16th Annual NAMAS Conference

Telehealth has undergone more changes in the past four years than most billed services see in a lifetime, and yet—here we go again! As we launch into telehealth in 2025, we face new telehealth codes, rules, and guidelines.

We must be prepared to update compliance policies for 2025, educate physicians and coding teams on these changes, and audit the compliance documentation. This session will ensure you are ready to go live with these telehealth changes on January 1, 2025.

We often receive questions regarding official resources that can be used to support compliance and make more informed, authoritative decisions. Unfortunately, we also frequently encounter decisions made in practices and facilities that lead to self-reporting scenarios that could have been avoided.

To effectively invoke change in practice, it is essential to be aware of available resources, know how to find them, and understand their impact on the changes. These changes can often be jarring for physicians, providers, and administrative staff, and decisions should not be approached lightly or without solid research and resources.

1. During this session, we will explore the research and resources from the (surgical/E/M) perspective that should be used to make informed decisions.
2. We will walk through real-life examples of scenarios where practices had to self-report and refund reimbursement they were not entitled to. 
3. We will review proactive and retrospective steps you can take to implement new services compliantly. 

Are you Team Paul, Team Scott, or Team Stephanie? Join Moderator Shannon DeConda as she leads teams in a friendly battle of trivia and wits, focusing on compliance and auditing knowledge. Let’s engage in some friendly competition and challenge each other's expertise. Prizes will be awarded to the winning team!

JOIN PAUL'S TEAM FOR TRIVIA
CLICK HERE TO *BUY A T-SHIRT TO REPRESENT TEAM PAUL!*

Are you Team Paul, Team Scott, or Team Stephanie? Join Moderator Shannon DeConda as she leads teams in a friendly battle of trivia and wits, focusing on compliance and auditing knowledge. Let’s engage in some friendly competition and challenge each other's expertise. Prizes will be awarded to the winning team!

JOIN SCOTT'S TEAM FOR TRIVIA

CLICK HERE TO *BUY A T-SHIRT TO REPRESENT TEAM SCOTT!*

Are you Team Paul, Team Scott, or Team Stephanie? Join Moderator Shannon DeConda as she leads teams in a friendly battle of trivia and wits, focusing on compliance and auditing knowledge. Let’s engage in some friendly competition and challenge each other's expertise. Prizes will be awarded to the winning team!

JOIN STEPHANIE'S TEAM FOR TRIVIA
CLICK HERE TO *BUY A T-SHIRT TO REPRESENT TEAM STEPHANIE!*

If you stop and think about it, physician education is a significant responsibility. You are effectively teaching physicians how to be compliant or noncompliant, and if you get it wrong, the consequences are far greater than just a poor rating.

Auditing feedback sessions in compliance and quality assurance are pivotal in ensuring organizational integrity and performance improvement. However, what happens when you are the physician educator and you disagree with the auditor’s conclusions?

This session will equip the educator with the skills and strategies necessary to navigate such scenarios confidently and professionally. Preparing for an effective training session is crucial for ensuring success, whether it’s an audit findings session or a general training session.

Learning Objectives:
1. Identify Training Needs: Determine your physicians’ specific training needs to tailor the content accordingly.
2. Design a Structured Curriculum: Create a curriculum that covers essential topics and skills in a structured
manner.
3. Engage and Educate: Utilize interactive and engaging training methods to enhance learning and retention.

So, You Got "The Letter"Retrospective payer audits wield a significant influence on your organization.

Prior to addressing the needs of healthcare compliance to ensure accuracy and integrity in billing and reimbursement processes, it is essential to grasp the workings of the payer audit system thoroughly.

Our session commences with identifying the key stakeholders and their roles as audit requestors. However, each audit requestor pursues distinct objectives and operates differently. Therefore, we will examine and contrast their objectives, methodologies, and areas of focus. Additionally, we will explore the implications of these audits for healthcare providers, including potential financial impacts, compliance obligations, and effective response strategies.

