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CMS Stacks the Deck Against You

 And it sure seems like they cheat.

five aces dealt to CMS

CMS’ Hand. They dealt. Naturally.

“When they own the information, Oh, they can bend it all they want.”

– from “Waiting on the World to Change” by John Mayer

The pace of hospital audits by RAC and MAC contractors in Medicare has never been greater, and now include pre-payment reviews as well. The States are ramping up their own Medicaid RAC contractors, and Medicare Advantage plans and now commercial insurers are adopting aggressive auditing tactics to compound the burden on hospitals. Hospitals’ rightful appeals of this growing body of denials in turn threatens to completely overwhelm an understaffed collection of Administrative Law Judges. Never has it been more important for hospitals to “get it right the first time” when it comes to proper documentation of medically necessary patient care and proper decisions regarding whether a patient meets the criteria for an inpatient admission or should placed into Observation status or treated in an outpatient setting.

How Do You Plan to Face This Challenge?

Because What You’ve BEEN Doing Just Isn’t Good Enough Anymore…

PAsummit_logo_353x524This is where the Physician Advisor and UR Team Boot Camp comes in. Over the course of three days, in a highly interactive learning environment, the Boot Camp will teach participants:

  • how to create and support an effective UR program
  • how to develop a Physician Advisor program appropriate to the hospital’s size
  • how to construct an effective partnership relationsip between the two functions to ensure proper documentation and site of service
  • how to communicate the importance of this partnership to others


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Learn Best Practices in Five Areas

…From Physicians Who Are Succeeding NOW

PAsummit_banner_796x122The focus of the Boot Camp will be on all steps in the process —

(1) getting the patient from ER to a bed;

(2) concurrent and daily review;

(3) dealing with denials;

(4) managing appeals; and

(5) engaging in grassroots legislative advocacy.

The Boot Camp will also include a preconference on CDI and ICD-10 issues to round out the training. Especially now, when it is so important to “get it right the first time,” this is a must event for hospital staff, and highly discounted rates for hospital teams make it possible for all of the right people to attend.


Find complete details on their site or download their brochure.







Hospital Leaders Cannot Afford to Wait!

CMS is Dropping You Into Dangerous Waters This Fall

sharkInfestedWaters_480x477The PA-UR Team Boot Camp is designed as a very practical, hands-on, highly interactive experience for hospital leaders and managers. 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 colleagues at the end of Day I, set up single issue breakfast table topics on the morning of Day II, and assign homework in the form of case studies about inpatient vs. observation for discussion over lunch on Day II and presentation later, plus there are faculty panels and audience Q &A throughout.

So Who Should Go to Chicago and Learn All This?

Everyone from Pre-Admission to Appeals…

PAsummit_logo_450x525Send virtually anyone involved with revenue cycle. Here is a non-exclusive list:

  • Chief Executive Officers (a good PA-UR program will save money from avoidable denials)
  • Chief Financial Officers (a good PA-UR program will save money from avoidable denials, maybe lots of money)
  • Chief Medical Officers (if you don’t have a PA, learn how to recruit and train one, whether internal or external; if you do have one, learn how to make him/her more effective in partnership with your ER staff, your UR staff, your hospitalists, and your nursing staff)
  • Corporate Compliance Officers (learn how to make the ROI case to the three people listed above)
  • Hospital Corporate Counsel (learn what and when to challenge, and what works … and what doesn’t)
  • External Affairs/Government Affairs Manager (if you have one — you should be meeting with your Member of Congress on this stuff)
  • And of course all of the following:
  • RAC liaisons
  • staff nurses
  • physician advisors
  • utilization review committee members
  • case managers
  • emergency room clinicians
  • medical coding and billing staff
  • CDI staff
  • ICD10 staff
  • patient accounts managers
  • other financial and auditing personnel

More Than One Type of Job Is Involved

Truly, There Can’t Be Any “Silos” Anymore

Teamworking_480x320But don’t just send one rep. They have reduced the group discount rate for hospitals and health systems in the first Early Bird period. Send your RAC liaison, your PA, and a nurse/case manager (or any combination or 3 or more) before June 14 for $695 each, using the discount code that Appeal Academy can supply you.

buybutton-GetBothOffers_390x138Isn’t It Time to Stop Being Cheated?

Get the Power To Get Paid NOW

WinningHand_480x320You CAN use the cards you are being dealt to WIN correct, appropriate reimbursements, legally and compliantly ( plus you don’t have to CHEAT like CMS does) and it can all MORE than pay for itself. It’s SIMPLE…

Estimate the cost of registration, travel, and a hotel group rate of $145 against the cost of one denied inpatient claim. You likely get lots of those, right?

Now consider… what if your team learns just one thing at the Boot Camp that helps them win ONE appeal? You’ve likely just paid for the whole conference and trip, even if you sent 4-5 people!

Now THAT’s a winning hand…

Join us in Chicago

This could be your best hospital investment in 2013

Get all the details from this brochure or visit their site.

See you in Chicago!

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