session GS01 8:30am – 9:30am
Betty Bibbins, MD, BSN, CHC, C-CDI, CPEHR, CPHIT
President, Chief Medical Officer, and Executive Physician Educator
DocuComp®, LLC
Cape Charles, VA
Dr. Bibbins, a Physician with a background in Nursing, is certified in Healthcare Compliance, Clinical Documentation Improvement, Electronic Health Records, and Health Information Technology. Dr. Bibbins has had over 35 years of healthcare experience as an educator, clinician, and administrator. She is President, Chief Medical Officer and Executive Physician Educator for DocuComp®, LLC. She has presented at numerous conferences and written many articles regarding physician documentation improvement.
Dr. Bibbins focus is on the needs of Physicians, Nurses, and HIMs in the providing of healthcare, and the Hospitals that depend on clinical documentation to capture appropriate levels of service, severity of illness, third party reimbursements, maintain Compliance, prepare for the Electronic Medical Record, prepare for increasing standards for the utilization-of-healthcare services, Medical Cost Recovery, and prepare for “Quality-of-Care” standards.
Objectives:
- Define the mission, goal, and advocacy statement of AIHCD
- Introductions of the AIHCD Steering Committee and current path for the future of the organization
- Address the changing and growing needs in the healthcare environment specifically focused on clinical documentation improvement, medical necessity, physician advisory and the denials and appeals process.
Friday, April 19, 2013 General Session GS02 9:45am – 10:45am “Documentation Enigmas & Conundra: From Observation to the OIG" by Bernice Hecker, MD, MHA, FACC
Summary: Patient setting of care determinations (observation vs. inpatient) and cross-walking E&M documentation to code selection confuse providers, commonly resulting in expensive denials and pre and post-pay reviews. Both setting of care determinations and appropriate documentation of E&M visits and consequent coding are straightforward if the provider knows the correct questions to ask. Providers must verify the submitted documentation answers those questions. Failure to submit the correct documentation will result in “cash flow challenges”.
Objectives:
- Understand the importance of accurate setting of care determinations to patients, CMS as well as providers.
- Understand the criteria for patient care determinations at the patient’s point of entry to care.
- Understand the relationship and application of medical necessity to E&M documentation and coding.
Bernice Hecker, MD, MHA, FACC
Medical Director, Noridian
Medicare Contractor Parts A&B
Seattle, WA
Bernice Hecker, MD, MHA, FACC Dr. Hecker is Medicare Medical Director for the Noridian states, Jurisdiction F and Minnesota. She has primary responsibility for policy, coverage, and medical review. She chairs CMS-mandated committees including annual Medical Director/CMS meetings and the LCD) Local Coverage Determination) Writers’ Meeting and presented the in-service trainings on Inpatient Review. She acts a consultant to the OIG, FDA, Justice, and AHRQ. Dr. Hecker graduated with special honors from both the University of Washington undergraduate and medical schools. She completed an Anesthesiology residency at the University of Virginia as well as fellowships in Pain Management and Cardiac Anesthesiology. She holds a Master’s in Hospital Administration from the University of Washington in Seattle. Dr. Hecker has worked as a medical officer in the US Navy on overseas assignment, in the National Health Services Corps, in academic medicine, in a horizontally and vertically–integrated private practice, and was Medical Director of a national non-profit quality review organization. She has consulted to industry on the development and implementation of electronic health records; has performed both bench and clinical research; has several research publications; is a former Anesthesiology Board examiner; is an active committee member of several professional organizations; and on the Boards of several organizations, including the of University of Washington’s Compliance Certification Program .
Friday, April 19, 2013 General Session GS03 11:00am – 12:00pm “The Role of Documentation Integrity in RC and ZPIC audits, EMR, and Medical Malpractice” by Scott Jones
Objectives:
- Discuss RC and ZPIC audits as they relate to documentation integrity.
- Assess risks associated with physician use of Electronic Medical Records (EMR).
- Review the impact of inadequate documentation on medical malpractice claims
D. Scott Jones, CHC, LHRM
Senior VP Claims, Risk Management and Corporate Compliance
HPIX
Philadelphia,PA
D. Scott Jones, CHC, LHRM, is vice president of corporate compliance and risk management for American
Healthcare Providers Insurance Services, a national professional liability insurance management company with
Headquarters in Philadelphia, PA. Mr. Jones is a former acute care hospital administrator, large medical practice administrator and is a nationally board certified Healthcare Compliance Officer. He is a frequent speaker before state, regional and national health care organizations. He has developed innovative patient safety-focused, hands-on risk management programs for health care organizations, physician groups, medical professional liability insurance companies, onshore and offshore captives and risk retention groups. Since joining HPIX, Mr. Jones has successfully built a library of continuing medical education content that was developed by various in-house authors, including himself, and several member physicians. He spends the majority of his time developing new risk management products and performing on site medical office practice assessments. In this role he focuses on assessment, implementation and compliance. He monitors HPIX early reporting standards within insured practices and provides feedback to physician clients so they understand the benefits of early reporting.
Friday, April 19, 2013 Lunch Break 12:00pm – 1:00pm
Friday, April 19, 2013 General Session GS04 1:15pm – 2:15pm “Compliance Investigations and Disclosures” by Andrea Merritt, MBA, BS, CIA, CHC and Colleen McKinley, Esq.
Objectives:
- Understand the protocols of pre-investigation, investigation, on-site searches, document requests, in-person interviews, and contact letters
- Address the role of Compliance Counsel in the investigation protocols
- Understand the self-disclosure protocol and its associated benefits
Ms. Andrea Merritt, MBA, BS, CIA, CHC,
Director, Compliance and Audit Services
Hall, Render, Killian, Heath, and Lyman, PSC
Detroit, MI
Andrea Merritt is the Director of Compliance and Audit Services for Nova Compliance Group, a Hall Render company, in Troy, Michigan. Andrea assists health care organizations on all aspects of compliance programs, including HIPAA. She is involved in conducting compliance program assessments,
training and education, auditing and monitoring, development of policies and procedures and addressing compliance concerns. Andrea is a member of the Health Care Compliance Association and has presented for the organization in the area of compliance effectiveness. She previously performed audit and compliance services for CHAN Healthcare Auditors at St. John Health. Andrea is also adjunct faculty in business at Walsh College and Lawrence Technological University.
Colleen McKinley, JD
Attorney, Hall, Render, Killian, Heath & Lyman, P.S.C.
Louisville, KY
PRACTICE AREAS
- Certificate of Need
- Credentialing & Peer Review
- Fraud & Abuse/Stark
- Hospital & Physician Transactions
- Licensing & Accreditation
- Medical Staff Organization & Structure
- Physician Group Practices
MEMBERSHIPS
- American Bar Association
- American Health Lawyers Association
- Louisville Bar Association
- Kentucky Bar Association Kentucky Academy of Hospital Attorneys, President - 1994-1995; Board of Directors - 2003-2004
- Kentucky Rural Health Association, Board of Directors - 2012-2013
PRESENTATIONS
- Kentucky Academy of Hospital Attorneys: Affordable Care Act.
- Professional Healthcare Institute of America: Affordable Care Act.
- Louisville Bar Association: Certificate of Need Issues.
Friday, April 19, 2013 2:30pm – 3:30pm Track A1 “Compliance in the Midst of Complexity … Success, One Step at a Time” by Ms. Gerrie James, MSN, CCS, CCP, CPUR, Certified ICD-10 CM/PCS, C-CDI
Summarize the “useful” medical record … one that:
- is comprised of documentation ONLY supporting medical necessity for the assigned level of care (inpatient, outpatient, outpatient observation services)
- translates the patient’s entire “story” into numerical codes portrays revenue integrity
- realizes best practice strategies used to engage Clinical-Coding Compliance Teams
- translates the value of engaging physician involvement
- senses that the responsibility to accomplish revenue integrity is a team effort
- appreciates the healthcare compliance journey with intentionality to walk in … one step at a time
Objectives:
- Comprehension of documentation that captures medical necessity in the appropriate setting.
- Recognize documentation that can be accurately converted to numerical codes.
- Recognize documentation that accurately captures consumption of resources.
- Comprehension of strategies to translate documentation into numerical codes.
- Comprehend the importance of physician “buy-in”.
- Realize the importance that teamwork has on revenue integrity.
- Comprehension of the steps in remaining compliant.
Ms. Gerrie James, MSN, CCS, CCP, CPUR,
Certified ICD-10 CM/PCS, C-CDI
Trainer Compliance Manager
Sharp Healthcare
San Diego, CA
Gerrie James has 30 years of nursing experience and has aligned her medical/surgical/oncology and labor/delivery clinical expertise with other areas unique to health care. Over the past ten years, Ms. James has focused much of her time in the Corporate Compliance arena. Gerri’s combination of clinical and coding expertise, has allowed her the opportunity to partner with clinicians at the point of care, all the while introducing them to the complexity of medical necessity documentation and the inpatient and outpatient coder’s world. Gerrie received her BSN from Old Dominion University, Norfolk, VA, and her MSN from San Diego State University, San Diego, CA. She is a member of the American Health Information Management Association (AHIMA), the California Health Information Association (CHIA), the Association of Clinical Documentation Improvement Specialists (ACDIS), the American Association of Nurse Assessment Coordinators (AANAC) and the Association for Integrity in HealthCare Documentation (AIHCD). Gerrie is a Certified Coding Specialist (CCS), a Resident Assessment Coordinator-Certified (RAC-CT), a Certified Professional in Utilization Review (CPUR), has a Legal Nurse Consultant Certificate, an ICD-10 CM/PCS Trainer and a Certified Compliance Professional (CCP).
Friday, April 19, 2013 2:30pm – 3:30pm Track B1 "The Role of the Physician Advisor, Linking Clinical Documentation with Medical Necessity" by Deka Jama, MD
Objectives:
- Understand the idea behind expanding the role of the Physician Advisor to include Clinical Documentation Improvement (CDI)
- Understand the basis for CDI with focus on Medical Necessity
- View the Physician Advisor as liaison between medical staff and Utilization Review/CDI team
- Case studies and examples
Deka Jama, MD
Physician Advisor and Hospitalist
Inova Health System
Falls Church, VA
Dr. Jama is a Board Certified Internist practicing in the Washington DC area. She received her medical degree from the Robert Johnson Medical School in New Jersey and completed her residency in internal medicine at the University of Minnesota. Dr. Jama is a Physician Advisor and Hospitalist with the Inova Health System in Northern Virginia. Dr. Jama chairs the Care Coordination Committee at Inova Alexandria Hospital where she is also an active member of the Quality Council.
