"PARTNERSHIP is not a GAMBLE: It is a SURE THING"

HIM/BO PARTNERSHIP -- FY07

**CONCURRENT (BREAKOUT) SESSIONS**

**SHORT DESCRIPTION OF EACH SESSION**

> **2007 Third Party Internal Control CEO Requirements and UFMS Accounts
> Receivable Preparation:** This session will provide an overview of the
> Third Party Revenue Internal Controls policy and the Portland
> experience in the perspective of a CEO. Discussion will also be held
> on the ORAP site review findings and other audits that were completed
> in FY 2006. Information will also be shared on the UFMS Accounts
> Receivable module and how this will impact the business office
> operations.
>
> **Accounts Receivable:** Accounts Receivable - What is new in A/R. A/R
> Standards and \"managing AR\". From the Recenue Cycle or Business
> Process Overview. Changes to RPMS A/R System, current release and
> future plans. Accounts Receivable - How to work claims that you know
> have been paid, but there are no remits, and insurance company will
> not send directly to clinic. How do we get them off the ASM
>
> **Audits/Coding within IHS:** The findings from the first two
> IHS-sponsored coding audits performed in 2006 will be presented. The
> audits were conducted as a result of IHS Third Party Accounts
> Management & Internal Control policy. Participants will gain insight
> into the purpose of the audit, the audit process, and policies and
> mandates necessitating the audit. Highlights of the coding portion of
> the audit will be discussed including the audit process, tools used,
> areas targeted and findings of the audits. Sites will gain knowledge
> to coordinate their own internal audit and prepare for the IHS audit
> using the IHS audit tools presented or by developing their own audit
> tools, processes, policies and procedures. This discussion will be
> beneficial to Medical Record and Business Office Personnel, CEO's and
> other administrative staff who are responsible for ensuring compliance
> with the Third Party Accounts Management & Internal Control Policy.
>
> **Business Office General Session:**
>
> **UFMS Transision Requirements -** This session will provide an
> overview of the main requirements in relation to the UFMS Accounts
> Receivable module and what the Business Office is required to do to
> prepare for conversion to the UFMS Oracle software system.    The go
> live date for UFMS is October 1, 2007. 
>
> **RPMS Business Office Applications Report** -- **OIT/ORAP -** This
> session will provide a status of current activity in relation to the
> RPMS applications including Patient Registration, Third Party Billing,
> Accounts Receivable, Point of Sale and others.    Main features will
> include NPI edits, Coordination of Benefits, UFMS modifications, HIPAA
> transactions and future releases.  
>
> **Revenue Projections --** This session will be a bried overview and
> some detailed examples of how to properly project your revenues from
> Alternate Resources.
>
> **Third Party Resource and Internal Control Policy -** This session
> will provide a brief demonstration of the New Online Third Party
> Internal Controls Policy Self Assessment. We will be providing updated
> information on the Internal Controls Policy and what information will
> need to be submitted via this online tool. In addition there will be a
> brief update on all changes and timelines of when this tool will be
> available. We will also briefly discuss the requirements and
> implications of this tool on the Service Unit and how it may fit into
> the Performance measures of your Service Unit.
>
> **DME and MNT -** MNT Reimbursement -- Are We Really Getting Paid? The
> Objectives of this sesssion are to understand the process of MNT
> billing and how to track the reimbursement process, to know which
> reports to ask your billing department for to track MNT reimbursement,
> and to understand a process for analyzing your reimbursement reports
> to provide meaningful information to your Supervisor and Hospital
> Management. This will be a discussion on preparing a CMS application
> for a Durable Medical Equipment (DME) license. The session will
> include information on the application and department requirements.
>
> **Ancillary Study --** Brief Discussion with those Hospitals that had
> to complete the Ancillary Ratio Study this fiscal year. What could be
> done differently in the future to ensure consistency among all the
> hospitals? What were some of the noted discrepancies?
>
> **Catastrophic Health Emergency Fund (CHEF)-** Processing high cost
> cases : A major challenge for the IHS is to find cost-effective
> strategies to maintain the public health focus. This focus has been a
> critical element in the achievement of significant improvement in the
> health status of AI/A people. To this end, the IHS/CHS program
> actively seeks partnerships with its stakeholders, other agencies, and
> maximizing alternate resources. This session will enable participants
> to learn how their peers are dealing with high cost cases and
> capitalize on CHEF. Since the demand for CHS is fast outpacing the
> supply of CHS resources there has been a heavy reliance on maximizing
> alternate resources and additional resources from the CHEF program;
