Medicare RAC Summit
Medicare RAC Summit
Medicare RAC Summit
Medicare RAC Summit
Medicare RAC Summit
Medicare RAC Summit



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Preconference | Day 1

RAC SUMMIT PRESENTATIONS
Speaker presentations are password protected for 90 days from the start of the Summit. Registrants may log in by clicking here. For further information, email registration@hcconferences.com or call 800-503-0510.


Agenda: Day II
Friday, July 24, 2015

7:00 am
Registration Opens

Networking Breakfast in the Exhibit Hall

Optional Faculty Hosted Table Topics
  • Topic: Results from EHR's CDI survey
    Host: John Zelem, MD, FACS, Executive Health Resources

  • Topic: Fight Note Bloat! Informative Short Notes vs. Copy/Paste Non-information
    Host: Michael A. Salvatore, MD, FACP, Beebe Medical Center

  • Topic: Bioethical Issues and the Physician Advisor
    Host: Howard Stein, DO, Centrastate Medical Center

  • Topic: UR committee -- Your Friend or a Bad Word?
    Host: Elizabeth Lamkin, PACE Healthcare Consulting

  • Topic: Appeal Strategies
    Host: Ernie de los Santos, Appeal Academy

  • Topic: ABNS and HINNS
    Host: Ronald Hirsch, MD, FACP, Accretive Physician Advisory Services (AccretivePAS)

  • Topic: New to the Physician Advisor Role?
    Host: Ronald J. Rejzer, MD, CHCQM, American College of Physician Advisors (ACPA)

  • Topic: What Makes a Compelling Case for the ALJ
    Host: Bob Soltis, CEO, the Advocacy Akademie, Former ALJ, Office of Medicare Hearings and Appeals (OMHA)

  • Topic: Critical Access Hospital Issues
    Host: No formal host
BOOT CAMP DAY II -- CLOSING PLENARY SESSION
8:00 am IV. ONGOING EDUCATION
  • Overview and Expectations for the Morning
  • Audience Response System Questions
  • Moving to the Dynamic Role of Effecting Change
Day Egusquiza
President, AR Systems, Inc., Twin Falls, ID (Chair)

    Speaker Bio

    Day Egusquiza is President of AR Systems, Inc. and brings over 30 years experience in health care reimbursement, hospital business office operations, contracting and compliance implementation. During her 20 years as Director of Revenue and Reimbursement at a community hospital in Idaho, she also was Director of a Physician Medical Management billing service, where she completed an integrated business office between a hospital and a large physician clinic. Her work includes providing guidance as a compliance & APC educator while providing operational insight on the revenue cycle impacts of RAC/Medicare Recovery Audit Contractors. Ms Egusquiza is a nationally recognized speaker on continuous quality improvement (CQI), benchmarking, redesigning, reimbursement systems and implementing an operational focus of compliance - both in hospitals and practices. She has been on the AAHAM National Advisory Council, HFMA National Advisory Council, and is a past President of the Idaho HFMA Chapter & recently received the Lifetime Achievement Award. Attendees at HFMA's ANI rated her in the top 25% for each year she has presented, earning her the 'Distinguished Speaker' award. She received her college degree at Lewis & Clark College in Portland, OR.
8:15 am Leading a Meaningful UR Committee
Role of the UR Committee -- A PA Perspective
Ronald J. Rejzer, MD, CHCQM
Senior Vice President/ Chief Physician Advisor, Parkland Health and Hospital Systems, Dallas, TX

