Return-Path: Received: from vps.transocean.com by vps.transocean.com with LMTP id IO0KLkfv7VkSYQAAInt2oQ ; Mon, 23 Oct 2017 06:31:51 -0700 Return-path: Envelope-to: JOHN@TRANSOCEAN.COM Delivery-date: Mon, 23 Oct 2017 06:31:51 -0700 Received: from mail16.sasmail1.com ([199.68.176.117]:35796) by vps.transocean.com with esmtps (TLSv1:ECDHE-RSA-AES256-SHA:256) (Exim 4.89) (envelope-from ) id 1e6cpP-0006SV-Cn for JOHN@TRANSOCEAN.COM; Mon, 23 Oct 2017 06:31:51 -0700 Received: by mail16.sasmail1.com id htnnj21hso81 for ; Mon, 23 Oct 2017 09:30:35 -0400 (envelope-from ) From: "Medicare Advantage" To: "JOHN@TRANSOCEAN.COM" Reply-To: marketing@healthaudioconf.com Date: Mon, 23 Oct 2017 09:16:08 -0400 Subject: Medicare advantage program compliance for physicians and hospitals MIME-Version: 1.0 Content-Type: multipart/alternative; boundary="_=aspNetEmail=_6d2950fa7dcf407ba022274c4f23f6eb" X-Mailer: aspNetEmail ver 3.5.2.0 x-sbe: SBE_75256a68-a906-4896-b70a-ec46a0824436 Message-ID: X-Spam-Status: No, score=-1.9 X-Spam-Score: -18 X-Spam-Bar: - X-Ham-Report: Spam detection software, running on the system "vps.transocean.com", has NOT identified this incoming email as spam. The original message has been attached to this so you can view it or label similar future email. If you have any questions, see root\@localhost for details. Content preview: Understanding Medicare Advantage Programs for Physicians and Hospitals Presented By: Duane C. Abbey Live Audio Conference | Date: Tuesday, October 24, 2017 | Time: 1 pm ET | Length: 90 minutes | CEU: 1.5 AAPC CEU Approved Register Now Medicare Advantage Programs for Physicians and Hospitals: Compliance Issues Approximately one-third of all Medicare beneficiaries are enrolled in various Medicare Advantage (MA) programs. The key descriptor for these programs in that of variability. These programs must cover what traditional Medicare covers, but they then expand from this basic coverage to expanded coverage for medical and surgical services. In some cases, the cost of these programs is less than that of traditional Medicare. 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[URIs: transocean.com] -0.0 SPF_PASS SPF: sender matches SPF record 0.0 HEADER_FROM_DIFFERENT_DOMAINS From and EnvelopeFrom 2nd level mail domains are different -1.9 BAYES_00 BODY: Bayes spam probability is 0 to 1% [score: 0.0003] 0.0 HTML_MESSAGE BODY: HTML included in message X-Spam-Flag: NO --_=aspNetEmail=_6d2950fa7dcf407ba022274c4f23f6eb Content-Type: text/plain; charset="UTF-8" Content-Transfer-Encoding: quoted-printable Understanding Medicare Advantage Programs for Physicians and Hospitals=0D= =0APresented By: Duane C=2E Abbey=0D=0ALive Audio Conference =7C Date: Tu= esday, October 24, 2017 =7C Time: 1 pm ET =7C Length: 90 minutes =7C CEU:= 1=2E5 AAPC CEU Approved=0D=0ARegister Now=0D=0AMedicare Advantage Progra= ms for Physicians and Hospitals: Compliance Issues=0D=0AApproximately one= -third of all Medicare beneficiaries are enrolled in various Medicare Adv= antage (MA) programs=2E The key descriptor for these programs in that of = variability=2E These programs must cover what traditional Medicare covers= , but they then expand from this basic coverage to expanded coverage for = medical and surgical services=2E In some cases, the cost of these program= s is less than that of traditional Medicare=2E=0D=0A=0D=0AMA programs rep= resent some real challenges for healthcare providers such as physicians, = hospitals, skilled nursing, home health among others=2E For MA programs, = an emphasis is given to provider relationships, particularly