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HomeTLC A


 

 

Course Name:

TLC A

Date of CE Release – 8/20/19

Date of CE Expiration – 8/20/21

Location – Online


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Non-Members

This Course Contains 6 On-Demand Modules

ACPA members can click on the "Enroll Now" button to purchase. Non-members must first register for a free membership to the ACPA Learning Center by clicking on the "Non-Members" button, then enroll for the course. After enrollment, click here to access the on-demand modules.



ACPA members can click on the "Enroll Now" button to purchase. Non-members must first register for a free membership to the ACPA Learning Center by clicking on the "Non-Members" button, then enroll for the course. After enrollment, click here to access the on-demand modules.




Overview

TLC A is a six-module course which provides core education for new Physician Advisors and a comprehensive overview of topics experienced Physician Advisors should be well-versed in. This course will help you understand the complex and comprehensive role of Physician Advisors, provide an overview of the Medicare appeals process, introduce the fundamental concepts of Clinical Documentation Integrity. and explain basic tenets such as the Medicare Two-Midnight Rule and Condition Code 44.

Objectives

After attending this program you should be able to understand the roles of a physician advisor, provide an overview of the Medicare appeals process, and introduce the concept of clinical documentation integrity.



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Non-Members

After enrollment, click here to access the on-demand modules.


 

Satisfactory Completion

Learners must listen to each self-directed audio recording while following along with the visual slides to receive a certificate of completion. You must participate in the entire activity as partial credit is not available. If you are seeking continuing education credit for a specialty not listed below, it is your responsibility to contact your licensing/certification board to determine course eligibility for your licensing/certification requirement.


Continuing Education Credits

In support of improving patient care, this activity has been planned and implemented by Amedco LLC and the American College of Physician Advisors. Amedco LLC is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

Physicians

Amedco LLC designates this enduring material for a maximum of 3.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

ABQAURP | American Board of Quality Assurance and Utilization Review Physicians

This online course is pre-approved by ABQAURP to provide up to 3.0 continuing education hours to apply towards the Health Care Quality & Management (HCQM) certification exam eligibility requirements or CHCQM recertification requirements for ABQAURP Diplomates. Participants wishing to have ACPA continuing education hours applied toward exam eligibility must present a copy of the ACPA CME certificate(s) along with their exam application. ABQAURP Diplomates must complete and return ABQAURP's CE Recertification Application, with the required fees, to submit for recertification approval.


Acknowledgement

Financial Commercial Support

No financial commercial support was received for this educational activity.

In-Kind Commercial Support

No in-kind commercial support was received for this educational activity.


Course Diretors

-Eddie Hu, MD, CHCQM-PHYADV University of North Carolina Health Care System
-Charles Locke, MD, CHCQM-PHYADV, Johns Hopkins Medicine
-Michael Salvatore, MD, CHCQM-PHYADV, Beebe Healthcare


Disclosure of Conflict of Interest

The following table of disclosure information is provided to learners and contains the relevant financial relationships that each individual in a position to control the content disclosed to Amedco. All of these relationships were treated as a conflict of interest, and have been resolved. (C7 SCS 6.1-­‐6.2, 6.5)


All individuals in a position to control the content of CE are listed in the program book. If their name is not listed below, they disclosed that they had no relevant financial relationships.


First Name Last Name Commercial Interest Relationship
Erica Remer Erica Remer, MD, Inc. Consultant

Disclaimer of Liability

The American College of Physician Advisors (ACPA) publishes and distributes materials created by our members and speakers for the benefit of all ACPA members. ACPA does not certify the accuracy or authority of these materials. These materials are distributed and presented as research information to be used by ACPA members, in conjunction with other research deemed necessary, in the exercise of ACPA members’ independent professional judgment. Original and fully-current sources of authority should be researched by ACPA members. ACPA disclaims all liability in relation to reliance on the content of these materials. The views expressed in the materials are the views of the material's authors and do not represent the views of ACPA. Any references are provided for informational purposes only and do not constitute endorsement of any sources.



Course Speakers

Ron Rejzer

As the founding President of the American College of Physician Advisors, Dr. Rejzer led the association from initial grass roots inception to the premier nationally recognized physician advisor organization. During his term in office, his vision for Physician Advisor certification became a reality by developing a strong partnership with American Board of Quality Assurance and Utilization Review Physicians and remains the gold standard for Physician Advisor certification. Dr. Rejzer is a native of Northwest Pennsylvania and 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. He obtained board certification in both Family Medicine and Emergency Medicine. Dr. Rejzer practiced full time Emergency Medicine in the Tidewater area of Virginia for over eighteen years, serving as President of the Virginia Peninsula Emergency Physicians, Inc. During the following 15 years, Dr. Rejzer held several Physician Executive leadership roles, including VPMA and Chief Medical Officer positions for several prominent healthcare organizations and Administrative Director for a large Mid-Atlantic Hospitalist management company. From 2013-2018 Dr. Rejzer served as the SVP, Chief Physician Advisor at Parkland Hospital in Dallas, TX. Additionally, Dr. Rejzer has served as a consultant for Hospitalist programs, Utilization Management and Physician Advisor programs and participated on several hospital boards and was elected President of the Newport News medical society in Virginia. He has actively participated in various Physician Advisor roles either part time or full time for over fifteen years and has been a nationally recognized speaker sharing his subject matter expertise regarding physician advisor roles and utilization management. As of August 2018, Dr. Rejzer is enjoying full time retirement at his home in NW Pennsylvania.

