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Workshop Schedule
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The Affordable Care Act & Your Practice

Day 1

8:30 – 10:00 Going from never filing patient claims to filing claims for all patients
Short Term Benefits
   • What’s happening with healthcare reform and how to make it work for you
   • Remain a cash practice!
   • Better document the patient encounter = eliminate problems now and in the
   • Outsource claims to professional medical billers for a fixed fee per claim
     charge and:
               1. Direct insurers to reimburse the patient
               2. Establish the professionalism of the practice by filing “clean” or
                   technically error free claims to insurers
               3. File one claim for multiple visits (such as chelation IV drips for 2
                   weeks) at $15 per claim
               4. Get significant reimbursement back to patients
               5. Know which insurers paid and how much
   • Provide patients with a valuable service that will assure their loyalty to the
     practice over time.
Long Term Benefits
   • Generate comparative effectiveness data to prove the value of your care
   • Join payer networks that pay well
   • Get more patient referrals
   • Have your practice set up to pass an audit

10:00 – 10:15 BREAK

10:15 – 12:00
Overview- Life of a Claim

   • Superbill
   • Generating a claim
   • Using technology to scrub claims before they are sent to a payer
   • Routing electronic claims to insurers
             Via clearinghouse(s)
             Via direct connection to payer
             Via TPA
   • Assuring claims make it into the payer’s system
   • Viewing edits and rules along the way
   • Costs of paper vs. electronic claims

12:00 – 1:00 LUNCH

1:00 - 2:45 HIPAA – What, Who, Why and How
    1. PHI or protected health information
    2. Internal staff training
    3. Vendor contracts
    4. Technology safeguards
    5. Physical plant, privacy barriers from sign in to exit

2:45 – 3:00 BREAK

3:00 - 4:00 Benefits vs. risks of going from no claims filed to filing claims for all patients
    1. What happens if you do nothing
    2. What happens if you manage the process
    3. Fraud and abuse = must truthfully document care and costs
              Practice liabilities
              Payer liabilities
              Fines already collected

4:00 – 5:00 NPIs and Taxonomy codes
Taxonomy codes underlying NPIs convey meaning to payers
    • Expanding your practice the legal way
    • The 3 levels of taxonomy codes
    • Using taxonomy code definitions to your advantage
    • How taxonomy codes are viewed by payers as claims are filed
    • Updating NPIs and adding more taxonomy codes


8:00 – 9:45 Why use ABC codes to document the care you provide
    • Short and long descriptions
    • Relative Value Units attached to ABC codes
    • Using ABC codes and RVUs to develop fees
    • Capturing sub-codes as claims are filed
    • Comparative effectiveness studies based on procedure and diagnostic codes

9:45 – 10:00 BREAK

10:00 – 12:00 Picking ABC codes for my practice (bring computer)

12:00 – 1:00 LUNCH

1:00 – 2:45 ICD coding explained and transitioning from 9 to 10

2:45 – 3:00 BREAK

3:00 – 3:30 Mapping your ICD-9 codes to ICD-10 codes to be ready for October 2014

3:30 – 4:30 The importance of a good super bill

    • Practice using diagnostic code ranking on a sample Superbill
    • Overview of how a medical biller will create a “clean” claim
    • Where sub-coding from the Superbill is used as claims are filed

4:30 – 5:00 Resources and next steps

    • HIPAA foolproof compliance
    • How to communicate with a medical billing company
           Online coordination

Continuing Medical Education Credits will be available
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