Friday, April 19, 2013 3:45pm – 4:45pm Track A2 “Advanced Denials & Appeals for Cardiology and Orthopedics” by Glenn Krauss, RHIA, BBA, CCS, CCS-P, CPUR, CCDS, C-CDI
Establishment of Medical Necessity through Effective Clinical Documentation
It is No Longer Just a “Hospital Concern”
Getting Started with Focus Upon Denials Avoidance –Cardiovascular and Orthopedic Service Line
This session will present the fundamental shortfalls in general medical record processes that contribute to hospital service denials that is the physician’s lack of understanding of their role in demonstrating medical necessity for all service provisions, whether services are ordered by or directly provided by physicians. Time proven effective strategies to promote physician buy-in and practical application of medical record documentation techniques to capture physician’s clinical judgment, thought processes and medical decision-making in support of medical necessity will be shared. Real case studies will be utilized in outlining a planning, development and implementation roadmap to bring back to your facility to jumpstart an initiative to promote physician understanding of the simplicity of documentation for medical necessity establishment.
Objectives:
- Take the following key points back to your facility that can be shared with the physician staff
- Comprehend the role of the physician in the establishment of medical necessity
- Understand and practically apply the concept of medical necessity to daily clinical documentation
- Incorporate the "Five Steps" of clinical documentation into the daily practice of medicine to reduce E & M medical necessity denials
- Learn the common pitfalls of E & M clinical documentation that detract from the accurate reporting of physician work performed and down-coding of E & M assignment.
- Learn the key principles of E & M assignment that incorporate effective clinical documentation with less work and time.
- Understand the true synergies of clinical documentation from a hospital and physician perspective that can successfully be used in promoting the concept of medical necessity to physicians
Glenn Krauss RHIA, BBA, CCS, CCS-P, CPUR, CCDS, C-CDI
Consultant
Revenue Cycle and Health Information Management
Glenn Krauss is a seasoned consultant in the Revenue Cycle and Health Information Management field with a passion for improving clinical documentation in all settings of the healthcare delivery system, – Glenn has more than 15 years’ experience in the healthcare industry as a consultant and has held various staff positions in numerous healthcare systems, including Revenue Systems Manager, Data Quality Manager, Director of Health Information Management, and Director of Case Management and Revenue Enhancement. His business background in and experience as a practicing coder and as a consultant in Clinical Documentation Improvement, medical necessity education for physicians with a focus upon the impact to the physician’s practice of medicine, MS-DRGs, ICD-9-CM, Chargemaster, Billing, APCs and CPT-4 coding enable him to effectively combine a working knowledge of hospital management with the importance of a functioning and effective Health Information Management Department.
He currently serves on the Advisory Board of the Association for Clinical Documentation Improvement Specialists. Glenn also has extensive experience in teaching physiology, surgical procedures and the rationale of therapeutic treatments with ICD-9 and CPT coding. His ability to help others conceptualize such complex medical, billing and clinical documentation issues have proved successful in both quality issues as well as reimbursement. Rounding out Glenn’s accomplishments has been numerous speaking engagements at different professional association meetings such as national and state level HFMA, Maryland AAHAM, Association for Clinical Documentation Improvement Specialists, and teleconferences that include AHIMA, Lorman Educational Services, HCPRO and Health Care Compliance Strategies. He has written extensively on subject matter content of clinical documentation improvement, medical necessity and clinical accuracy in coding in publications such as HCPRO, Health Leaders, and Physician News.
Friday, April 19, 2013 3:45pm – 4:45pm Track B2 “Creating an Effective Clinical Picture” by Candice Koldyke, RHIA, CCS
Objectives:
Recognize ICD-9 vs. ICD-10 Medical Necessity/Clinical Improvement changes
Understand how Clinical documentation gets clarification of the clinical picture
Discuss how CDI staff role will be affected
Candice Koldyke RHIA, CCS
Training & Development Department
St. Vincent Health
Indianapolis, IN
Candice L. Koldyke RHIA, CCS, C-CDI
Training & Development/Process Improvement, St. Vincent Health, Indianapolis, IN
Candice is currently the trainer for HIM & Clinical Documentation staff and also is a Process Improvement Consultant at St. Vincent Health in Indianapolis, Indiana. Ms. Koldyke has over 20 years of experience in the health care field. She holds certifications as a Registered Health Information Administrator, Certified Coding Specialist, and Clinical Documentation Improvement and is an AHIMA Approved ICD-10 Trainer. Candice has been trained in Lean Six Sigma methodologies and enjoys working on the Indiana Health Information Management Association (IHIMA) ICD-10 Education Task Force.
Saturday, April 20, 2013
Saturday, April 20, 2013 General Session GS05 8:30am – 9:30am “National Quality Strategy”; Aligning our efforts to transform America's Healthcare.”
By Bernard Rosof, MD, MACP, CEO
Objectives:
- Recognize better quality of care
- Comprehension of Improving the health of the population/community
- Discuss Affordable Care
Following the presentation the participants should have a better understanding of the National Quality Strategy including the national priorities and goals. This will include Engaging patients and families in managing their health and making decisions about their care, Improving the safety and reliability of America's healthcare system and Ensuring that patients receive well-coordinated care within and across all healthcare organizations, settings and levels of care.....and the tools necessary to accomplish this.