Contemporary Role of the Physician Advisor

Ronald Hirsch, MD, FACP, CHCQM, CHRI

Vice President, R1 RCM Inc.

Dr. Ronald Hirsch is a Vice President of the Regulations and Education Group at R1 RCM Inc. He received his medical degree from the Chicago Medical School in North Chicago, Illinois and completed his internal medicine residency at Kaiser Permanente Medical Center in Hollywood, California. Dr. Hirsch was a general internist and HIV specialist and practiced at Signature Medical Associates, a multispecialty practice located in Elgin, Illinois.  He was Medical Director of Case Management at Sherman Hospital in Elgin from 2006 to 2012, where he also was Chairman of the Medical Records Committee from 1995 to 2012, and served on the Medical Executive Committee. Dr. Hirsch also served on the Sherman Home Care Board of Directors from 1999 to 2012, was Chairman of the Board of Health for the City of Elgin from 1997 to 2012 and was medical director at two area nursing facilities in the 1990’s. Dr. Hirsch is certified in Health Care Quality and Management by the American Board of Quality Assurance and Utilization Review Physicians.  He is on the Examination Writing Committee, the Advisory Board, and Conference Committee of the National Association of Healthcare Revenue Integrity and he is certified in healthcare revenue integrity, Dr. Hirsch is the editor of the ACPA monthly newsletter, on the editorial board of the RACmonitor.com, is a weekly guest on the Monitor Mondays national webcast, and is a course director for Athena Forum. He is a Fellow of the American College of Physicians, a member of the American Case Management Association, and the co-author of The Hospital Guide to Contemporary Utilization Review, with the second edition published in 2018.

Condition Code 44 Basics

Erica Remer, MD, FACEP, CCDS

PRESIDENT, ERICA REMER, MD, INC.

Dr. Erica Remer practiced as an emergency physician for 25 years and has extensive coding, CDI, and ICD-10 expertise. She was a Physician Advisor of a large multi-hospital system for four years before transitioning to independent consulting in July 2016. Her passion is educating CDI specialists, coders, and healthcare providers with engaging, case-based presentations on documentation, CDI, ICD-10, and denials management. She has written numerous articles and serves as the co-host of Talk Ten Tuesdays, a weekly national podcast. Dr. Remer is on the Association of Clinical Documentation Integrity Specialists (ACDIS) Advisory Board, the Board of Directors for the American College of Physician Advisors (ACPA), and she is Co-Chair for the ACPA Clinical Documentation Integrity Committee.

CDI and Quality for the Physician Advisor

DENISE WILSON, MS, RN, RRT

SENIOR VICE PRESIDENT, DENIAL RESEARCH GROUP/APPEALMASTERS

Denise Wilson is a Registered Respiratory Therapist, Registered Nurse, and has a Master’s degree in Information Systems from the University of Illinois, Springfield. Ms. Wilson has over 30 years' experience in healthcare, including clinical management, education, compliance, and appeal writing. She has extensive experience as an appeals expert and has managed thousands of appeal cases and presented hundreds of cases at the Administrative Law Judge level. As a nationally known speaker and educator on denial and appeals processes, payer behaviors, and standards of care, she has educated thousands of healthcare professionals around the country in successfully overturning medical care denials.

Medicare Appeals

Charles Locke, MD

Dr. Charles Locke has been a Physician Advisor, Utilization/Clinical Resource Management for Johns Hopkins Hospital since 2011 and the Senior Physician Advisor since 2013. He is also an Assistant Professor in the Department of Medicine, Johns Hopkins School of Medicine. He has been active in areas CMS hospital payment and audit policy, including visit status determination and the Recovery Audit (RA) program. Dr. Locke continues to have active clinical duties, including serving a preceptor for Johns Hopkins internal medicine residents in an ambulatory clinic and as an attending physician on one of the inpatient medicine services at Johns Hopkins Hospital. Dr. Locke received his medical degree from the University of Pennsylvania, completed his internship and residency in internal medicine at the University of Virginia Health Sciences Center, and is a graduate of the Johns Hopkins Faculty Development Program for Clinical Educators.

Medicare's 2 Midnight Rule

R. Phillip Baker, MD, FACOG

Dr. R. Phillip Baker is the founding and managing partner in Piedmont Physicians for Women an OB/GYN practice for 32 years. He has extensive background in managed care and contracting while acting as the President of an IPA and Chairman of the Board of a regional PHO. Initially serving as a part time Physician Advisor doing mainly second level reviews took on the role as a full time Physician Advisor and Medical Director for Case Management and CDI in 2014. Responsibilities also include denials management for Self Regional Healthcare a regional hospital in Greenwood, SC. Dr. Baker serves on several committees including Co-Chair of the Finance Committee for My Health First an upstate South Carolina ACO, Corporate Compliance Committee for My Health First, Governmental Affairs Committee ACPA as well as several committees at the South Carolina Hospital Association. He was also appointed to the inaugural class of “Hirsch’s Heroes” in 2015 for his work with the process to file complaints with CMS against Medicare Advantage Plans. He joined the Board of Directors for the American College of Physician Advisors in 2017.

Medicare Advantage 


 

For questions & more information, please contact us at cgorniak@wmrhq.com.

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