Affordable Care Act and What ACOs Mean to You
The program will provide an overview of the Affordable Care Act and the False Claims Act. It will also feature how Mercy Health has established one of the nation’s top 10 Accountable Care Organizations (ACOs), Mercy Health Select. These acts have affected all of the healthcare industry and are making the continuum of care more cohesive; administrators need to understand the new rules and the driving forces behind large health systems and ACOs.
Michael R. Bissegger
is a VP and Associate General Counsel with Mercy Health. He serves as General Counsel for two Mercy Regions and provides antitrust counsel for all of Mercy. Prior to joining Mercy, Mr. Bissegger was a partner at Epstein Becker & Green, P.C. in Washington, D.C. He has extensive experience representing clients in all sectors of the health care industry. Prior to joining Epstein Becker & Green, Mr. Bissegger was a staff attorney at the Federal Trade Commission in Washington, D.C. Mr. Bissegger received his J.D. from Cornell Law School in 1992.
is the Director of Operations for the Clinically Integrated Network/Accountable Care Organization in the Mercy Health Springfield Market with a dual role in Business Development. Responsible for population health and the transition to value-based reimbursements in her market, Shannon implements and tracks the outcome of strategic efforts around preventative care, chronic disease management, inpatient quality, and post-acute discharges. Prior to her employment at Mercy, Shannon worked for TriHealth at Bethesda and Good Samaritan Hospitals.
Shannon holds a Bachelor of Science degree from Miami University and is in the process of obtaining her MHA from Urbana University. Active in healthcare management for nearly two decades, she has participated in many medical conferences across the country and has a long list of professional volunteer and contribution experiences.
Reducing SNF Overpayment Risk through a Focused Response to SNF PEPPER Target Areas and Recent Government Audit Activity
Course Description/Content Focus
This intermediate-advanced instructional level course reviews Skilled Nursing Facility billing trends including CMS’ Public Use File Release and SNF PEPPER reports, with an overview of analyzing facility statistics compared to peers. A review of government target areas impacting current medical review activity and associated overpayment risks will be discussed. Recommended best practices for Medicare billing compliance and strategies for putting an appropriate action plan in place in response to specific facility billing data outliers will be reviewed.
(OTR/L, CHC, RAC-CT, VDTCT), serves as President of Proactive Medical Review & Consulting, LLC. and is an Occupational Therapist with twenty years of experience serving in long term care rehabilitation leadership positions and as a clinical program specialist. She is certified in healthcare compliance. She has successfully partnered with post-acute care and rehabilitation service providers to improve clinical outcomes, compliance programs, medical record documentation, 5 star survey results, and to reduce error rates under medical review. Proactive clients have consistently yielded less than 5% error rate under medical review with 93% of denied amounts overturned on appeal.
Working with legal counsel to prepare defensive arguments and provide expert witness testimony, she has defended SNF providers under large volume ZPIC and RAC government audits, successfully recovering reimbursement. Amie’s recent publications include articles for the American Occupational Therapy Association, American Association of Nurse Assessment Coordination, American College of Health Care Administrators, and the American Health Lawyers Association.
How SNF Survey in an ACO World
In this session, we will break down ACOs and the level of accountability for 100% of expenditures and care for a defined population of patients. We will cover the importance of providing evidence-based care in a collaborative and coordinated model. We will also address the importance of improving coordination of care for services provided under Medicare Parts A and B and a successful foundation for strong clinical integration. Additional items include: population health, IT infrastructure, reporting needs and factors to successfully collaborate as an ACO partner.
is the Director of Population Health Management at Riverview Health where he is helping to design strategies to support both Medicare and commercial Accountable Care Organizations. Mark has a broad background working in quality improvement and patient safety, health policy research, health education, and public health. For the past 20 years, he has worked primarily in hospital settings but has worked for commercial payers, the CDC, and an academic medical center.
(MBA, FACHE, HFA, Lean SSBB, CHC), is the Regional Director of Operation for Riverview Health where he oversees the Long Term Care Services Lines, Laboratory Service Lines and is Lean Six Sigma Process Improvement trainer. Riverview is located in Noblesville, IN. He oversees the quality of care & outcomes for residents of (26) multiple long term care facilities. Serving as the financial and clinical quality intermediary between the long-term care facilities management team.
Mr. Stewart holds a MBA from Indiana Wesleyan University, a BS in Healthcare Management from Towson University and is also a Licensed Nursing Home Administrator as well as a Licensed Practical Nurse which he obtained from St. Philips College. Mr. Stewart also holds Black Belts in LEAN and SIX SIGMA with additional expertise that includes strong administrative, operational and leadership skills.