Bernard Rosof, MD, MACP,
CEO, Chair, Board of Directors
Huntington Hospital North Shore-LIJ Health System
Huntington, NY
Dr. Bernard Rosof is at the forefront of national initiatives in the areas of quality and performance improvement. He is the Chair of the Board of Directors of Huntington Hospital (North Shore-LIJ Health System) and a member of the Executive Committee of the Board of the Health System. He is a member of the Board of Directors of the National Quality Forum, and the Co-Chair of the National Priorities Partnership convened by the NQF to set national priorities and goals to transform America’s healthcare. Dr. Rosof is the Chair of the NPP’s Committee on Overuse. Dr. Rosof is the Chair of the Physician Consortium for Performance Improvement convened by the AMA that continues to lead efforts in developing, testing and implementing evidence-based performance measures for use at the point of care. He is also a former member of the Clinical Performance Measurement Committee of the NCQA. Dr. Rosof is the Chair of the Physician Advisory Committee for United Health Group. Dr. Rosof is CEO of Quality HealthCare Consultants (QHC) that provides strategic advisory services to the community of health care providers interested in improving the quality and safety of health care delivery in our nation.
Dr. Rosof is Professor in the Department of Medicine at the Hofstra North Shore-LIJ School of Medicine in New York. He is a Master of the American College of Physicians and Chair Emeritus of the Board of Regents of the American College of Physicians. Dr. Rosof is the recipient of the Laureate Award from the American College of Physicians and the Theodore Roosevelt Award for Distinguished Community Service. He received the 2011 Founders Award presented by the American College of Medical Quality in recognition of his long-standing national leadership and exceptional ability to foster and support healthcare quality improvement. In 2012, Dr. Rosof also received the distinguished Stengel Award from the American College of Physicians for outstanding service to the College and Internal Medicine. Dr. Rosof is currently the Chair of the Institute of Medicine (National Academy of Science) Committee on Chronic Multi Symptom Illness. Dr. Rosof has published many medical articles on quality, performance and professionalism. He is the co-founder of the Fay J. Lindner Center for Autism and other related disabilities for the North Shore-LIJ Health System and remains on the Board of this organization. He has been recognized for his contributions to the health and welfare of this vulnerable population.
Saturday, April 20, 2013 General Session GS06 9:45am – 10:45am “Using Care Managers in the ED for Admission Medical Necessity”
by Becky L. Nicholl, RN, GCNS, CRM
Objectives:
- Define case management and the Care Manager role
- Understand Medical Necessity criteria and Levels of Care
- Understand the effect of case management on boosting the hospital’s bottom line
Becky Nicholl, RN, GCNS, CRM
Vice President of Quality/Risk Management
Mary Rutan Hospital
Bellefontaine, Ohio
Becky oversees the Care Coordination and Medical Records departments and has successfully created a Care Manager role in the Emergency Room setting in order to maximize the opportunity for meeting medical necessity on all patients placed as Inpatients and to clearly separate those that should be Observation Status.
Becky is a Geriatric Clinical Nurse Specialist who has worked twenty-five years as a Quality/Risk Manager in the hospital setting. She achieved the status of Diplomate in Healthcare Administration from the American Academy of Medical Administers. Becky is also a Certified Risk Manager. She was on the Editorial Board of the Aspen Publishers for 5 years as a consultant for the manual: “Health Care Facilities Risk Management: Forms, Checklists, & Guidelines”.
Saturday, April 20, 2013 General Session GS07 11:00am – 12:00pm “Documentation Distress? Maintain Composure in Chaos”
by Harriett, Wall, BS, MBA
ICD-10 anxiety? A wreck over RACs? Qualms about queries?
The world of CDI is awash with change. This session is designed to help you chart your plan for personal peace despite difficult people, changing processes, and challenging assignments. The session will help you explore alternative stress busters and design a personal plan that will help you maintain your composure and reduce tension in your team. The session will also touch on managing stress for those working remotely now or in the future.
Objectives:
- Identify your job specific stress triggers: people, places, situations, processes, paperwork, and deadlines
- Develop a strategy for reducing the occurrence of stressful situations where possible
- Develop a strategy for managing stressful situations at work incorporating deep breathing, brief meditations, and humor
- Explore and practice activities that reduce stress
- Have fun!
Harriett Wall, B.S., MBA
Vice President
Kohler HealthCare Consulting, Inc.
Woodstock, MD
Harriett has over 20 years of leadership, consulting, business development and marketing in the healthcare industry serving providers, payers, and vendors. She has a strong operations background with particular expertise in clinical documentation improvement, disease management, patient access, and performance improvement. She is a popular speaker for healthcare professional organizations in the U.S. and has been a speaker at national and regional venues in Australia. Harriett received her B.S. degree in Physical Therapy from Northeastern University and was awarded her MBA by Harvard Business School. Harriett is active in HFMA and other professional associations.
Saturday, April 20, 2013 Lunch Break 12:00pm – 1:00pm
Saturday, April 20, 2013 General Session GS08 1:00pm – 2:00pm "Three Pillars of Structurally Sound Documentation; Medical Necessity, Quality and Diagnostic Specificity"
by Jessica Whitely MD, BMA, PAC-CDI
This presentation will teach participants the components necessary to ensure exemplary documentation. By focusing on medical necessity, quality, and specificity practitioners can learn to document concise, relevant information that provides an accurate account of patient’s health status and demonstrates the provision of reasonable and necessary services.
Objectives:
- Understand what medical necessity is and the best ways to demonstrate medical necessity through documentation.
- Understand necessary components of quality care and the opportunities to demonstrate the provision of quality care through documentation.
- Understand how to document with specificity, and learn the important role that it plays in the healthcare system.
Jessica Whitley, MD, BMA, PAC-CDI
Medical Director, Review Services
KePRO of Ohio
Seven Hills, OH
Dr. Jessica Whitley is a graduate of Case Western Reserve School of Medicine and is board certified in Internal Medicine. She currently practices medicine as a hospitalist physician in the Cleveland, OH area. She has been active in clinical documentation improvement and utilization review since 2007, at which time she served as the Medical Director of the Care Coordination Department for Lake Health Systems in Willoughby, OH. In 2008, she joined DocuComp LLC as a physician educator consultant and has excelled in her ability to communicate the importance of clinical documentation improvement to other physicians. Dr. Whitley realized the importance of bridging the business and clinical aspects of medicine, so she attended Cleveland State University and completed a Master of Business Administration with a concentration in Healthcare Administration in 2009. She has a passion for excellence, and enjoys opportunities to utilize her valuable combination of business and clinical skills in order to help to facilitate the practice of evidence-based, high quality, efficient health care. Those who have worked with Dr. Whitley are often impressed not only with her breath of knowledge, but also remark about her warm and engaging personality. She considers her ability to connect and build positive relationships with many people to be her greatest strength.
Saturday, April 20, 2013 General Session GS09 2:15pm – 3:15pm “ICD-10 for the Non-HIM Professional: The presentation will include ideas on areas of focus for non-HIM professionals and tips on how to support a successful implementation from the budget, training & process improvement perspectives.”
By Nicole Harper, PhD, RHIA, MBA, CCS-P, C-CDI
Objectives:
- Suggest ideas on ways to support non-HIM professionals during the transition to ICD-10
- Provide tips on effective training & education opportunities
- Discuss mitigation strategies for reporting and operational concerns
Nicole Harper, PhD, RHIA, MBA, CCS-P, C-CDI
Director, Training & Development/Process Improvement
St. Vincent Health
Indianapolis, IN
Nicole Harper is currently the Director of Training & Development/Process Improvement & Clinical Documentation Integrity at St. Vincent Health in Indianapolis, Indiana. Dr. Harper has over 20 years of experience in the health care field. She holds certifications as a Registered Health Information Administrator, Certified Coding Specialist-Physician Office, Clinical Documentation Improvement and is an AHIMA Approved ICD-10 Trainer. Nicole is trained in Lean Six Sigma methodologies and enjoys working on the Indiana Health Information Management Association (IHIMA) where she co-chairs the ICD-10 Education Task Force.She received a PhD in Leadership & Organizational Change from Walden University, Baltimore, MD.
Saturday, April 20, 2013 Track A3 3:30pm – 4:30pm “Inpatient versus Observation; CDI for both Case Manager and CDI Specialist”
by Cynthia Compton, CCS, FCS, C-CDI
Objectives:
- Provide a practical and quantifiable definition of medical necessity
- Outline the elements of medical necessity given the definition of medical necessity
- Learn and understand best practice strategy for documentation to consistently demonstrate medical necessity regardless of patient designation.
Cynthia Compton, CCS, FCS, C-CDI
Executive Director Care Management and Utilization Review
Jane Todd Crawford Hospital
Liberty, KY
Cynthia Compton is a consultant in the Revenue Cycle and Health Information Management field with more than 15 years’ experience in the healthcare industry both as a consultant and various staff positions in a healthcare system. Ms. Compton has extensive experience with working with Medical Staffs and ancillary staff to understand DRG methodology and the importance of documentation in the medical record. Ms. Compton organized a team to work with medical necessity issues within a 3 hospital system recovering more than $100,000 in the first year alone. This effort included implementation of process systems and the development of an effective appeal process. Ms. Compton’s areas of expertise include: Clinical Coding Reviews, Clinical Coder education, Clinical Documentation Improvement Specialists education and training, and Clinical education and Training in Medical Necessity Issues.
Saturday, April 20, 2013 PAC-CDI 3:30pm – 6:00pm PAC-CDI Institute (Conclusion)
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3rd Annual AIHCD Conference Speakers (2013)
Betty B. Bibbins, MD, BSN, CHC, C-CDI, CPEHR, CPHIT
President, Chief Medical Officer, and Executive Physician Educator
DocuComp, LLC
Cape Charles, VA
Dr. Bibbins, a Physician with a background in Nursing, is certified in Healthcare Compliance, Clinical Documentation Improvement, Electronic Health Records, and Health Information Technology. Dr. Bibbins has had over 35 years of healthcare experience as an educator, clinician, and administrator. She is President, Chief Medical Officer and Executive Physician Educator for DocuComp LLC. She has presented at numerous conferences and written many articles regarding physician documentation improvement.
Dr. Bibbins focus is on the needs of Physicians, Nurses, and HIMs in the providing of healthcare, and the Hospitals that depend on clinical documentation to capture appropriate levels of service, severity of illness, third party reimbursements, maintain Compliance, prepare for the Electronic Medical Record, prepare for increasing standards for the utilization-of-healthcare services, Medical Cost Recovery, and prepare for “Quality-of-Care” standards.