    Speaker Bio

    Dr. Ronald J. Rejzer is SVP, Chief Physician Advisor for Parkland Health and Hospital System in Dallas, TX. A native of Northwest Pennsylvania, he received his medical degree in 1980 from the Hahnemann Medical University in Philadelphia, followed by a residency at the Medical College of Virginia/VCU in Family Medicine. Dr. Rejzer practiced full time Emergency Medicine in the Tidewater area of Virginia for over eighteen years and was Board Certified in both Family Medicine and Emergency Medicine. For the past 15 years, Dr. Rejzer has held various Physician Executive roles, including VPMA and Chief Medical Officer positions for several prominent healthcare organizations and Administrative Director for a large Mid-Atlantic Hospitalist management company. Additionally, Dr. Rejzer has served as a consultant for Hospitalist programs, Utilization Management development and Physician Advisor programs and participated on several hospital boards and was elected President of a local medical society in Virginia. He has participated in Physician Advisor roles either part time or fulltime, for over twelve years. He currently serves full time as the SVP, Chief Physician Advisor at Parkland Hospital in Dallas, TX. Dr. Rejzer was recently elected as the President of the American College of Physician Advisors, Inc. Dr. Rejzer is also a Diplomat of the ABQAURP.
    Presentation Material (Acrobat)
Role of UR in a UR Committee
Pamela Foster, APSW, MBA, ACM
Director, Care Coordination, Case Management & Social Services, Mayo Clinic Health System, Eau Claire, WI

    Speaker Bio

    Pamela Foster is the Coordinator of the Care Coordination Program at Mayo Clinic Health System, Northwest WI region. She has over 20 years of experience and leadership in case management and utilization review in community, academic, tertiary and critical access hospitals. She currently serves on the American Case Management Association's National Board of Directors as well as the National Quality Forum's Care Coordination Steering Committee.
    Presentation Material (Acrobat)
8:45 am

Panel Discussion: Making a Dedicated Ambulatory Unit Work -- Outpatient in a Bed (Pros and Cons)

Pamela Foster, APSW, MBA, ACM
Director, Care Coordination, Case Management & Social Services, Mayo Clinic Health System, Eau Claire, WI

    Speaker Bio

    Pamela Foster is the Coordinator of the Care Coordination Program at Mayo Clinic Health System, Northwest WI region. She has over 20 years of experience and leadership in case management and utilization review in community, academic, tertiary and critical access hospitals. She currently serves on the American Case Management Association's National Board of Directors as well as the National Quality Forum's Care Coordination Steering Committee.
    Presentation Material (Acrobat)
Linda Gomes, RN
Clinical Reimbursement Manager, Bridgeport Hospital, Bridgeport, CT

    Speaker Bio

    Linda Gomes has more than thirty years of nursing experience, including clinical pediatrics, nursing management, and nursing informatics, before transitioning to her present position as Clinical Reimbursement Manager at Bridgeport Hospital in Connecticut. In addition to her nursing degree, she holds a BS in Business Management from Post College in Waterbury, CT. and an MS in Health Systems Management from Sacred Heart University in Fairfield, CT. Linda's interests outside of her career include a passion for the game of golf and a passion for spoiling her grandchildren.
Maria Johar, MD
Administrative Director, ProMedica, Toledo, OH

    Speaker Bio

    Dr. Maria Johar is the System Physician Advisor at ProMedica Health System.

    ProMedica was acknowledged for being an integrated health system that serves more than 4.4 million patients across its 13 hospitals, four ambulatory surgery centers and more than 300 other facilities each year.

    She joined the Promedica family in Oct 2012. She comes with over fifteen years of experience in the fields Of Utilization Review, Quality, Appeals, Joint Commission, Clinical Documentation, Safety and Infection Control. She is trained in LEAN methodology for system improvements.

    Prior to working with ProMedica Health System, she worked with Mercy Health System, Lima memorial Health System and Liberty Medical Center. She has worked with Ohio State Medicaid board on several process improvement initiatives. She has worked as a private consultant to physician offices and Hospitals as well as writing a book called DRG Tools.

    She lives in Toledo with her husband, two boys and two dogs.

    She is sits on the Lucas county suicide prevention board, and is associated with the National Physician Advisors Association, national and state case management associations and the National Association of Healthcare Quality.
    Presentation Material (Acrobat)
Delana Knupp, RN, CRRN
Integrated CDI/Case Management Director, Wise Regional Health Systems, Decatur, TX