> making it difficult to meet all requests and must rely on
> administrative requirements to ensure that CHS funds are made
> available for emergency and urgent care throughout the year.
>
> This session will provide participants with an understanding of the
> CHEF program and its process from the Headquarters, Area, and local
> (SU/Tribal) perspective. The session will cover the history, process,
> CHS/MIS, and review citations proposed from the Indian Health Care
> Improvement Act and review the CHEF guidelines. Questions and issues
> related to managing high cost cases, negotiating rates/discounts, and
> managing high cost cases will be discussed by a panel of CHS/CHEF
> experts from the Area and SU/Tribal level. The basic principles of the
> CHEF program will be reviewed and will enhance participants an
> understanding on why the CHEF program was established and how the CHEF
> program fits into the overall IHS health care system and the
> importance of partnerships with the Business Office, Medical Records,
> and Patient Registration. The CHEF operating procedures and desk
> instructions will be shared with the attendees so they can carry away
> these guidelines after the sessions to take back and apply to their
> programs.
>
> **CHS and UFMS:** The CHSMIS FI Interface Processes presentation
> demonstrates the business process and data flow of CHSMIS Obligations
> and FI Payments. The presentation demonstrates new and modified
> obligation interface transaction events from CHSMIS and the
> presentation depicts interfaced FI payment records to UFMS. Also, the
> presentation covers the required extract from UFMS to the FI for
> payment verification. The presentation demonstrates the FI
> reimbursement payment process overview within UFMS.
>
> **Coding -- Back to Basics: ICD 9 Coding Guidelines & The Coder's
> Role:** This session will discuss the importance of the most recent
> ICD 9 Official Coding Guidelines and the importance of applying the
> guidelines in all healthcare settings. All coders and billers at all
> levels (beginning-advanced/certified) must stay abreast of the
> Official Coding Guidelines. Our role as coders in the 21^st^ Century
> with the Electronic Health Record, and the relationship with
> effective/accurate coding will also be discussed.
>
> **CPT Coding -- How do I analyze and assign CPT Code(S) to Operative
> Reports?:** Participants will review effective techniques for
> analyzing and abstracting pertinent information from operative reports
> that are essential in assigning the appropriate CPT Surgery Code to
> the surgery performed.
>
> **Compliance -- EHR Issues -- Fraud Prevention in EHR:** This session
> will talk about the context/content of the legal health record in a
> hybrid environment (paper/electronic) and the risk of documentation
> shortcuts specific in the EHR that can lead to fraudulent
> documentation. The importance of documenting for medical necessity
> will be discussed with specific examples of how to avoid these
> problems. Terri has been a member of several AHIMA practice councils
> since 2004 addressing EHR implementation, compliance, defining the new
> roles and responsibilities for HIM professionals and helping to define
> the legal health record. She will discuss the AHIMA practice council
> recommendations.
>
> **Customer Service Means Thinking "Strategically":** This highly
> interactive session will give participants the opportunity to explore
> the relationship with "strategic visioning" and "customer service." It
> is imperative that an organization possess a focused strategic plan
> that has hight expectations for improved customer service and an
> over-arching vision of success based on cultural values. This session
> is based upon the premise that learning does not have to be "painful".
> Participants will learn a strategic visioning process, will share
> improved custormer service stategies, and will learn team-trust
> building skills.
>
> **Dealing with Difficult People:** This highly interactive session
> will address strategies in dealing with difficult people, including
> customers, colleagues, and administrators. The skills presented will
> include communications, mediation, team-trust building, personal
> wellness, and healthy relationships. We all process the ability to
> change our attitude and behavior. The theme is "when we are ready to
> learn; teachers appear..." It is time to stop saying I will try,
> perhaps, or maybe, and create some "action" that creates positive
> change. Participants will learn specific skills in communications,
> mediation, team-trust-building, personal wellness, and healthy
> relationships. Participants will practice skill building strategies,
> and will set personal goals for improvements.
>
> **Debt Collection -- Best Practices (Transworld and IHS):** The
> purpose of this session is to provide a fresh look at debt collection
> and the debt collection module to new users. It is also designed to
> provide practical tools for maximizing your debt collection resources
> and results. Whether your facility is IHS or Tribal, uses RPMS or
> another product, this session will offer proven solutions to help
> reach accounts receivable performance metrics.

