Preconference A — Sunday, September 7 (Morning)
Observation Status
Deborah K. Hale, CCS

The compliance risk associated with incorrect level of care determinations is increasing with expansion of the Recovery Adult Contrators (RAC) audits and ongoing HPMP initiatives. This session will review CMS changes to the monitoring process and provide hospitals with steps to help them achieve level of care accuracy.

Preconference A Registration • Check-in

Driving and Restraining Forces for Establishing Admission Necessity

• Hospital Payment Monitoring Program Initiatives
• Recovery Audit Contractors (RAC)
• Medical Staff Concerns

• External Data Sources
• Internal Data Sources

Interpreting Level of Care Regulations

• Medicare Benefit Policy Manual
• Medicare Claims Processing Manual

Interpreting Level of Care Regulations

• OPPS Final Rule for 2009
• Inpatient Only List
• Observation Status
• State Variances in QIO Recommendations
• Fiscal Intermediary/MAC Interpretations

• Appealing Proposed Level of Care Denials
• Case Management Role
• Utilization Review Committee
• Physician Advisor Role
• Clinical Decision Unit
• Condition Code 44 versus Provider Liable Claims

Adjourn

Preconference B — Sunday, September 7 (Morning)
Multiple Paths to Developing Competency in Yourself and Others
Karen Zander, MS, RN, CMAC, FAAN

This half day session will discuss definitions of competency, as well as a process of defining competency by role. Classic categories of competency will be examined and participants will have the opportunity through group interaction to develop a competency description for one role selected by the group. This interactive session will offer both the process and an example of what can be done to define competency.

Introduction: What Does “Competency” Mean to Case Management Professionals?
Method: Open discussion of these items

• The importance of feeling mastery over common and challenging cases.
• How big a problem is that of keeping up with new regs, new skills, new resources?
• Is there a reward attached?
• Is certification a measure?

• Competency is not an “all or nothing” proposition or behavior.
• What lies underneath the job description?
• Classic competency categories.

• Alternatives to Traditional Paths to Competency
• Summary: The Choice is Yours.

*Preconference C — Sunday, September 7 (Afternoon)
Liability Issues for Case Managers
Elizabeth E. Hogue, Esq.

Case managers are under increasing pressure to make legally defensible decisions. The purpose of this presentation is to explore the legal and ethical aspects of case management. What do national standards of care say about liability, including standards published by the Case Management Society of America (CMSA) and Medicare Conditions of Participation (COP’s)? What legal liability for adverse payment decisions may be involved in the process of providing case management services? From a practical point of view, what can case managers do in order to protect themselves? These are the key issues to be addressed in this half day session.

Objectives:

• List four (4) requirements that must be met in order to prove negligence.
• Describe three (3) recent court cases that address issues of liability for case managers.
• Identify two (2) practical ways in which case managers can manage their risks of legal liability.

• Liability for Negligence
• Application to Case Managers - Recent Case Law
• The Referral Process. Patient Rights, Kickbacks and Rebates
• Practical Ways to Avoid Liability for Negligence

Preconference D — Sunday, September 7 (Afternoon)
Developing Staff Individually and As a Team: Do Not Eat Your Young
Karen Zander, MS, RN, CMAC, FAAN

How can we hire right, keep our new case managers growing and move them into a cohesive team? Sound like a tall order? It’s a moving target over time. Questions to be addressed in this interactive session include: How can you avoid the fact that on the job training means one day of precepting and then you should be an expert? Or how do you really know what the staff are doing? What feels to them like “support” vs. “snoopervising”? Join this lively discussion and walk away with some methods you can use for developing new case managers both individually and within the group.

Objectives:
Describe methods to avoiding discouraging or destroying new case management professionals by developing both new AND experienced staff individually and as a cohesive work group.

• Methods for Hiring, Orienting, and Supervising New Employees
• The Manager/Director as Developer: Stages of Group Growth
• Methods for Developing a Cohesive Group

Preconference E — Sunday, September 7 (All Day)
Case Management Boot Camp 2008: Be The Best Case Manager That You Can Be!!!
Toni G. Cesta, PhD, RN, FAAN
Beverly Cunningham, MS, RN

All new for 2008!!! This all-day workshop is designed to provide up-to-date information to both the novice as well as the experienced case manager. So, whether you need to hone your skills or you are just getting started, this workshop will have something for you! Practical and pragmatic, the information provided will be applicable to your everyday practice.

Come to Boot Camp and polish you skills or gain new knowledge that you can apply to your role as a case manager or a director of a department. Either way, we guarantee that we will help you to “be all that you can be!!!”

Preconference E Registration • Check-in

Case Management: The State of the Art
Toni G. Cesta, PhD, RN, FAAN

Refreshment Break

Lunch Break