for physicia= ns and hospitals=2E In some cases, a given provider will be part of a net= work or under contract to the given MA plan, and, thus, cod=C3=ACng, bill= ing and reimbursement are governed by the contract=2E =0D=0A=0D=0AIn othe= r cases, a given healthcare provider may by filing a claim with an MA pla= n across the country in which there is no relationship between the MA pla= n and the provider=2E If a claim is filed by a healthcare provider that i= s not part of the MA plan=E2=80=99s network, it is to be adjudicated unde= r the traditional Medicare rules=2E Given the variability in coverage and= medical policies, there can be confusion when claims are adjudicated and= paid=2E=0D=0A=0D=0AJoin this informative session with expert speaker Dua= ne C=2E Abbey, Ph=2ED=2E, where he will discuss the three different persp= ectives of the MA program: =0D=0A=0D=0AMedicare benef=C3=ACciary to the M= A plans=0D=0AProviders=E2=80=99 cod=C3=ACng, billing and reimbursement re= lative to MA plans=0D=0AMedicare=E2=80=99s relationship and compliance re= lative to MA organizations=0D=0ASession Highlights=0D=0AUnderstand what M= edicare Advantage is=0D=0AUnderstand what kinds of services are covered b= y MA programs=0D=0ADo physicians and hospitals contract with MA organizat= ions=0D=0AHow do MA programs pay for services of physicians, hospitals an= d other healthcare providers=0D=0AWhat if a physician or hospital is not = contracted with a MA program=0D=0AWhat kind of appeal processes are avail= able when physicians and hospitals disagree on payment or coverage=0D=0AW= hat this risk adjustment process is=0D=0AHow claims are adjudicated and p= ayment is made for both contracted and non-contracted situations=0D=0ACom= pliance issues surrounding payment to MA organizations=0D=0ASession Agend= a=0D=0AIntroduction to Medicare advantage (MA) programs=0D=0AWho can bene= fit from the program=0D=0ADifferent MA plans and how they differ from one= another=0D=0AThree perspectives of MA program:=0D=0AMedicare benef=C3=AC= ciary=0D=0AConditions for individual cost-benefit analysis=0D=0ACompariso= n with Part A, Part B and Part D=0D=0AIf one MA plan goes off, register f= or another MA plan=0D=0AProviders, including physicians, hospitals, clini= cs, etc=2E=0D=0AOverview of and conditions for network v=2E out-of-networ= k (OON) providers=0D=0AThe different types of providers=0D=0APayment guid= elines from a given Medicare advantage organization=0D=0AAppeals processe= s and possible areas of concern=0D=0AHow the appeals process is different= than 42 CFR 422=2E311=0D=0ACMS: the Medicare program=0D=0AMedicare advan= tage program overview, beneficiaries, contracts, compliance issues, and m= ore=0D=0AMAOs payment through base rate and risk adjusted rate=0D=0ACMS H= ierarchical Condition Category overview with examples=0D=0AHow more diagn= ostic conditions mean a higher risk scor=C3=A8 and an increase in payment= =0D=0AIssues related to compliance and more=0D=0AWhy risk scor=C3=A8 gam=C3= =ACng is not going to go away=0D=0ASteps CMS is taking to ensure that =C3= =ACnsurance firms are not illegally changing risk scores=0D=0ASkills an a= uditor must possess=0D=0AAnd more=0D=0ACLICK HERE TO REGISTER=0D=0AFor Sp= ec=C3=ACal Offers, Deals =26 Discounts:=0D=0A=E2=9C=86 Call Now at 1-866-= 458-2965 or email at customerservice=40audioeducator=2Ecom (Reference cod= =C3=A8: EHOSMP09_SH)=0D=0AAbout Our Speaker=0D=0ADuane C=2E Abbey, Ph=2ED= =2E is a management consultant and president of Abbey =26 Abbey, Consulta= nts, Inc=2E, which specializes in healthcare consulting