-   Getting started with Debt Collection

-   How does it work with IHS RPMS and Tribal facilities

-   Maximizing your debt collection results

-   Maintaining a consistent Debt Collection workflow

-   Goals of Debt Collection

> **Debt Collection -- Overview of Debt Management Policy:** This
> session will provide an overview of the IHS Debt Management policy and
> how this policy relates the process of collecting and servicing
> non-tax IHS receivables.   The session will include a review of the
> steps and timelines on when an outstanding debt should be sent to
> Treasury for follow-up and the differences between a write off and a
> closeout.    This policy will also be used as part of the UFMS
> implementation plan so it is important that the session be attended by
> Business Office Managers, Accounts Receivable technicians and
> Facility/Area Financial Managers. 
>
> **Dental Billing- Basics & Updates:** PowerPoint presentation with
> handouts. Review of clinical & office components of Dental Billing
> cycle including Superbills, Coding, Claims submission, Documentation
> requirements, and specialty billing. Review of ADA Code updates and
> proper use of new codes. Resources for dental billers.
>
> **EDI Partnerships \"HowThey Work\":** Mr. Cost and his company
> Infinedi have been providing claims processing, clearinghouse and EDI
> services for Indian Health Services the past 8 years. In those eight
> years Infinedi has encompassed 10 states and 46 facilities. Infinedi
> utilizes a unique method of web-based claim submission and reporting
> in addition to current EDI transactions. His seminar will showcase as
> a best practice, an extremely successful history of the partnership
> with Indian Health Services. Rhonda Beaver, Business Office Manger for
> Oklahoma Creek Nation Indian Health Services, will join Mr. Cost.
>
> **Electronic Health Record (EHR)** -"EHR -- Coming to Your Facility
> Soon!
>
> A Panel Presentation by David Taylor, National EHR Deployment
> Consultant, Deborah Burkybile, National EHR Deployment Consultant,
> Lori Moore, Albuquerque Area CAC, Peggy Schults, HIM Director,
> Claremore Indian Hospital. This panel presentation will provide
> participants with an overview of the Indian Health Service (IHS)
> Resource Patient Management System (RPMS) Electronic Health Record
> (EHR) functionality, its use and progressive implementation throughout
> the Indian Health Service and Tribal facilities. It will also offer
> practical information from an Area Clinical Applications Coordinator
> (CAC) about when and how to activate the EHR Coding Queue (chart audit
> tool) and the various reports that will need to be generated
> periodically by Health Information Management Systems staff. Finally,
> the audience will learn from the experiences of a facility that has
> successfully implemented EHR and receive valuable tips and insight on
> how to plan for EHR implementation from Health Information Management
> Systems and Business Office perspectives.
>
> **Electronic Health Record Computer Lab:** The Indian Health Service
> has/is implementing the new EHR capabilities throughout Indian
> Country. This ongoing lab environment will allow the end users to get
> hands on experience in utilizing this system. This will allow for data
> entry, coding, selection and documentation of coding requriements,
> etc.
>
> **E/M Coding and Auditing:** Learn to audit using the CMS E&M coding
> tool, hands on experience with using the tool, auditing outpatient
> visits.  Clinical indicators and protocols for those diagnoses that
> occur most often will also be reviewed, helping coders to understand
> the importance of looking for certain clinical indicators when coding
> complex diagnoses.
>
> **Employee Relations for Managers:** HIM and BO Managers have the roll
> of supervising and monitoring employee performance. This includes but
> is not limited to writing position descriptions, performance standards
> and evaluation, writing performance improvement plans, dealing with
> difficult employees, basic supervision, etc.
>
> **FMCRA:** Federal Medical Care Recovery Act - Powerpoint presentation
> provided to enhance participant knowledge of Oklahoma Area
