Why should you Attend: It's better to know what changes CMS has finalized so that providers are ready to implement new coding or billing requirements such as the use of new modifiers, etc. Additionally, providers will have a sense of what payment rate changes/shifts are expected for individual services (by CPT code, such as evaluation and management visits, observation, drugs, etc.) and/or for Comprehensive APCs, which are like mini-outpatient DRGs or episodes. Knowing where the largest changes are can help finance directors, hospital CFOs, coding, billing, reimbursement, and compliance staff be ready for impact on their organizations.
Areas Covered in the Session:
All major financial and/or operational changes finalized by CMS for CY 2017 OPPS
Status indicator changes
Comprehensive APC (mini-DRG) changes
Payment changes for drug administration, E/M visit codes, observation, composite APCs, drugs, biologicals, radiopharmaceuticals, blood and blood products, as well as other major APC category payment rate changes
Changes related to reporting modifiers and much more!
Observation Notice Act changes if released
Section 603 related technical and operational changes for grandfathered vs. non-grandfathered provider-based off-campus locations
And much more!
Ms Jugna Shah,
Jugna Shah is a Nationally recognized expert in health care policy and financing reform and the founder of Nimitt Consulting, Inc. Since 2001, Nimitt Consulting has specialized in providing information and education on regulatory initiatives and policies that affect health care service delivery, quality, cost, accessibility, and compliance.
In the U.S., Ms. Shah works with a variety of hospitals and health systems to address the clinical, operational, and financial challenges they face under Medicare's payment systems - specifically, Medicare's Outpatient Prospective Payment System (OPPS), based on Ambulatory Payment Classifications (APCs). She helps providers address and overcome complex coding, billing, revenue cycle, and compliance issues, with a focus on medical and radiation oncology, pharmacy and drug coverage, radiology, use and refinement of E/M visit guidelines, and more. In addition to working with providers, Nimitt Consulting provides expertise on reimbursement and policy to drug and device manufacturers, trade associations, and law firms.
A successful advocate, Ms. Shah has raised important payment system concerns to the Centers for Medicaid and Medicare Services (CMS) and the federal Advisory Panel on APCs. Many of her recommendations have been accepted and implemented by CMS, thereby making the APC system not only operationally simpler but also more equitable for providers nationwide. Nimitt Consulting Inc. also works internationally on case-mix design, system development, and implementation initiatives. Ms. Shah has led several World Bank and US Agency for International Development (USAID) health care financing reform initiatives that involve providing long-term policy and technical assistance to foreign governments. She has worked in Albania, Bulgaria, the Czech Republic, Hungary, Iceland, the Republic of Moldova, Romania, Turkey, and Slovakia. Since 2007, Ms. Shah has served as Secretary for Patient Classification Systems International (PCSI), an international case-mix organization and was recently elected to Vice-President.
Ms. Shah is a popular and dynamic educator who regularly presents on OPPS, APCs, and related topics. She is a frequent speaker at local, regional, national, and international conferences including the Healthcare Financial Management Association (HFMA), the American Health Information Management Association (AHIMA), HCPro, and Ingenix. She is also a lead instructor at the PCSI case-mix summer school held annually in June. As part of her commitment to education, Ms. Shah helped create several of the field's leading publications on OPPS/APCs, including HCPRO's APC Answer Letter, The APC Weekly Monitor, and Briefings on APCs. She is also the author of several books, including OPPS Drug Administration Strategies: Your Comprehensive Guide to Accurate Coding, Billing and Charging and The Drug Revenue Toolkit.
Prior to founding Nimitt Consulting, Inc., Ms. Shah was a senior manager with KPMG's Assurance-Based Advisory Services Practice, guiding providers through the clinical and financial implications of APC implementation. Previously, Ms. Shah worked with 3M Health Information Systems as an Ambulatory Care Product Marketing Manager. She holds a Bachelors of Science in Biopsychology from Oberlin College, and a Masters of Public Health Policy & Administration from the University of Michigan.
- Revenue Cycle Directors
- Billing Office
- Charge Description Master Coordinators
- Others in the hospital interested in understanding the changes CMS has finalized for CY 2017.