and related areas= =2E Read more=0D=0AWe hope you found this message to be useful=2E=0D=0AIf= you don=E2=80=99t wish to receive any further communication, please clic= k the unsubscribe link below=2E Your request will be processed within 10 = days=2E =0D=0AAudio Educator =7C 2222 Sedwick Rd, Durham NC 27713 =7C 866= -458-2965 =0D=0AThis message has been sent by Audio Educator=2E=0A=0A=0AT= his message is intended for JOHN=40TRANSOCEAN=2ECOM=2E If you do not wish= to receive future emails, please click here: http://Incoming=2Esaveastam= p=2Eca/unsubstracker=2Easpx?=7B0=7D=7BJOHN=40TRANSOCEAN=2ECOM=7D=7B75256a= 68-a906-4896-b70a-ec46a0824436=7D=2E=0D=0A --_=aspNetEmail=_6d2950fa7dcf407ba022274c4f23f6eb Content-Type: text/html; charset="UTF-8" Content-Transfer-Encoding: quoted-printable <=21DOCTYPE html PUBLIC =22-//W3C//DTD XHTML 1=2E0 Transitional//EN=22 =22= http://www=2Ew3=2Eorg/TR/xhtml1/DTD/xhtml1-transitional=2Edtd=22>=0D=0A=0D=0A=0D=0A =0D=0A Medicare advantage program compliance for physicians and hospitals=0D=0A =0D=0A=0D=0A<= body>=0D=0A<= td>
=0A=0D=0A=0D=0A=0D=0A=0D=0A=0D=0A=0D=0A=0D= =0A=0D=0A=0D=0A=0D=0A=0D=0A=0D=0A=0D= =0A=0D=0A=0D=0A=0D=0A=0D=0A=0D=0A=0D=0A=0D=0A=0D= =0A=0D=0A=0D=0A=0D=0A=0D=0A=0D=0A=0D=0A=0D=0A=0D=0A=0D=0A=0D=0A
    =0D=0A
  • Introduction= to Medicare advantage (MA) programs
    • =0D=0A
  • Who can benefit from the= program
    • =0D=0A
  • Different MA plans and how they differ from one an= other
    • =0D=0A
  • Three perspectives of MA program:
    • =0D=0A=0D=0A
  • Medicare benef=26igrave;ciary
    • =0D=0A
      =0D=0A
    • Conditions for= individual cost-benefit analysis
      • =0D=0A
    • Comparison with Part A, Par= t B and Part D
      • =0D=0A
    • If one MA plan goes off, register for anothe= r MA plan
      • =0D=0A
    =0D=0A
  • Providers, including physicians, hospi= tals, clinics, etc=2E
    • =0D=0A
      =0D=0A
    • Overview of and conditions = for network v=2E out-of-network (OON) providers
      • =0D=0A
    • The differe= nt types of providers
      • =0D=0A
    • Payment guidelines from a given Medic= are advantage organization
      • =0D=0A
    • Appeals processes and possible a= reas of concern
      • =0D=0A
    • How the appeals process is different than 42= CFR 422=2E311
      • =0D=0A
    =0D=0A
  • CMS: the Medicare program<= /li>=0D=0A
=0D=0A
  • Medicare advantage program overview, beneficiaries, contr= acts, compliance issues, and more
    • =0D=0A
  • MAOs payment through base r= ate and risk adjusted rate
    • =0D=0A
  • CMS Hierarchical Condition Categ= ory overview with examples
    • =0D=0A
  • How more diagnostic conditions m= ean a higher risk scor=26egrave; and an increase in payment
    • =0D= =0A
  • = Issues related to compliance and more
    • =0D=0A
  • Why risk scor=26egrav= e; gam=26igrave;ng is not going to go away
    • =0D=0A
  • Steps CMS is tak= ing to ensure that =26igrave;nsurance firms are not illegally changing ri= sk scores
    • =0D=0A
  • Skills an auditor must possess
    • =0D=0A<= li>And more=0D=0A=0D=0A=0D=0A    =0D=0A=0D=0A=0D=0A=0D=0A=0D=0A= =0D=0A=0D=0A=0D= =0A=0D=0A=0D=0A=0D=0A=0D=0A=0D=0A=0D=0A
    Understanding Medicare Advantag= e Programs for Physicians and Hospitals
    Presented By: Du= ane C=2E Abbey
    Live Audio Conference =7C Date: Tuesday, October 24, 2017 =7C Ti= me: 1 pm ET =7C Length: 90 minutes =7C = CEU: 1=2E5 AAPC CEU Approved
    Regist= er Now
    Medicare Advanta= ge Programs for Physicians and Hospitals: Compliance Issues