> computerized handling of FMCRA cases thereby enhancing recovery
> efforts of revenue expended on treatment provided to third party
> injury patients.
>
> **FQHC (Federal Qualified Health Centers):** This presentation will
> consist of various updates. You will be updated on the UB-04 process,
> NPI (National Provider Identifier), Training Sessions, and how FQHCs
> are affected by Jurisdiction 3 ruling. More information will be
> disseminated if time allows. UGS.
>
> **General Session**:
>
> **HIM Updates --** Speaker will provide an update on what is new and
> improved in the HIM enviroment for FY07 and FY08.
>
> **BO Updates** - Speaker will provide an update on what is new and
> improved in the BO enviroment for FY07 and FY08.
>
> **ORAP Updates -** Speaker will provide an update IHS  collection
> trends for Medicare, Medicaid and Pvt Insurance, payment policy issues
> that impact revenue, and current and future issues.
>
> **NPI Implemenation -** This session will provide an overview of the
> NPI final rule, which HIPAA standard transactions NPI affects,
> eligibility guidelines and a review of the applicable RPMS systems. 
>
> **Compliance Plans -** An overview of the compliance process, OIG Work
> Plan, and IHS compliance practices.
>
> **Deficit Reduction Act -** The DRA that applies to IHS includes an
> [Overview of the False Claims Act]{.underline} (claims & liability)and
> Federal Health Care Programs, Program Oversight,-QUI Tam
> "Whistleblower" Provisions and procedures, Rights of parties to Qui
> Tam Actions, Award to Qui Tam Whistleblowers, No Retaliation, Examples
> of Health Care Fraud (billing for services not rendered or goods not
> provided-Falsifying certificates of medical necessity and billing for
> services not medically necessary-Billing separately for services that
> should be a single service-Falsifying treatment plans or medical
> records to maximize payments-Failing to report overpayments or credit
> balances; Duplicate billing; Unlawfully giving healthcare providers,
> such as physicians, inducements in exchange for referrals for service,
> Suggested workplace practices for ongoing health care compliance with
> the false claims act.
>
> **ROM --** This will provide a bired overview of what is in each
> Chapter withing the Revenue Operations Manual. Provide more detailed
> information on what is provided in Patient Registration area of
> importance, and explain why web site was provided.
>
> **Optimizing Resources, Access and Care: A Comprehensive Campaign for
> 2007 and Beyond - Creative Horne Group -** IHS' Office of Resource
> Access & Partnerships (ORAP) is funding an initiative to bring the
> business office functions and personnel, including Contract Health
> Services, to a greater level of partnership in meeting the business
> challenges the Indian health community faces. This program includes
> training and information for IHS business office and Contract Health
> employees as well as outreach to the AI/AN patient population to raise
> awareness of alternative benefits that can increase revenue, and
> ultimately, quality of care in healthcare programs and facilities.
> Horne Creative Group, Inc., was chosen to produce the informational,
> outreach and training materials for this effort and will present an
> overview of the effort, answer questions, and capture input from those
> in the field who will ultimately use the materials. Successfully
> implemented, ORAP expects all health programs to see a significant
> increase in third-party revenue over the course of the next few years.
>
> **Health Information Management General Session:**
>
> **Medical Records 101 - 'LOOK, LISTEN & LEARN'** - This fun
> presentation will provide educational tools and basic guidelines for
> managers and supervisors of how to provide an excellent orientation
> presentation for new staff, or a refresher course to re-motivate
> employees on what your department is all about, the mission of the
> agency, and what expectations, such as skills and characteristics, are
> required to work in the health care field. A team building exercise
> (with prizes) will be included in this session. This presentation is
> utilized by Navajo Area H.I.M. their annual yearly training session
> for new employees.

