Part I – Payer Contracting
This online program will give you the skills to analyze your contracts, strategically develop contract proposals and create a monitoring and analysis process.
This 6-hour program will provide you with the knowledge to:
Session I: Gathering and Analyzing Your Contracts
- Gather and analyze your contracts
- Articulate practice value, developing contract proposals and building a go-forward strategy
- Establish a contract monitoring and evaluation process
Most practices know what is required to accomplish due diligence on their contracts but dread the thought of systematically gathering payer agreements and fee schedules, analyzing the findings, and developing and executing a strategy to renegotiate agreements. The challenge of being faced with so many hard-to-find puzzle pieces in the quest to accomplish even the first steps of finding the agreements, amendments and relevant schedules can quickly overwhelm a practice and derail it from its goals. This session will share turnkey processes that will get you headed in the right direction and on task even when obstacles are in the way. The primary focus of this session will be on building your foundation—the gathering, analysis and strategy development stage of your payer contracting project.
This session will set the stage for the content in Session II of the education series: How to initiate a negotiation, what makes your practice special, and how to model and test an offer so that you have a clear understanding of why it is so important to start with a solid foundation.
Session II: Articulating Practice Value, Developing Contract Proposals and Building a Go-Forward Strategy
This session will build upon the contracting foundation established in Part I. Once a practice has tracked down contacts, agreements and fee schedules, the contracting process enters the next phase: Developing proposals and crafting your practice value proposition. The first focus of this session will be on identifying your specific negotiation targets, including identifying top CPT® codes, comparing rates, evaluating proposals and methodologies across your book of business and establishing targets for negotiation. The instructor will then use this analysis to construct proposals, including sample verbiage and recommended strategies. The session will provide insight into the alternative payment model landscape for practices to consider and position as part of the negotiation process. Additionally, this session will focus on developing the practice value proposition, providing templates to use to start the process of articulating the value during the negotiation process. The final focus will include recommended go-forward strategies to integrate the contracting practice into the core financial management strategy.
Session III: Establishing a Contract Monitoring and Evaluation Process
The concluding session addresses contract monitoring and evaluation. The first hour will be a hands-on workshop demonstrating the Microsoft Excel VLOOKUP function as a tool to analyze payer performance. A sample dataset will be provided for all attendees to manipulate during the session. The session will then demonstrate how to track and analyze payer performance through contract monitoring, providing methods for ensuring that the rates negotiated match payment rates.
Part I – Session I: Gathering and Analyzing Your Contracts
Penny Noyes, CHC
President, Health Business Navigators
Penny Noyes brings four decades of healthcare related experience to medical practices on both the payer/MCO and provider sides of the industry. Since 1999, when Ms. Noyes founded HBN, she has been working with a variety of healthcare-related clients who require assistance with payer contracting and credentialing. She has written and executed business plans, renegotiated managed care agreements, provided market exposure, improved client revenue and increased the bottom line. She is sought after by numerous organizations to provide opinions on hot issues for periodicals and to do educational seminars on the topics of payer contacting and credentialing as she brings her "roll up the sleeves," candid approach to material presented.
Ms. Noyes has held various leadership positions throughout her career in healthcare. She served as Senior Vice President of Business Development for a venture capital backed start-up, U.S. HealthWorks, a practice management company specializing in occupational medicine where she was able to negotiate both improved reimbursement and achieved delegated credentialing with all payers for nearly 100 clinics in 7 states representing nearly $100 million in annual revenue. Prior to that she spent 11 years at Allmerica Financial, an $11 billion insurance and financial services company, where she was an Assistant Vice President responsible for product development of health plans nationwide, as well the contracting and credentialing of 180,000 providers nationwide. While at Allmerica she also led a project related to the development of PHCS in collaboration with 17 other health insurance companies. Earlier in her career she worked at Blue Cross of Massachusetts for 6 years on development and marketing of fully insured and self-funded health plans and HMO products, including some of the earliest Medicare risk-based plans.
Director, Payer Contracting Analysis and Negotiations, Health Business Navigators
Amanda is a graduate of Western Kentucky University and University of Kentucky Law School, J. David Rosenberg College of Law. She has been working at Health Business Navigators since her law school graduation in 2015 and, since that time, has become one of the country’s most seasoned and knowledgeable payer contracting specialists. As an attorney she is a member of the Kentucky Bar Association and the Bowling Green/Warren County Bar Association, but does not currently engage in private practice nor act in the capacity of providing legal advice. Instead, she has become known for her diligence in the obstacle-ridden process of gathering payer agreements and fee schedules, analyzing key data and contract terms that have been collected and verified, and turning the new found information into the foundations of successful payer contracting strategies and the associated negotiations, including determining the impact of payer offers and modeling counter offers, as well as reviewing final contracts or amendments to determine if they reflect the negotiated terms.
