Overview

The burden of hospital audits by both government contractors and commercial health plans continues unabated. There is still confusion over interpretation and implementation of the “two midnight rule”. States are ramping up their own Medicaid RAC contractors, and especially during the past year Medicare Advantage plans and commercial insurers are adopting aggressive auditing tactics to compound the burden on hospitals. Hospitals’ rightful appeals of this growing body of denials in turn have completely overwhelmed an understaffed collection of Administrative Law Judges, and hearings are taking two years when they are even able to be scheduled. Members of Congress have heard hospital complaints loud and clear and demanded reform, MedPAC has even weighed in, and there may be a glimmer of hope in the courts with the new administration adding additional unknowns.

But never has it been more important for hospital to ‘get it right the first time’ when it comes to proper documentation of inpatient care and proper decision making regarding whether a patient meets the criteria for an inpatient admission or should be placed into observation status or treated in an outpatient setting. Over the course of the next three days, in a highly interactive learning environment, the bootcamp will teach participants:

• How to incorporate a physician advisor program and an utilization management into an integrated program.
  
• Best practices in documentation, CDI and telling an enhanced patient story PLUS physician education strategies.
  
• How to create a collaborate dream team – Contracting, Payer Relations, Provider Challenges, Appeal and Denial Prevention Team and Legal Team.
  
• How to prepare for the new battlefield: Managed Medicare Part C and Commercial payers.
  

WHO SHOULD ATTEND?

The PA-UR Team Boot Camp is designed as a very practical, hands-on, highly interactive experience for hospital physician advisors, clinical leaders, coding and denial managers, and other key staff involved in the critical decisions about patient status and patient flow. No just sitting around listening to talking heads. We will use an Audience Response System to do some polling and ask some questions as we go along, give everyone a short fun quiz at the end of each day, arrange for hosted informal dinners with faculty and colleagues at the end of Day II, set up single issue breakfast table topics on the morning of Day III, and assign homework in the form of case studies about inpatient vs. observation status for discussion over lunch on Day II and presentation later. Plus there are faculty panels and audience Q&A throughout.

So who should attend? Here is a non-exclusive list: