10:15 a.m. - 11:45 a.m.
Mastering the Mechanics of Managed Care Credentialing
Amy Niehaus, CPMSM, CPCS, MBA
Credentialing and Privileging Track | TU02 | 1.5 CEs | Mid-Level
Looking for that foundational knowledge that will enable you to establish a compliant managed care credentialing program from A-Z? This program is for medical services professionals that are new to the managed care field or are seeking delegation from payers. Using best practices and real-life applications in the workplace, attendees will learn key concepts applicable to NCQA standards and CMS regulations in managed care, including policies and procedures, initial credentialing and recredentialing requirements, acceptable verification sources, ongoing monitoring, facility credentialing, and delegation.
Resolving Credentialing Concerns for Clinicians Reentering Practice
Elizabeth Korinek, MPH and Sally Pelletier, CPMSM, CPCS
Credentialing and Privileging Track | TU03 | 1.5 CEs | Mid-Level
Returning to practice or reengaging in specific practice areas can be a daunting process, both for the clinician and for the hospital where they seek to practice. Is your institution open to working with clinicians seeking to return to practice after an extended voluntary absence from patient care? Do you know what resources are available to help these clinicians regain their skills? Do you have consistent policies to guide decision-making when addressing requests from clinicians to expand/change their scope of practice and/or refresh skillsets they have not used in several years? These situations present a career opportunity for the clinician and could address important staffing needs at the hospital. However, they also pose challenges for medical staff professionals (MSPs) tasked with credentialing these clinicians.
MSPs struggle with how to objectively and consistently navigate the requirements of privileging and credentialing processes, while at the same time ensuring that patients are safe and well cared for as these clinicians regain their clinical skills. This session will identify the unique challenges presented by clinicians who have a gap in patient care or in experience in specific procedures or services. The session will include an overview of national reentry trends, guidance on reentry policies to ensure you have appropriate processes in place, review of approaches to facilitate an effective and safe transition onto the clinical staff, methods for monitoring to meet focused practice evaluation expectations, and presentation of case studies.
Transforming the Medical Staff Office in a LEAN Process Improvement Environment
Dustin Jackson, MHA, CPCS, CPMSM and Heather Woodring
Professional Development Track | TU04 | 1.5 CEs | Mid-Level
LEAN process improvement methodology has been used for years in manufacturing, and is gaining popularity in health care. This session will give you the tools and knowledge to be at the forefront of LEAN performance improvement within your organization by providing fundamentals and principles of LEAN performance improvement methodology as well as real world applications to Medical Staff Office operations and credentialing.
Interactive Case Studies: New and Challenging Issues that Build "Character"
Erin Mullenberg, JD, CPMSM and John Synowicki, JD
Accreditation and Regulatory Track | TU05 | 1.5 CEs | Advanced
This interactive session will focus on real cases hospitals and health care organizations have faced. You will be guided through discussions with your peers and others and then have an opportunity to anonymously vote on how you would have handled the facts. Following the voting there will be further discussion of the facts, applicable laws and alternative solutions. This will be a fun and informative session which will provide both networking and learning.
A Discussion with HFAP and URAC
Accreditation and Privileging Track | TU06 | 1.5 CEs
Session presenters and description details coming soon
2:00 p.m. - 3:30 p.m.
You're the Expert...Why Aren't You the Leader Yet?
Maggie Palmer, MSA, CPMSM, CPCS and Brianna Foulkrod, CPCS, CPMSM
Professional Development Track | TU07 | 1.5 CEs | Mid-Level
You LOVE being an MSP! You love the challenges and the fact no two days are ever the same. You commit yourself to learning EVERYTHING and feel you are the SME (Subject Matter Expert) in your organization, but no one else notices. What can you do to get to "the next level", know what the realities are for career growth, and get your leadership to see your potential? We'll be sharing stories from the trenches as well as experiences of those who have made the trek to senior leadership.
Verify and Comply: CMS, JC, NCQA, HFAP and DNV Credentialing Standards Compared and Contrasted
Carol Cairns, CPMSM, CPCS and Sally Pelletier CPMSM, CPCS
Accreditation and Regulatory Track | TU08 | 1.5 CEs | Mid-Level
Compliance with multiple regulatory and accreditation standards is mandatory for healthcare organizations. However, it is becoming increasingly challenging to understand the similarities and differences in requirements. This session compares and contrasts the specific standards for the five agencies in a manner that is unlike any other. Join us to receive an informative and concise understanding of accreditation requirements related to credentialing.