**FOIA (might be part of the HIPAA Privacy) - #35**

> **HIPAA Privacy Policies and Procedures and Forms/Privacy Act:** A
> joint presentation on Principles and Overview of the Freedom of
> Information Act (FOIA) and the Privacy Act (PA) and HIPAA Privacy Rule
> as these laws plays hand-to-hand in the processes when it comes to
> medical, health and business office (billing) records. Discuss
> Introduction/Intermediate to FOIA updates and FOIA reporting
> requirements; Privacy Act and HIPAA Privacy Rule with discussion of
> the Disclosure Requirements (Routine Uses) of Medical, Health and
> Billing Records. We will time for a Questions and Answers at the end
> of the presentation, usually 15-30 minutes.
>
> **Indian Health Service Collaboration with New Mexico Medicaid and
> Tribal Programs :** The Albuquerque Area and Navajo Area Indian Health
> Service, in partnership with the New Mexico Human Services
> Department's Medical Assistance Division, will present and discuss the
> unique IHS-State Medicaid Program partnership as a model for success
> in accessing and increasing Medicaid as a third-party resource.  This
> relationship began with the onset of managed care in New Mexico in the
> late 1990s and has grown into a partnership that is based on open
> communication, sharing information, and mutual trust and respect.
>
> **Management Reports** - Third Party Billing, Accounts Receivable, and
> Patient Registration. What reports should be used, and how to read the
> reports that the CEO\'s are responsible for, so that we can fully
> explain to them the info.
>
> **Medicaid 101 - 2007:** This session is designed to focus on Medicaid
> day-to-day operations. CMS programs at times can be challenging due to
> the unique relationship between Tribes, States, and the Federal
> Government. Our discussion will include a short overview of Medicaid.
> A majority of the time will be spent addressing Medicaid concerns
> faced by Business Office and Health Information Management
> Professionals.
>
> **Medicare 101 - 2007:** This session is designed to focus on Medicare
> day-to-day operations. CMS programs at times can be challenging due to
> the unique relationship between Tribes, States, and the Federal
> Government. Our discussion will include a short overview of Medicare.
> A majority of the time will be spent addressing Medicare concerns
> faced by Business Office and Health Information Management
> Professionals.
>
> **Medicare Part A:** This session will provide updates on billing to
> Part A for Medicare for the sites that utilize Trailblazer Health
> Enterprises, LLC as their fiscal intermediary. The session will also
> provide an overview of Rehabilitation provisions as well as
> instructions in billing for those services. An overview of the top 10
> billing errors will be covered.
>
> **Medicare Part B Montage:** This session will cover the status of the
> Medicare Administrative Contract (MAC), an overview of NPI, a review
> of the new CMS-1500 claim form fields, the Provider Compliance Error
> Rate (PCER) and the top Part B billing denials and the resolutions.
> Join the Medicare Part B IHS Provider Education Representative for a
> montage of Medicare.
>
> **Medicare Part A and B -- GPNet:** This session will provide a brief
> overview of the GPNet software that is used to bill and track Medicare
> billing which will help the billing staff maximize its use. A
> demonstration of the software as well as a questions and answer
> session will be covered.
>
> **Medicare Part D:** Need to know the latest updates to Medicare Part
> D? This session will provide information updates and new contract
> information. Attendees will also be able to ask any questions related
> to enrollment.
>
> **National Archives and Records Administration:** Requirements for
> retaining/storing, archiving, and destroying documents in the HIM and
> BO environments.
>
> **Obtaining OMB Approval and Information Collections:**
>
> **PAMS (Patient Account Management System):** Power Point PAMS report
> comparison to the third party internal control policy; status of alpha
> sites;  general PAMS questions & answers.
>
> **Patient Benefits Coordination:** The Patient Benefit Coordinators
> will explain the processes for assisting patients in getting on third
> party resources. We will also explain the Benefits Coordination Page 5
> and how it is working at our facility.
>
> **Patient Registration -- V7.1 Patch #2:** This session w ill provide
> an overview of the latest changes made to the RPMS Patient
> Registration application. Some of the covered topics include changes
> to the registration editor that displays how insurance eligibility is
> displayed. This session will also provide tips on running the correct
> registration reports as well as a question and answer session.