    Speaker Bio

    Delana Knupp is an Integrated CDI/Case Management Director at Wise Regional Health Systems in Decatur, TX. She is a nurse with approximately 18 years in the healthcare field -- everything from helping her younger brother open up his own Physical Therapy practice, to becoming an EMT Paramedic with four small children at home, to obtaining her ASN from Excelsior University in Albany, NY. She has experience in a wide variety of clinical areas, CDI, audit analyst and UR. She has over seven years in leadership positions bringing about electronic documentation, CDI and now, in the last year, Integrated CDI. Under her umbrella of Integrated CDI she has UR, traditional CDI, and audit analysis. Delana feels passionate about effective communication and loves this journey of being the bridge that holds together the clinical and revenue side of the house.
    Presentation Material (Acrobat)
Kathy Shumpert, RN
Director of Surgical and Obstetrical Services, Dukes Memorial Hospital, Peru, IN; Former Clinical Documentation Improvement Specialist, Community Howard Regional Health, Kokomo, IN

    Speaker Bio

    Kathy Shumpert's passion is to do purposeful worthwhile work by utilizing her 7 years of experience as a Clinical Documentation Improvement Specialist to educate physicians, CDI staff and coders to prevent revenue loss and improve physician documentation. Not only has she been a registered nurse for 18 years, but Kathy has recently earned a Master's degree in Nursing Administration from Indiana University. She has a strong background in long-term care administration, surgery, case management, and home health care. Kathy has conceptualized and created an Integrated CDI model. She is an expert CDI trainer providing ongoing education. Additionally, she successfully writes coding and medical necessity appeals. Kathy Shumpert has spoken at the national ACDIS conference and the National RAC/MAC Summit in 2014. In fact, she speaks as often as she can in hopes to find someone who is as passionate about CDI as she is. She is still looking for that individual.
9:15 am

Hospitalists as PAs -- How to Incorporate the Role into the Daily Function

Ronald J. Rejzer, MD, CHCQM
Senior Vice President/Chief Physician Advisor, Parkland Health and Hospital Systems, Dallas, TX

    Speaker Bio

    Dr. Ronald J. Rejzer is SVP, Chief Physician Advisor for Parkland Health and Hospital System in Dallas, TX. A native of Northwest Pennsylvania, he received his medical degree in 1980 from the Hahnemann Medical University in Philadelphia, followed by a residency at the Medical College of Virginia/VCU in Family Medicine. Dr. Rejzer practiced full time Emergency Medicine in the Tidewater area of Virginia for over eighteen years and was Board Certified in both Family Medicine and Emergency Medicine. For the past 15 years, Dr. Rejzer has held various Physician Executive roles, including VPMA and Chief Medical Officer positions for several prominent healthcare organizations and Administrative Director for a large Mid-Atlantic Hospitalist management company. Additionally, Dr. Rejzer has served as a consultant for Hospitalist programs, Utilization Management development and Physician Advisor programs and participated on several hospital boards and was elected President of a local medical society in Virginia. He has participated in Physician Advisor roles either part time or fulltime, for over twelve years. He currently serves full time as the SVP, Chief Physician Advisor at Parkland Hospital in Dallas, TX. Dr. Rejzer was recently elected as the President of the American College of Physician Advisors, Inc. Dr. Rejzer is also a Diplomat of the ABQAURP.
    Presentation Material (Acrobat)
Michael A. Salvatore, MD, FACP
Physician Advisor, Beebe Medical Center, Lewes, DE

    Speaker Bio

    Dr. Michael Salvatore received his MD from the University of Arizona in 1977. His post-graduate training 1977 - 1982 was at Duke University. He practiced Critical Care Medicine for 30 years before becoming a full time PA at Beebe Healthcare in 2012. He has been married for 43 years and has 2 daughters. When not working as a PA, he is watching birds with his wife.
    Presentation Material (Acrobat)
9:45 am Networking Break and Prize Drawing
10:10 am

The Physician Advisor as the National Transportation Safety Board of CDI

John Zelem, MD, FACS
Vice President, Compliance and Education, Executive Health Resources, Newtown Square, PA

    Speaker Bio

    Dr. Zelem currently serves as a Executive Medical Director, Client Relations and Education for Executive Health Resources (EHR). At present, more than 2,000 hospital and healthcare organizations across the country are using EHR's solutions. A Board Certified general surgeon with more than 25 years of clinical experience, Dr. Zelem is responsible for quality assessment and improvement at EHR's client hospitals. Dr. Zelem is also a member of EHR's physician education team and regularly visits EHR's client hospitals to provide medical executives and staff members with ongoing education on a variety of topics including Medicare and Medicaid compliance and regulations, medical necessity, Recovery Audit Contractors, utilization review, denials management and length of stay. In addition, Dr. Zelem is a renowned industry author who has published many books and is a well-known motivational speaker and presents often to professional and public/patient audiences on health and wellness, personal development, and leadership and success.