Part I – Session II: Articulating Practice Value, Developing Contract Proposals and Building a Go-Forward Strategy
Doral Davis-Jacobsen, MBA, FACMPE
Chief Executive Officer, Prosper Beyond
Doral Davis-Jacobsen, MBA, FACMPE, is a Partner at Prosper Beyond LLC, a specialized healthcare consulting firm in Asheville, N.C. Doral is a seasoned healthcare consultant with more than 20 years of experience serving healthcare providers ranging from solo practitioners to large academic medical centers. She is a popular speaker and author, always looking around the corner to help her clients prepare for what's next. Doral is known for assisting practices with next generation managed care contract negotiations, payment reform and revenue cycle. She is a Fellow in the American College of Medical Practice Executives. Doral serves as the Chair for the North Carolina MGMA Payer Contracting Committee 2021. She has written numerous articles on medical practice revenue cycle, managed care contracting and payment reform and is a frequent speaker at national, regional and local healthcare forums. Doral is the co-author of MGMA's book, Transitioning to Alternative Payment Models: A Guide to Next Generation Managed Care Contracting
, published in October 2016.
Part I – Session III: Establishing a Contract Monitoring and Evaluation Process
Nate Moore, CPA, MBA, FACMPE
President, Moore Solutions Inc.
Nate Moore, CPA, MBA, FACMPE, speaks, consults, records and writes about business intelligence in medical practices throughout the country. Nate’s book, Even Better Data, Better Decisions: Advanced Business Intelligence for Medical Practices
, is an MGMA bestseller. Nate’s consulting focuses on using SQL Server to mine and leverage medical practice data into actionable knowledge.
Nate creates a series of powerful Excel Videos at mooresolutionsinc.com
demonstrating how to use Microsoft Excel in a medical practice. Excel Videos have been viewed thousands of times by practice managers across America. Nate also moderates the Excel Users MGMA Community, the online resource for practice administrators to collaborate about Microsoft Excel.
Part II – Revenue Cycle Management
The revenue cycle in ambulatory care settings is vast and complex, which makes understanding and managing it crucial for financial, clinical and regulatory success. This certificate program includes a full cycle education on topics that progress from patient registration to receipt of payments. It will cover topics such as: credentialing, coding, payment posting, denial oversight, regulatory guidelines, use of technology, internal audits, value-based payment models and analytical reporting. This certificate program will empower participants to operationalize aspects of the revenue cycle as well as provide actionable insights for individuals tasked with managing the revenue cycle. Participants of this four-part series will be given the resources to enhance revenue integrity by examining four important aspects of the revenue cycle:
This 6-hour program will provide you with the knowledge to:
- Assess and master revenue cycle management
- Estimate the impact of daily activities upon the revenue cycle
- Determine methods for continuous revenue cycle improvement and ongoing oversight
Certificate course content is extracted from the MGMA bestseller, “Revenue Cycle Management: Don’t Get Lost in the Financial Maze.
Session I: Patient Access & Pre-Visit Services
Session II: Claim Preparation (Mid-Cycle)
Session III: Payment Oversight
Session IV: KPIs, Quality Programs & Reporting (KQR)
Shawntea "Taya" Moheiser, MBA, CMPE, CMOM
Chief Revenue Cycle Officer, H4 Technology, LLC
Taya Moheiser, MBA, CMPE, CMOM, is a subject matter expert (SME) in healthcare compliance, organizational governance, process optimization and revenue cycle management. She has held senior-level executive management positions in private practices, collaborative institutes and national care coordination organizations. Taya consults on all areas of healthcare operations including performance improvement, quality improvement, risk reduction and the shift to value-based payment methodologies.
Taya has served on MGMA’s Government Affairs Council and recently co-authored Revenue Cycle Management: Don’t Get Lost in the Financial Maze
. Taya graduated summa cum laude from Bellevue University with a bachelor of science in healthcare management, and she is seeking an executive healthcare MBA from Creighton University. Taya also is the current president of Nebraska HIMSS and sits on two workgroups with MGMA that provide feedback to CMS on proposed legislation. Taya is a frequent speaker for state and national MGMA meetings, as well as several rural health associations.
