CMS Regulations

One of the primary functions of the PIN is to support facility staff in educating others about performance improvement (PI). The PIN Education Committee works to identify the education needs of both CAH quality coordinators and the staff they work with. The Committee then provides targeted resources to meet those needs. The Committee has developed the power points on this page to support providing education to facility staff about PI.

Education Presentations

 

Update on EMTALA (12/10/2013)

Program Overview

This webinar focuses on Critical Access Hospital and frontier issues related to EMTALA compliance.  Group discussion about the minimum requirements for hospital care contained within the Emergency Medical Treatment and Active Labor Act, effective strategies for compliance and avoiding problem areas. The session includes information about recent EMTALA citations from around the State.
Objectives:

  • Review basic EMTALA requirements to assure that facility policy and procedures meet regulatory requirements.

  • Discuss and learn current best practices for providing high quality emergency care within regulatory guidelines.

Faculty:

Robert W. Olsen is Vice President at MHA...An Association of Montana Health Care Providers.
In this position, Mr. Olsen provides provider advocacy and representation for regulatory affairs, third party reimbursement and is a lobbyist in the Montana Legislature. Mr. Olsen directs the Association data and quality improvement services, and is involved in internal financial management.  Prior to joining MHA in 1989, he held several positions in the Montana Medicaid program, including auditor, hospital services program manager and supervisor for acute care services including hospital, physician, home health, laboratory and radiology services.
Mr. Olsen holds a Bachelor’s degree in business finance from Montana State University - Bozeman and a Master’s degree in health administration from Montana State University - Billings. Mr. Olsen is a Fellow in the American College of Healthcare Executives. Mr. Olsen is an active member in, and serves as the Association liaison to, the Montana Chapter of Healthcare Financial Management Association and is a member of the Medical Group Management Association.
 A native Montanan, Mr. Olsen enjoys most outdoor activities including fishing, golf, boating, hiking and hunting.
MHA, also known as the Montana Hospital Association, provides advocacy, education and other services to its members. MHA members provide inpatient and outpatient hospital, nursing home, home health, hospice, physician and assisted living services.

Handout
Webinar recording

 

2013 Documentation to Support Patient Status

Program Overview

The training will focus heavily on the handoffs between the providers and nursing and vice versa. Orders take effect when written, moving patients from OBS to inpatient; how do we ensure that this is well communicated? CAHs are the only hospitals being paid for every hour in OBS status.

Faculty Presenting:

Day Egusquiza brings over 30 years of experience in health care reimbursement, hospital business office operations, contracting and compliance implementation. Additionally, her experience includes eight years as a Director of a Physician Medical Management billing service and, most recently, she completed an integrated business office between a hospital and a large physician clinic. Her work includes providing guidance as a compliance and reimbursement educator while providing operational insight on the revenue cycle impacts of RAC/Medicare Recovery Audit Contractors.

Ms. Egusquiza is a nationally recognized speaker on continuous quality improvement (CQI), benchmarking, redesigning, reimbursement systems and implementing an operational focus of compliance—both in hospitals and practices.

Audio Recording

 

2012 CAH Patient Status & Observation: Why is it so Difficult? The Challenges of Coverage & Compliance.

Program Overview

This operational based class will have 3 focus areas: regulatory updates, patient status (inpatient vs. observation), and billable hours vs. hours in a bed.

Each topic will review the regulatory impact with a focus on moving from regulations to operational implementation. The class will focus heavily on bedside nursing and providers with practical ideas on how to engage each group in Utilization Review while allowing for billable hours through ongoing assessment, reassessment, and active physician involvement.

Faculty Presenting:

Day Egusquiza brings over 28 years experience in health care reimbursement, business office operations, contracting and compliance implementation. Additionally, her experience includes eight years as a Director of a Physician Medical Management billing service and most recently completed an integrated business office between a hospital and a large physician clinic. Her work includes providing insight and guidance as a compliance, HIPAA and APC educator to department heads as well as business operations staff. Charge Master, Charge Capture and Lost Revenue are a part of her fun project list and yes, RAC!

Presentation Handout

Quick Reference Handout

Audio Recording