Bernice Hecker, MD, MHA, FACC
Medical Director, Noridian
Medicare Contractor Parts A&B
Seattle, WA
Dr. Hecker is Medicare Medical Director for the Noridian states, Jurisdiction F and Minnesota. She has primary responsibility for policy, coverage, and medical review. She chairs CMS-mandated committees including annual Medical Director/CMS meetings and the LCD) Local Coverage Determination) Writers’ Meeting and presented the in-service trainings on Inpatient Review. She acts a consultant to the OIG, FDA, Justice, and AHRQ.
Dr. Hecker graduated with special honors from both the University of Washington undergraduate and medical schools. She completed an Anesthesiology residency at the University of Virginia as well as fellowships in Pain Management and Cardiac Anesthesiology. She holds a Master’s in Hospital Administration from the University of Washington in Seattle.
Dr. Hecker has worked as a medical officer in the US Navy on overseas assignment, in the National Health Services Corps, in academic medicine, in a horizontally and vertically–integrated private practice, and was Medical Director of a national non-profit quality review organization. She has consulted to industry on the development and implementation of electronic health records; has performed both bench and clinical research; has several research publications; is a former Anesthesiology Board examiner; is an active committee member of several professional organizations; and on the Boards of several organizations, including the of University of Washington’s Compliance Certification Program .
Jessica Whitley MD, BMA, PA-CDI
Medical Director, Review Services
KePRO of Ohio
Akron, OH
Dr. Jessica Whitley is a graduate of Case Western Reserve School of Medicine and is board certified in Internal Medicine. She currently practices medicine as a hospitalist physician in the Cleveland, OH area. She has been active in clinical documentation improvement and utilization review since 2007, at which time she served as the Medical Director of the Care Coordination Department for Lake Health Systems in Willoughby, OH. In 2008, she joined DocuComp LLC as a physician educator consultant and has excelled in her ability to communicate the importance of clinical documentation improvement to other physicians.
Dr. Whitley realized the importance of bridging the business and clinical aspects of medicine, so she attended Cleveland State University and completed a Master of Business Administration with a concentration in Healthcare Administration in 2009. She has a passion for excellence, and enjoys opportunities to utilize her valuable combination of business and clinical skills in order to help to facilitate the practice of evidence-based, high quality, efficient health care. Those who have worked with Dr. Whitley are often impressed not only with her breath of knowledge, but also remark about her warm and engaging personality. She considers her ability to connect and build positive relationships with many people to be her greatest strength.
Dr. Whitley realized the importance of bridging the business and clinical aspects of medicine, so she attended Cleveland State University and completed a Master of Business Administration with a concentration in Healthcare Administration in 2009. She has a passion for excellence, and enjoys opportunities to utilize her valuable combination of business and clinical skills in order to help to facilitate the practice of evidence-based, high quality, efficient health care. Those who have worked with Dr. Whitley are often impressed not only with her breath of knowledge, but also remark about her warm and engaging personality. She considers her ability to connect and build positive relationships with many people to be her greatest strength.
D. Scott Jones, CHC
Senior VP Claims, Risk Management and Corporate Compliance
HPIX
Philadelphia, PA.
D. Scott Jones, CHC, LHRM, is vice president of corporate compliance and risk management for American Healthcare Providers Insurance Services, a national professional liability insurance management company with Headquarters in Philadelphia, PA. Mr. Jones is a former acute care hospital administrator, large medical practice administrator and is a nationally board certified Healthcare Compliance Officer. He is a frequent speaker before state, regional and national health care organizations. He has developed innovative patient safety-focused, hands-on risk management programs for health care organizations, physician groups, medical professional liability insurance companies, onshore and offshore captives and risk retention groups.
Since joining HPIX, Mr. Jones has successfully built a library of continuing medical education content that was developed by various in-house authors, including himself, and several member physicians. He spends the majority of his time developing new risk management products and performing on site medical office practice assessments. In this role he focuses on assessment, implementation and compliance. He monitors HPIX early reporting standards within insured practices and provides feedback to physician clients so they understand the benefits of early reporting.
Ms. Andrea Merritt, MBA, BS, CIA, CHC
Director, Compliance and Audit Services
Hall, Render, Killian, Heath, and Lyman, PSC
Detroit, MI
Andrea Merritt is the Director of Compliance and Audit Services for Nova Compliance Group, a Hall Render company, in Troy, Michigan. Andrea assists health care organizations on all aspects of compliance programs, including HIPAA. She is involved in conducting compliance program assessments, training and education, auditing and monitoring, development of policies and procedures and addressing compliance concerns. Andrea is a member of the Health Care Compliance Association and has presented for the organization in the area of compliance effectiveness. She previously performed audit and compliance services for CHAN Healthcare Auditors at St. John Health. Andrea is also adjunct faculty in business at Walsh College and Lawrence Technological University.