Kem Tolliver, CMPE, CPC, CMOM
President, Medical Revenue Cycle Specialists, LLC
Kem Tolliver is a public speaker, co-host of the RevDive podcast and co-author of Revenue Cycle Management: Don't Get Lost in the Financial Maze
. Medical practices managed by Kem have received MGMA Better Performer distinctions in the areas of A/R and collections.
As president of Medical Revenue Cycle Specialists, LLC, she and her team lead healthcare organizations in practice startup and transformation, revenue cycle improvements, clinical documentation improvement, educational programming, payer contracting, HIT software development, EHR/PM software customization, risk management and telehealth integration.
With a desire to impact public health, she offers strategies to CINs, ACOs and MCOs on interoperability, clinical workflow redesign and transitional care management. She has bachelor of science degrees in healthcare administration and organization management, with summa cum laude and magna cum laude distinctions, from Washington Adventist University.
Maintaining board certifications from AAPC, MGMA and PMI allows Kem to be an industry thought leader who is called upon to provide strategic guidance on regulatory and operational improvement outcomes. She has served on the Board of Directors at Laurel Regional Hospital, as well as on the Board of Directors of Maryland MGMA as the chair of the Government Affairs Committee and the State of Maryland’s ACMPE Certification Rep. Kem is the President of the PG County Chapter of AAPC.
Part III – Cash Flow, Accounts Payable and Payroll Management
Are you responsible for cash management in your practice? Does worrying about cash flow and meeting payroll keep you up at night? Have you ever wondered how to manage cash flow and accounts payable in a productive and meaningful way? Perhaps you want to be more in charge of the finance process in your practice. This online event will provide you with the building blocks to manage your accounts payable and payroll management and develop strategic processes for cash flow management so you can feel confident when meeting with the CFO or accountants in future meetings.
This 3-hour program will provide you with the knowledge to:
Session I: Cash Flow Management
- Manage cash flow in a productive and meaningful way
- Apply a basic understanding of bookkeeping and internal cash controls
- Employ strategies to manage the practice payroll
Have you ever wondered how to manage cashflow in a productive and meaningful way? This session will give you the building blocks to monitor bank balances, protect cash flows and design the cash receipt process. This session will equip you with the knowledge to ask the CFO or accountant the tough questions and will “get” what they’re saying in future meetings.
Session II: Accounts Payable Management
Management of accounts payable is an ongoing requirement for practice success. This session will provide a basic overview of bookkeeping, internal cash controls and vendor payment models as well as skill in negotiating payment terms, reconciling accounts and supervising accounts payable processes.
Session III: Payroll Management
This session will give you the tools you need to be successful in your practice to manage payroll. Even if you outsource these functions, if you’re the one who oversees payroll, this session offers basic insights on how to supervise and manage your largest expense.
Part IV – Financial Reporting and Budgeting
Financial health is paramount to ensuring the long-term success of a practice, but where to start? Reporting and managing financials can be daunting, especially for those who don’t have a background in accounting or finance. This online event will teach you basic financial management principles and equip you with processes and best practices to measure, report, analyze and forecast financial performance. The program also explores how to best leverage technology e.g., software and systems) to make financial reporting easily accessible to healthcare leaders.
This 2-hour program will provide you with the knowledge to:
Session I: Budget Creation and Management
- Produce budgets and forecasts
- Manage financial reports
- Apply strategies that make your practice audit-ready
- Demonstrate the impact of corporate taxes on your practice
Session II: Financial Reporting
Session III: Audit Management
Session IV: Corporate Tax Reporting
Part III – Session I: Cash Flow Management
Christine Kalish, MBA, CMPE
President, Brittain-Kalish Group
Christine Kalish, MBA, CMPE, is a senior executive and trusted healthcare advisor with deep experience in ambulatory care and academic medicine. For more than thirty years, Kalish has been leading organizations and teams to develop critical infrastructure and growth planning to improve operations, workflow, human resources and revenue cycle. She continually searches for innovative ways to assist her clients so they can deliver quality care for the populations they serve.
Penny M. Crow, MS, SHRM-SCP, RHIA
Principal and Chief Compliance Officer, Brittain-Kalish Group
Penny M. Crow, MS, SHRM-SCP, RHIA, is a nationally recognized executive with progressive senior leadership experience in a wide range of healthcare organizations. As an RHIA, she has a successful track record in health information management, revenue cycle, risk management, and quality improvement. Her MS in I-O Psychology has fueled her passion for working with leaders to prepare and develop future workforces.