    Ap= proximately one-third of all Medicare beneficiaries are enrolled in vario= us Medicare Advantage (MA) programs=2E The key descriptor for these progr= ams in that of variability=2E These programs must cover what traditional = Medicare covers, but they then expand from this basic coverage to expande= d coverage for medical and surgical services=2E In some cases, the cost o= f these programs is less than that of traditional Medicare=2E

    MA = programs represent some real challenges for healthcare providers such as = physicians, hospitals, skilled nursing, home health among others=2E For M= A programs, an emphasis is given to provider relationships, particularly = for physicians and hospitals=2E In some cases, a given provider will be p= art of a network or under contract to the given MA plan, and, thus, cod=26= igrave;ng, billing and reimbursement are governed by the contract=2E
    =
    In other cases, a given healthcare provider may by filing a claim wi= th an MA plan across the country in which there is no relationship betwee= n the MA plan and the provider=2E If a claim is filed by a healthcare pro= vider that is not part of the MA plan=26rsquo;s network, it is to be adju= dicated under the traditional Medicare rules=2E Given the variability in = coverage and medical policies, there can be confusion when claims are adj= udicated and paid=2E

    Join this informative session with expert sp= eaker Duane C=2E Abbey, Ph=2ED=2E, where he will discuss= the three different perspectives of the MA program:

    =0D=0A
      =0D=0A
    • Medicare benef=26igrave;ciary to the MA plans
      • =0D= =0A
    • = Providers=26rsquo; cod=26igrave;ng, billing and reimbursement relative to= MA plans
      • =0D=0A
    • Medicare=26rsquo;s relationship and compliance re= lative to MA organizations
      • =0D=0A
    =0D=0A
    <= font color=3D=22=23000000=22 face=3D=22Verdana=22 size=3D=223=22>Session = Highlights
    =0D=0A
      =0D=0A
    • Understand what Medicare= Advantage is
      • =0D=0A
    • Understand what kinds of services are covered b= y MA programs
      • =0D=0A
    • Do physicians and hospitals contract with MA or= ganizations
      • =0D=0A
    • How do MA programs pay for services of physicia= ns, hospitals and other healthcare providers
      • =0D=0A
    • What if a phys= ician or hospital is not contracted with a MA program
      • =0D=0AWhat = kind of appeal processes are available when physicians and hospitals disa= gree on payment or coverage=0D=0A
    • What this risk adjustment proce= ss is
      • =0D=0A
    • How claims are adjudicated and payment is made for bo= th contracted and non-contracted situations
      • =0D=0A
    • Compliance issu= es surrounding payment to MA organizations
      • =0D=0A
    =0D=0A=0D=0A
    Session Agenda
    C= LICK HERE TO REGISTER
    For Spec=26igrave;a= l Offers, Deals =26amp; Discounts:
    =E2=9C=86 Call Now at 1-866-458-2965 or email at customerservice=40audioeducator=2Ecom (Reference cod=26= egrave;: EHOSMP09_SH)
    About Our Speaker<= /font>
    D= uane C=2E Abbey, Ph=2ED=2E is a management consultant and presid= ent of Abbey =26amp; Abbey, Consultants, Inc=2E, which specializes in hea= lthcare consulting and related areas=2E Read more<= /font>
    =0D=0A

    We hope you found this message to be useful=2E
    If you don=26rsquo;t w= ish to receive any further communication, please click the unsubscribe li= nk below=2E Your request will be processed within 10 days=2E
    Audio E= ducator =7C 2222 Sedwick Rd, Durham NC 27713 =7C 866-458-2965
    This m= essage has been sent by Audio Educator=2E

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