    Prior to joining EHR, Dr. Zelem practiced general surgery at Griffin Hospital, a 160-bed acute care community hospital located in Derby, Conn., and then practiced general surgery at Baptist Memorial Hospital-Booneville, a 67-bed acute care hospital located in Booneville, Miss. Dr. Zelem received his medical degree from Boston University School of Medicine and bachelor's degree in biology from Boston College.
    Presentation Material (Acrobat)
10:35 am

The PA's Role with Physician Training

Ronald J. Rejzer, MD, CHCQM
Senior Vice President/ Chief Physician Advisor, Parkland Health and Hospital Systems, Dallas, TX

    Speaker Bio

    Dr. Ronald J. Rejzer is SVP, Chief Physician Advisor for Parkland Health and Hospital System in Dallas, TX. A native of Northwest Pennsylvania, he received his medical degree in 1980 from the Hahnemann Medical University in Philadelphia, followed by a residency at the Medical College of Virginia/VCU in Family Medicine. Dr. Rejzer practiced full time Emergency Medicine in the Tidewater area of Virginia for over eighteen years and was Board Certified in both Family Medicine and Emergency Medicine. For the past 15 years, Dr. Rejzer has held various Physician Executive roles, including VPMA and Chief Medical Officer positions for several prominent healthcare organizations and Administrative Director for a large Mid-Atlantic Hospitalist management company. Additionally, Dr. Rejzer has served as a consultant for Hospitalist programs, Utilization Management development and Physician Advisor programs and participated on several hospital boards and was elected President of a local medical society in Virginia. He has participated in Physician Advisor roles either part time or fulltime, for over twelve years. He currently serves full time as the SVP, Chief Physician Advisor at Parkland Hospital in Dallas, TX. Dr. Rejzer was recently elected as the President of the American College of Physician Advisors, Inc. Dr. Rejzer is also a Diplomat of the ABQAURP.
    Presentation Material (Acrobat)
10:50 am

Communication Tools with the Provider Community -- Local Experiences and the Role of the PA

Pamela Foster, APSW, MBA, ACM
Director, Care Coordination, Case Management & Social Services, Mayo Clinic Health System, Eau Claire, WI

    Speaker Bio

    Pamela Foster is the Coordinator of the Care Coordination Program at Mayo Clinic Health System, Northwest WI region. She has over 20 years of experience and leadership in case management and utilization review in community, academic, tertiary and critical access hospitals. She currently serves on the American Case Management Association's National Board of Directors as well as the National Quality Forum's Care Coordination Steering Committee.
Maria Johar, MD
Administrative Director, ProMedica, Toledo, OH

    Speaker Bio

    Dr. Maria Johar is the System Physician Advisor at ProMedica Health System.

    ProMedica was acknowledged for being an integrated health system that serves more than 4.4 million patients across its 13 hospitals, four ambulatory surgery centers and more than 300 other facilities each year.

    She joined the Promedica family in Oct 2012. She comes with over fifteen years of experience in the fields Of Utilization Review, Quality, Appeals, Joint Commission, Clinical Documentation, Safety and Infection Control. She is trained in LEAN methodology for system improvements.

    Prior to working with ProMedica Health System, she worked with Mercy Health System, Lima memorial Health System and Liberty Medical Center. She has worked with Ohio State Medicaid board on several process improvement initiatives. She has worked as a private consultant to physician offices and Hospitals as well as writing a book called DRG Tools.

    She lives in Toledo with her husband, two boys and two dogs.