Colleen McKinley, JD
Attorney
Hall, Render, Killian, Heath & Lyman, P.S.C
Louisville, KY
PRACTICE AREAS
- Certificate of Need
- Credentialing & Peer Review
- Fraud & Abuse/Stark
- Hospital & Physician Transactions
- Licensing & Accreditation
- Medical Staff Organization & Structure
- Physician Group Practices
MEMBERSHIPS
- American Bar Association
- American Health Lawyers Association
- Louisville Bar Association
- Kentucky Bar Association Kentucky Academy of Hospital Attorneys, President - 1994-1995; Board of Directors - 2003-2004
- Kentucky Rural Health Association, Board of Directors - 2012-2013
PRESENTATIONS
- Kentucky Academy of Hospital Attorneys: Affordable Care Act.
- Professional Healthcare Institute of America: Affordable Care Act.
- Louisville Bar Association: Certificate of Need Issues.
Ms. Gerrie James, MSN, CCS, CCP,
Certified ICD-10 CM/PCS Trainer
Corporate Compliance, Sharp HealthCare (SHC)
San Diego, CA
Gerrie James has 30 years of nursing experience and has aligned her medical/surgical/oncology and labor/delivery clinical expertise with other areas unique to health care. Over the past ten years, Ms. James has focused much of her time in the Corporate Compliance arena. Gerrie’s combination of clinical and coding expertise, has allowed her the opportunity to partner with clinicians at the point of care, all the while introducing them to the complexity of medical necessity documentation and the inpatient and outpatient coder’s world.
Gerrie coordinates and encourages team involvement, while gently pulling each member into a keen awareness of compliance. She emphasizes standardization and accuracy of clinical documentation, charge entry, diagnosis/procedure coding and billing processes. After facilitating the Recovery Audit Contractor (RAC) demonstration project (California) for SHC she currently partners with others in a proactive preparation/response to the permanent RAC program. Gerrie’s ability to work closely with clinicians, coders and physicians serves as a successful link toward achieving excellence in maintaining not only compliance, but also revenue integrity.
Gerrie received her BSN from Old Dominion University, Norfolk, VA, and her MSN from San Diego State University, San Diego, CA. She is a member of the American Health Information Management Association (AHIMA), the California Health Information Association (CHIA), the Association of Clinical Documentation Improvement Specialists (ACDIS), the American Association of Nurse Assessment Coordinators (AANAC) and the Association for Integrity in HealthCare Documentation (AIHCD). Gerrie is a Certified Coding Specialist (CCS), a Resident Assessment Coordinator-Certified (RAC-CT), a Certified Professional in Utilization Review (CPUR), has a Legal Nurse Consultant Certificate, an ICD-10 CM/PCS Trainer and a Certified Compliance Professional (CCP).
Deka Jama, MD
Physician Advisor and Hospitalist
Inova Health System
Falls Church, VA
Dr. Jama is the Chief Medical Officer and Physician Advisor for PivotPoint Health. She is also a Board Certified Internist practicing in the Washington DC area. She received her medical degree from the Robert Johnson Medical School in New Jersey and completed her residency in internal medicine at the University of Minnesota. Dr. Jama has been working with the Inova Health System in Northern Virginia as Utilization and Denial Management consultant for the past few years. She chairs the Care Coordination Committee at Inova Alexandria Hospital where she is also an active member of the Quality Council.
Glenn Krauss, RHIA, BBA, CCS, CCS-P, CPUR, CCDS, C-CDI
Consultant
Revenue Cycle and Health Information Management
Glenn Krauss is a seasoned consultant in the Revenue Cycle and Health Information Management field with a passion for improving clinical documentation in all settings of the healthcare delivery system, – Glenn has more than 15 years’ experience in the healthcare industry as a consultant and has held various staff positions in numerous healthcare systems, including Revenue Systems Manager, Data Quality Manager, Director of Health Information Management, and Director of Case Management and Revenue Enhancement. His business background in and experience as a practicing coder and as a consultant in Clinical Documentation Improvement, medical necessity education for physicians with a focus upon the impact to the physician’s practice of medicine, MS-DRGs, ICD-9-CM, Chargemaster, Billing, APCs and CPT-4 coding enable him to effectively combine a working knowledge of hospital management with the importance of a functioning and effective Health Information Management Department.
He currently serves on the Advisory Board of the Association for Clinical Documentation Improvement Specialists. Glenn also has extensive experience in teaching physiology, surgical procedures and the rationale of therapeutic treatments with ICD-9 and CPT coding. His ability to help others conceptualize such complex medical, billing and clinical documentation issues have proved successful in both quality issues as well as reimbursement. Rounding out Glenn’s accomplishments has been numerous speaking engagements at different professional association meetings such as national and state level HFMA, Maryland AAHAM, Association for Clinical Documentation Improvement Specialists, and teleconferences that include AHIMA, Lorman Educational Services, HCPRO and Health Care Compliance Strategies. He has written extensively on subject matter content of clinical documentation improvement, medical necessity and clinical accuracy in coding in publications such as HCPRO, Health Leaders, and Physician News.
Candice Koldyke RHIA, CCS, C-CDI
Training & Development Department
St. Vincent Health
Indianapolis, IN
Candice is currently the trainer for HIM & Clinical Documentation staff and also is a Process Improvement Consultant at St. Vincent Health in Indianapolis, Indiana. Ms. Koldyke has over 20 years of experience in the health care field. She holds certifications as a Registered Health Information Administrator, Certified Coding Specialist, and Clinical Documentation Improvement and is an AHIMA Approved ICD-10 Trainer. Candice has been trained in Lean Six Sigma methodologies and enjoys working on the Indiana Health Information Management Association (IHIMA) ICD-10 Education Task Force.