Auditing feedback sessions in compliance and quality assurance are pivotal in ensuring organizational integrity and performance improvement. However, what happens when you are the physician educator and you disagree with the auditor's conclusions? This session will equip the educator with the skills and strategies necessary to navigate such scenarios confidently and professionally.
Throughout this session, participants will explore techniques for approaching auditing feedback sessions when they hold differing perspectives on the findings. We'll delve into proactive communication strategies, effective listening techniques, and constructive feedback methodologies to foster productive dialogue between auditors and auditees.
Key topics covered include:

1. Understanding Your Position:
   • Recognizing and articulating your perspective on the audit findings.
   • Identifying specific areas of disagreement and underlying concerns.
2. Preparing for the Feedback Session:
   • Strategizing your approach to the feedback session to ensure clarity and professionalism.
   • Gathering evidence and documentation to support your perspective.
3. Engaging in Constructive Dialogue:
   • Utilizing active listening techniques to understand the auditor's perspective.
   • Asking clarifying questions and seeking common ground to facilitate discussion.
4. Asserting Your Position Professionally:
   • Advocating for your viewpoint respectfully and assertively.
   • Presenting evidence and rationale to support your arguments effectively.
5. Resolving Disagreements and Moving Forward:
   • Exploring strategies for finding common ground and reaching a resolution.
   • Developing action plans for addressing any discrepancies and implementing corrective measures.

"Where do we go from here?" Receiving a recoupment letter from an insurance company can be daunting as it signals the need for a strategic response to ensure compliance and mitigate financial impact.

In our session, we will delve into effective strategies for navigating this challenge, placing a strong emphasis on collaborating with the Compliance Committee to adopt a comprehensive audit approach. Participants will learn how to formulate a strategic audit plan tailored to address recoupment letters, with a focus on achieving both regulatory compliance and financial recovery. We will also discuss the legal implications associated with audits triggered by recoupment letters and emphasize the critical role of the Compliance Committee in devising audit responses that align with compliance standards and organizational policies.

Additionally, the session will explore various factors that influence the decision-making process when selecting audit approaches, whether it involves utilizing internal audit capabilities, engaging external auditors, or invoking attorney-client privilege with legal counsel. Lastly, attendees will identify the specific roles and responsibilities that Compliance Committee members hold in audit preparation, spanning from initial assessment through to the implementation of corrective actions. discrepancies and implementing corrective measures.

Participation is strongly encouraged (that's what we are at conference for), but observers welcome.
Delivering concise and impactful presentations is invaluable, especially when educating physicians. This session aims to empower educators with the skills needed to deliver impromptu presentations effectively, fostering dynamic and engaging learning experiences for physicians.
Participants will engage in interactive exercises designed to hone their ability to deliver spontaneous presentations on physician education topics. Through practice and feedback, attendees will gain confidence in their impromptu speaking abilities and learn how to articulate key points clearly and persuasively.
Learning Objectives:

1. Mastering Spontaneous Communication:
   • Develop proficiency in delivering impromptu presentations on physician education topics.
   • Learn techniques for organizing thoughts quickly and effectively under pressure.
2. Adapting to Audience Needs:
   • Identify strategies for tailoring impromptu presentations to meet the specific learning needs of physicians.
   • Practice adjusting presentation style and content based on audience feedback and engagement.
3. Crafting Clear and Concise Messages:
   • Refine the ability to convey complex information clearly and concisely during spontaneous presentations.
   • Learn how to prioritize key points and eliminate unnecessary details for maximum impact.

"Who's on First, What's on Second."
Receiving a notification from a payer initiates a critical phase that demands a meticulous approach to ensure compliance and financial stability.

This session provides a comprehensive, step-by-step guide to structuring audits in alignment with specific audit scopes and payer policies. Participants will learn how to effectively define and refine audit scopes to address the specifics outlined in payer notifications. Practical methods for incorporating National Correct Coding Initiative (NCCI) edits, and Current Procedural Terminology (CPT) guidelines into audit procedures will be explored, enhancing accuracy and compliance by identifying and addressing coding discrepancies.