The Exponential Growth of Telegraph: Essential Knowledge for Organizations That Credential Practioners
Todd Sagin, MD, JD and Vicki Searcy
Credentialing and Privileging Track | TU09 | 1.5 CEs | Mid-Level
The scope and breadth of telehealth is transforming the health care industry. It is critical that health care organizations understand the requirements relating to the credentialing telemedicine practitioners. This presentation will first review the current status of telehealth, its acceptance among physicians and patients, and the evidence for its efficacy. The faculty will present the requirements for the privileging of telemedicine practitioners and the challenges posed by evolving and diverse regulatory and accreditation requirements. Several case scenarios will be described to highlight the various considerations that must be weighed by credentialing bodies.
Enrollment and Credentialing: The Integration Opportunity
Amy Niehaus, CPMSM, CPCS, MBA
Provider Enrollment Track | TU10 | 1.5 CEs | Mid-Level
As healthcare organizations continue to search for ways to reduce costs while maintaining quality, the credentialing and enrollment departments are coming to the forefront as ideal candidates for integration. While both perform distinct and critical functions, there is significant overlap with the practitioner data and skill sets as well as an interdependency crucial for an organization’s success. Through real-life examples, attendees will learn approaches to successfully integrate these two functions and leverage this opportunity to achieve greater efficiency and enhance revenue within their organization.
Hiding in Plain Sight- 2019
Erin Muellenberg, JD, CPMSM and Kay Brown, CPMSM, CPCS
Credentialing and Privileging Track | TU11 | 1.5 CEs | Mid-Level
This session will discuss contemporary cases involving providers and impersonators that impacted patient or community safety. Updates will be provided on other cases that have recently been in the news. Finally, this session will identify “red flags” and credentialing processes to help you further investigate findings.
4:00 p.m. - 5:30 p.m.
Telemedicine Credentialing: A Real World Perspective
Angie Kozicky, CPCS, Roberta Monte, Doinique Juif-Robertson and Leslie Gore
Credentialing and Privileging Track | TU12 | 1.5 CEs | Mid-Level
The world of telemedicine is new, exciting and rapidly changing. In this Q&A session, we will discuss how MSPs manage telemedicine credentialing and privileging, and apply practical examples. Utilizing our combined knowledge of this emerging industry, guidance will be offered to streamline your process and define your organization's role in terms of oversight and quality assurance.
Applying Emotional Intelligence as an MSP
Faith Rhoades, MMHC, CPMSM, CPCS, FMSP
Professional Development Track | TU13 | 1.5 CEs | Advanced
What is your EQ/emotional intelligence, and what impact does it have on your leadership? This session investigates the elements that define EQ/emotional intelligence, and looks at ways to develop your EQ for personal and professional growth. This session relies on audience interaction and participation.
Understanding CMS Credentialing and Privileging Requirements for Hospitals, Ambulatory, and Critical Access
Kathleen Matzka, CPMSM, CPCS, FMSP
Accreditation and Regulatory Track | TU14 | 1.5 CEs | Introductory
The Centers for Medicare and Medicaid regulations for acute care hospitals and critical access hospitals are required to be met by all facilities providing care to Medicare and Medicaid Patients. This program will cover the CMS requirements for credentialing and privileging and will also discuss what CMS surveyors expect to see when surveying a hospital.
Unifying Medical Staffs: The 'Systemization' of Medical Staff Activities in Multi-Campus Health Systems
Todd Sagin, MD, JD
Accreditation and Regulatory Track | TU15 | 1.5 CEs | Mid-Level
More than half the nation's hospitals are part of multi-campus health systems, typically with multiple medical staffs. This session will explore the options for creating more efficient and effective use of physicians and support professionals by merging medical staffs or medical staff activities. The pros and cons of this activity will be outlined; the legal and regulatory considerations enumerated; common implementation challenges explained; and a review of best practices and most successful models discussed. This session will be relevant to physicians and medical staff professionals who are currently in multi-hospital systems or may find themselves in one in the near future.
Showcasing Your Successes Through Quality Monitoring and Audits
Tawna Miles, CPCS
Executive Managment Track | TU16 | 1.5 CEs | Advanced
Performing quality and file auditing can be a solution for achieving audit ready files, uniform standards of quality, measures for performance and productivity, methods for identifying staff education and performance improvement and improved data integrity.
We all think we are doing a stellar job by being efficient, timely and producing high quality work. Yet, how many times have you had to defend it? How many times are you challenged on it? Have you ever asked yourself “How do I know we are achieving it, meeting targets, meeting our customer and organization expectations?”
Come hear how one health system CVO incorporates a quality structure to effectively track, monitor, communicate and report their efficiencies in credentialing, provider enrollment and database management. You will see how effectively communicating those results and being transparent with the good, and the not so good, in your processes will gain you trust, appreciation, credibility and fewer frustrations.