Bernard Rosof, MD, MACP
CEO, Chair, Board of Directors
Huntington Hospital North Shore-LIJ Health System
Huntington, NY
Dr. Bernard Rosof is at the forefront of national initiatives in the areas of quality and performance improvement. He is the Chair of the Board of Directors of Huntington Hospital (North Shore-LIJ Health System) and a member of the Executive Committee of the Board of the Health System. He is a member of the Board of Directors of the National Quality Forum, and the Co-Chair of the National Priorities Partnership convened by the NQF to set national priorities and goals to transform America’s healthcare. Dr. Rosof is the Chair of the NPP’s Committee on Overuse. Dr. Rosof is the Chair of the Physician Consortium for Performance Improvement convened by the AMA that continues to lead efforts in developing, testing and implementing evidence-based performance measures for use at the point of care. He is also a former member of the Clinical Performance Measurement Committee of the NCQA. Dr. Rosof is the Chair of the Physician Advisory Committee for United Health Group. Dr. Rosof is CEO of Quality HealthCare Consultants (QHC) that provides strategic advisory services to the community of health care providers interested in improving the quality and safety of health care delivery in our nation.
Dr. Rosof is Professor in the Department of Medicine at the Hofstra North Shore-LIJ School of Medicine in New York. He is a Master of the American College of Physicians and Chair Emeritus of the Board of Regents of the American College of Physicians. Dr. Rosof is the recipient of the Laureate Award from the American College of Physicians and the Theodore Roosevelt Award for Distinguished Community Service. He received the 2011 Founders Award presented by the American College of Medical Quality in recognition of his long-standing national leadership and exceptional ability to foster and support healthcare quality improvement. In 2012, Dr. Rosof also received the distinguished Stengel Award from the American College of Physicians for outstanding service to the College and Internal Medicine. Dr. Rosof is currently the Chair of the Institute of Medicine (National Academy of Science) Committee on Chronic Multi Symptom Illness. Dr. Rosof has published many medical articles on quality, performance and professionalism. He is the co-founder of the Fay J. Lindner Center for Autism and other related disabilities for the North Shore-LIJ Health System and remains on the Board of this organization. He has been recognized for his contributions to the health and welfare of this vulnerable population.
Ms. Becky L. Nicholl, RN, GCNS, CRM
Vice President of Quality/Risk Management
Mary Rutan Hospital
Bellefontaine, Ohio/span>
Becky Nicholl oversees the Care Coordination and Medical Records departments and has successfully created a Care Manager role in the Emergency Room setting in order to maximize the opportunity for meeting medical necessity on all patients placed as Inpatients and to clearly separate those that should be Observation Status.
Becky is a Geriatric Clinical Nurse Specialist who has worked twenty-five years as a Quality/Risk Manager in the hospital setting. She achieved the status of Diplomate in Healthcare Administration from the American Academy of Medical Administers. Becky is also a Certified Risk Manager. She was on the Editorial Board of the Aspen Publishers for 5 years as a consultant for the manual: “Health Care Facilities Risk Management: Forms, Checklists, & Guidelines”.
Harriett Wall, B.S., MBA
Vice President
Kohler HealthCare Consulting, Inc.
Woodstock, MD
Harriett has over 20 years of leadership, consulting, business development and marketing in the healthcare industry serving providers, payers, and vendors. She has a strong operations background with particular expertise in clinical documentation improvement, disease management, patient access, and performance improvement. She is a popular speaker for healthcare professional organizations in the U.S. and has been a speaker at national and regional venues in Australia. Harriett received her B.S. degree in Physical Therapy from Northeastern University and was awarded her MBA by Harvard Business School. Harriett is active in HFMA and other professional associations.
Nicole Harper, PhD, RHIA, MBA, CCS-P, C-CDI
Director, Training & Development/Process Improvement
St. Vincent Health
Indianapolis, IN
Nicole Harper is currently the Director of Training & Development/Process Improvement & Clinical Documentation Integrity at St. Vincent Health in Indianapolis, Indiana. Dr. Harper has over 20 years of experience in the health care field. She holds certifications as a Registered Health Information Administrator, Certified Coding Specialist-Physician Office, Clinical Documentation Improvement and is an AHIMA Approved ICD-10 Trainer. Nicole is trained in Lean Six Sigma methodologies and enjoys working on the Indiana Health Information Management Association (IHIMA) where she co-chairs the ICD-10 Education Task Force.She received a PhD in Leadership & Organizational Change from Walden University, Baltimore, MD.
Cynthia Compton, CCS, FCS, C-CDI
Executive Director Care Management and Utilization Review
Jane Todd Crawford Hospital
Liberty, KY
Cynthia Compton is a consultant in the Revenue Cycle and Health Information Management field with more than 15 years’ experience in the healthcare industry both as a consultant and various staff positions in a healthcare system. Ms. Compton has extensive experience with working with Medical Staffs and ancillary staff to understand DRG methodology and the importance of documentation in the medical record. Ms. Compton organized a team to work with medical necessity issues within a 3 hospital system recovering more than $100,000 in the first year alone. This effort included implementation of process systems and the development of an effective appeal process. Ms. Compton’s areas of expertise include: Clinical Coding Reviews, Clinical Coder education, Clinical Documentation Improvement Specialists education and training, and Clinical education and Training in Medical Necessity Issues.