Best practices for integrating Clinical Documentation Improvement (CDI) strategies specific to ICD-10-CM coding will also be covered, ensuring thorough documentation review essential for compliance and optimized reimbursement. Essential techniques for conducting comprehensive documentation reviews will be emphasized, focusing on thoroughness and compliance with payer guidelines to mitigate audit discrepancies. Participants will gain insights into effectively applying payer-specific policies and coding guidelines during audit processes to ensure audits are conducted accurately and in alignment with payer expectations.

The session will also explore the optimal use of coding and compliance tools to streamline audit workflows, enhancing efficiency, accuracy, and overall audit outcomes. Through practical insights and real-world examples, attendees will be equipped to confidently navigate payer notifications, leveraging structured audit approaches that uphold compliance and financial integrity.

Audience participation, with no individual required participation.

Through interactive simulations and guided discussions, participants will refine their skills in engaging physicians, fostering meaningful interactions, and maximizing learning outcomes.
Throughout the session, attendees will be presented with various scenarios, ranging from challenging questions and interruptions to feedback opportunities. By actively participating in these scenarios, attendees will gain valuable insights and practical strategies for enhancing their effectiveness as educators in conference settings.
Learning Objectives:

1. Navigate Challenging Interactions:
   • Develop strategies for effectively responding to challenging questions, interruptions, and unexpected situations during conference sessions.
2. Foster Meaningful Engagement:
   • Learn techniques for engaging physicians and fostering interactive discussions that promote active learning and participation.
3. Maximize Learning Outcomes:
   • Identify strategies for structuring conference sessions to maximize learning outcomes and retention among attendees.
4. Adapt to Audience Needs:
   • Practice adapting presentation styles and content to meet the diverse learning needs and preferences of conference attendees.
5. Receive and Utilize Feedback:
   • Cultivate skills in receiving and utilizing feedback from physicians to enhance future conference presentations and educational initiatives.
6. Promote Collaboration and Networking:
   • Explore ways to facilitate collaboration and networking opportunities among physicians during conference sessions to enhance learning and professional development.
7. Enhance Presentation Delivery Skills:
   • Refine presentation delivery skills, including clarity, confidence, and audience engagement, through hands-on practice and feedback.
8. Build Confidence in Educator Role:
   • Boost confidence and competence in the educator role by actively engaging in interactive scenarios and receiving constructive feedback from peers and facilitators.

"When Things Get Real" focuses on the critical steps in reporting audit findings and developing actionable plans based on those findings.

Participants will learn essential techniques for compiling and presenting audit results effectively to stakeholders. This includes strategies for creating comprehensive action plans encompassing education, disciplinary actions, and potential refunds for overpayments.

The session emphasizes the importance of engaging stakeholders and ensuring transparency throughout the audit process. Participants will gain insights into effectively communicating audit findings to relevant parties, fostering understanding and collaboration. Key topics covered include understanding the processes for handling overpayment refunds and implementing compliance education initiatives based on audit outcomes.

By the end of the session, attendees will be equipped with practical skills and strategies to navigate the complexities of reporting audit findings, developing actionable plans, and promoting compliance within their organizations.

Effective audit reports go beyond stating findings like "not supported"—they are about clarity, impact, and actionable insights.  
In this session, we will dive deep into crafting clear and concise audit reports that resonate as we learn to discover techniques to convey findings effectively and persuasively, explore methods to engage your readers, and ensure your message is understood.
This session will be interactive as we gain practical insights while using real-world examples to enhance our reporting proficiency. Then we will put your skills to the test with interactive exercises designed to reinforce key concepts.

In the session "Making the Best Better," participants will explore strategies for continuous improvement in compliance processes to mitigate future audits effectively.

Key topics include developing strategies for continuous monitoring and risk assessment to preemptively address potential audit triggers. Participants will also learn how to leverage technology and data analytics to enhance compliance monitoring and management, promoting proactive identification and mitigation of compliance risks.

The session will emphasize the importance of fostering a culture of compliance and continuous learning within the organization. Attendees will gain insights into implementing continuous improvement initiatives that integrate data-driven decision-making and enhance overall compliance efficacy.

Participants will be equipped with practical tools and approaches to drive continuous improvement in compliance processes, foster proactive compliance management through technology and analytics, and cultivate a culture that prioritizes ongoing learning and adherence to regulatory standards.