    She is sits on the Lucas county suicide prevention board, and is associated with the National Physician Advisors Association, national and state case management associations and the National Association of Healthcare Quality.
Ronald J. Rejzer, MD, CHCQM
Senior Vice President/ Chief Physician Advisor, Parkland Health and Hospital Systems, Dallas, TX

    Speaker Bio

    Dr. Ronald J. Rejzer is SVP, Chief Physician Advisor for Parkland Health and Hospital System in Dallas, TX. A native of Northwest Pennsylvania, he received his medical degree in 1980 from the Hahnemann Medical University in Philadelphia, followed by a residency at the Medical College of Virginia/VCU in Family Medicine. Dr. Rejzer practiced full time Emergency Medicine in the Tidewater area of Virginia for over eighteen years and was Board Certified in both Family Medicine and Emergency Medicine. For the past 15 years, Dr. Rejzer has held various Physician Executive roles, including VPMA and Chief Medical Officer positions for several prominent healthcare organizations and Administrative Director for a large Mid-Atlantic Hospitalist management company. Additionally, Dr. Rejzer has served as a consultant for Hospitalist programs, Utilization Management development and Physician Advisor programs and participated on several hospital boards and was elected President of a local medical society in Virginia. He has participated in Physician Advisor roles either part time or fulltime, for over twelve years. He currently serves full time as the SVP, Chief Physician Advisor at Parkland Hospital in Dallas, TX. Dr. Rejzer was recently elected as the President of the American College of Physician Advisors, Inc. Dr. Rejzer is also a Diplomat of the ABQAURP.
Michael A. Salvatore, MD, FACP
Physician Advisor, Beebe Medical Center, Lewes, DE

    Speaker Bio

    Dr. Michael Salvatore received his MD from the University of Arizona in 1977. His post-graduate training 1977 - 1982 was at Duke University. He practiced Critical Care Medicine for 30 years before becoming a full time PA at Beebe Healthcare in 2012. He has been married for 43 years and has 2 daughters. When not working as a PA, he is watching birds with his wife.
Kathy Shumpert, RN
Director of Surgical and Obstetrical Services, Dukes Memorial Hospital, Peru, IN; Former Clinical Documentation Improvement Specialist, Community Howard Regional Health, Kokomo, IN

    Speaker Bio

    Kathy Shumpert's passion is to do purposeful worthwhile work by utilizing her 7 years of experience as a Clinical Documentation Improvement Specialist to educate physicians, CDI staff and coders to prevent revenue loss and improve physician documentation. Not only has she been a registered nurse for 18 years, but Kathy has recently earned a Master's degree in Nursing Administration from Indiana University. She has a strong background in long-term care administration, surgery, case management, and home health care. Kathy has conceptualized and created an Integrated CDI model. She is an expert CDI trainer providing ongoing education. Additionally, she successfully writes coding and medical necessity appeals. Kathy Shumpert has spoken at the national ACDIS conference and the National RAC/MAC Summit in 2014. In fact, she speaks as often as she can in hopes to find someone who is as passionate about CDI as she is. She is still looking for that individual.
11:20 am

Q&A Session with Morning Faculty

Audience Response System -- Final Quiz

Day Egusquiza
President, AR Systems, Inc., Twin Falls, ID (Moderator)

    Speaker Bio

    Day Egusquiza is President of AR Systems, Inc. and brings over 30 years experience in health care reimbursement, hospital business office operations, contracting and compliance implementation. During her 20 years as Director of Revenue and Reimbursement at a community hospital in Idaho, she also was Director of a Physician Medical Management billing service, where she completed an integrated business office between a hospital and a large physician clinic. Her work includes providing guidance as a compliance & APC educator while providing operational insight on the revenue cycle impacts of RAC/Medicare Recovery Audit Contractors. Ms Egusquiza is a nationally recognized speaker on continuous quality improvement (CQI), benchmarking, redesigning, reimbursement systems and implementing an operational focus of compliance - both in hospitals and practices. She has been on the AAHAM National Advisory Council, HFMA National Advisory Council, and is a past President of the Idaho HFMA Chapter & recently received the Lifetime Achievement Award. Attendees at HFMA's ANI rated her in the top 25% for each year she has presented, earning her the 'Distinguished Speaker' award. She received her college degree at Lewis & Clark College in Portland, OR.
    Presentation Material (Acrobat)
12:00 pm Adjourn

Go to Agenda:
Preconference | Day 1




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