ICD-10 & Accountable Care - Financial and Legal Implications

3.0 CME Credits

3.0 CE Credits

ABQAURP sub-specialty credits: Managed Care 2.5, Physician Advisor 3.0, Patient Safety/Risk Management 3.0, Case Management 3.0, Transitions of Care 2.0

Address the new financial and legal implications introduced by the Affordable Care Act (ACA) and ICD-10. Expand your understanding of the legal responsibilities faced by ACOs working with CMS data, discover tools for ACO success, evaluate the financial implications of the ACA, review ICD-10, and recognize the importance of documentation

Now is the time to gain an in-depth understanding of what is required to be a successful practitioner under the ACA. Protect your practice and improve the health of both your patients and community in this new environment. Be among the leaders who have a winning Affordable Care Act-era practice.

At the conclusion of the activity, attendees will be able to:

  • Discuss what types of data ACOs receive from CMS
  • Determine ACOs’ legal obligations with respect to those data
  • Identify ACO data use best practices
  • Review ICD-10 and the impact of recent conversion in October 2015
  • Recognize the importance of documentation on severity of illness and mortality adjustments
  • Discuss meaningful engagement tools with physicians to improve documentation
  • Discuss ACO success with population health and risk stratification tools
  • Review physician leadership and essential aspects of Medicare shared savings success
  • Discuss the financial impact of the mandatory elements of reform
  • Review the components of mandatory reform programs across the continuum and how they impact one another
  • Describe the elements of how to strategically plan ahead to maximize the programs financially
  • Evaluate how the mandatory programs tie into many of the alternate payment models and how they help to maximize the alternate payment models

This session was recorded live at our 2016 Annual Health Care Quality & Patient Safety Conference and is a portion of the online course entitled: Quality Under the Affordable Care Act: Keys to Success.

This course is intended for Physicians of all specialties, Nurses, and Other Health Care Professionals with appropriate CME credit and nursing contact hours offered for each profession.

The American Board of Quality Assurance and Utilization Review Physicians, Inc. (ABQAURP) is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

ABQAURP 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 is an approved provider of continuing education for nurses. This activity is designated for 3.0 contact hours through the Florida Board of Nursing, Provider # 50-94.

This program is approved for Category 2 credit by the American Osteopathic Association.

All participants must achieve a final assessment score of at least seventy percent (70%) for recertification and continuing education credits. You have 60 days to complete the course after ordering. Please note: Exam candidates taking the Core Body of Knowledge and Diplomates renewing their certification may have less time to complete, as determined by deadlines imposed. This activity is valid from July 19, 2016 through March 15, 2019.


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COURSE FEES: Diplomate $80.00      Member $100.00      Non-Member $120.00

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About The Authors
Members of the CME Committee, Planners, and Faculty have disclosed to ABQAURP any relevant financial relationships. No relevant financial relationships or conflicts of interest exist in regard to the content of this activity.

Christopher J. Laney, JD, CHCQM - Baptist Health

Christopher Laney is Corporate Counsel for Baptist Health in Louisville, Kentucky, a full-spectrum health system consisting of eight hospitals, more than 170 outpatient facilities, and a network of 450 employed physicians and more than 1,600 independent physicians. Mr. Laney advises the Population Health Department on the development of an ACO and participation in the Medicare Shared Savings Program, the development and implementation of a statewide clinical integration program, and other value-based purchasing initiatives. He also advises all business units on HIPAA security and privacy issues.

Sam Antonios, MD, FACP, FHM, CCDS - Via Christi Clinic
Dr. Sam Antonios is the Medical Director of Information Systems and Utilization Management and Clinical Documentation Improvement at Via Christi Clinic in Kansas. Sam is a board certified internist and practices as a hospitalist at Via Christi. He oversees the implementation of electronic records, redesign of operations along with management of core informatics projects. He also is responsible for clinical documentation improvement efforts, denial reviews, and utilization management reviews. He was involved in the leadership of Via Christi through preparation, testing, and conversion to ICD-10 from documentation, clinical, IT, HIM, and process perspective last October. He works closely with the quality department in leading quality improvement projects.

D. Keith Fernandez, MD - Privia Health
Dr. Keith Fernandez is Senior Physician Executive at Privia Health in Houston. Prior to joining Privia, Dr. Fernandez served as President and Physician-in-Chief of the Memorial Hermann Physician Network, Chief Medical Officer of the Memorial Hermann Accountable Care Organization, and chairman of MHMD’s Clinical Programs Committee. In those roles, he developed a robust clinic integration program with over 2000 physicians and over 50 physician-led committees providing quality, safety and vendor governance for Memorial Hermann. He spearheaded the development of Memorial Hermann’s Patient Centered Medical Homes and Care Management program that formed the bedrock of the most financially successful Medicare Shared Savings Program for 3 years running with over 180 million dollars in shared savings, as well as multiple high performance commercial ACO, Medicare Advantage and risk based contracts.

Melinda Hancock, CPA, FHFMA - Dixon Hughes Goodman LLP / Healthcare Financial Management Association
Melinda Hancock is a Partner at Dixon Hughes Goodman, one of the top 20 largest accounting firms in the U.S. She also currently serves as National Chair for the Healthcare Financial Management Association. Melinda’s executive leadership at DHG Healthcare includes responsibility for development of services pointed to the mandatory elements of payment reform: value-based purchasing, readmissions, hospital-acquired conditions, shared savings models, governmental and commercial bundled payments, and the Medicare innovation model.

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