**Perpetuating Individual Success -- Key Note -**

> **Point of Sale (POS): Pharmacy Point of Sale (POS):** This
> presentation will provide an overview of the Point of Sale Pharmacy
> billing software and the role of patient registration, medical
> records, and the business office in ensuring a successful
> implementation.
>
> **PNC Bank:** The session will cover payer recruitment for 835
> processing, touch on RPMS posting and review PNC\'s xpack network
> services and clearing house
>
> **RPMS Table Maintenance -- What you need to know:** This session will
> provide an in-depth review of the RPMS Table Maintenance feature in
> Third Party Billing, Accounts Receivable and Patient Registration.  
> Those users and managers who have access to manager keys and table
> maintenance options should definitely attend.   The speaker will
> review existing functionality and provide an overview of any new
> functionality recently added.  
>
> **Social Security Is Important To You!:** Social Security wants to
> help you help your clients understand the Retirement, Survivors,
> Disability and Supplemental Security Income Programs. Additionally, we
> will explain how Social Security can help with Medicare prescription
> drug costs. We will also highlight the American Indians and Alaska
> Natives page on the Social Security website,
> [www.socialsecurity.gov/aian](http://www.socialsecurity.gov/aian)
>
> **Third Party Resource and Internal Control Policy -** This session
> will provide a detailed demonstration of the New Online Third Party
> Internal Controls Policy Self Assessment. We will be providing updated
> information on the Internal Controls Policy and what information will
> need to be submitted via this online tool. In addition there will be a
> brief update on all changes and timelines of when this tool will be
> available. We will also briefly discuss the requirements and
> implications of this tool on the Service Unit and how it may fit into
> the Performance measures of your Service Unit. It will also provide a
> Q&A/Feedback portion of the session.
>
> **UFMS (United Financial Management System) Overview:** The Unified
> Financial Management System (UFMS) is a project initiated to improve
> financial performance throughout the Department of Health and Human
> Services (HHS).  It will provide an integrated, Department-wide
> solution that aligns business and technology to enhance financial
> management. UFMS is operational at the Food and Drug Administration
> (FDA), the Centers for Disease Control and Prevention (CDC), and the
> Program Support Center (PSC) and its Customer Agencies.  Indian Health
> Service will go live on the system effective 10/1/08.  The new UFMS
> system will incorporate the Accounts Payable, Accounts Receivable,
> Budget Execution, General Ledger, Purchasing, Project Accounting, and
> iProcurement modules of the ORACLE Federal Financial package. PRISM (a
> CompuSearch product not affiliated with Oracle) will also be
> implemented.  This overview will discuss the IHS implementation
> specifics and timetables.

**VA's CPRS and Its Impact on the HIM Department:**