Part III – Session II: Accounts Payable Management
Tammy R. Walsh, CHFP, CRCR, FHFMA
CEO/President, Paramount Healthcare Solutions, LLC
Tammy is an executive finance and operations leader with 20+ years’ experience with a focus in healthcare providing cross-industry expertise in strategy, operations, business development, financial consulting and client service with strong leadership, problem-solving, planning, team-building and project management skills. Her background as a CFO for physician groups has led her to be a proven leader to revitalize and restructure problem organizations ensuring organizational excellence.
Tammy is CEO/Founder of a physician consulting services firm providing strategy and optimization to provider groups and health care organizations across the nation. The services range from physician compensation methodologies, revenue cycle optimization, hospital-physician alignment, clinic operational process improvement, compliance and overall leadership insight. Her services also offer interim-CFO and COO capabilities for provider groups.
Tammy is a member of the Healthcare Financial Management Association (HFMA) and serves as an officer for the Lone Star Chapter as well as chairing the state-wide Texas Conference in 2020 and 2021. She is also a member of the American College of Healthcare Executives (ACHE) and Medical Group Management Association (MGMA). Tammy is a frequent speaker and writer on physician-related revenue cycle, finance and strategic topics for these organizations and many others.
Tammy is an adjunct professor teaching courses in Leadership and Healthcare Finance to the Master of Business Administrative Healthcare Students at Texas Christian University. She serves as the Board Chair at the University of North Texas Health Science Center MHA Advisory Board. She is also a member of the Advisory Board at the University of Texas at Arlington, College of Business, Accounting Department.
She is a Certified Healthcare Financial Professional (CHFP) and Certified Revenue Cycle Representative (CRCR). She was recently awarded the Fellow Healthcare Financial Management Association (FHFMA) designation.
She is a graduate of University of Houston, Texas, with a B.S. degree in Finance.
Part III – Session III: Payroll Management
Sharon Z. Ginchansky, MAOM, SHRM-SCP
MAOM Consultant, Brittain-Kalish Group
Sharon Z. Ginchansky, MAOM, SHRM-SCP, is an organizational consultant with the Brittain-Kalish Group, specializing in revitalizing leadership and organizational change to improve operations and to enhance the way businesses engage their staff. She is recognized as an expert in leading organizations through start up, culture changes, acquisitions and divestitures, and labor negotiations. She has more than 25 years of operational and human resources experience working as an executive in the healthcare field.
Ginchansky holds a bachelor’s degree in English from American Jewish University and a master’s in organizational management from University of Phoenix. She is a member of SHRM, DallasHR and is a former long-time member of Vistage International.
Dawn Adams, MS, PMP, SHRM-SCP
Human Resources Training Consultant, Brittain-Kalish Group
Dawn Adams is a veteran of delivering innovative solutions to solve deep organizational challenges in partnership with leaders from the airline to telecom industries. Recognized for being a catalyst to building high-performance cross-functional teams that exceed organization goals, her passion is enabling organizations to maximize the effectiveness of their most valuable asset — by ensuring that the right people are in the right place, with the right supports, so they are empowered to do the right thing.
Part IV – Session I: Budget Creation and Management
Sr. Director, Finance & Analytics, MGMA
Brett McCallon is Sr. Director of Finance & Analytics for MGMA and specializes in financial planning & analysis (FP&A) and general analytics. Brett’s passion is providing data-driven insights to business leaders and operators that allow them to make more-informed strategic decisions. Brett believes that a robust finance and accounting function can add value far beyond just financial reporting and compliance. Prior to joining MGMA, Brett spent seven years in a Fortune 500 healthcare setting, performing a variety of roles, including FP&A, analytics and internal consulting, where his contributions helped generate tens of millions of dollars in value through cost management and efficiency initiatives.
Part IV – Session II: Financial Reporting
Steven K. Sinclair, CPA, CMPE
Chief Financial Officer, Graves-Gilbert Clinic
Steven holds a degree in accounting from Western Kentucky University and is a CPA with five years of experience in public accounting. However, the past 34 years of his career have been spent in healthcare. His extensive experience includes responsibility for all financial aspects of a large multispecialty clinic, as well as capital improvement projects, information technology services, purchasing and physician recruitment.
A special interest in revenue cycle management has helped his group achieve outstanding results in this area, including MGMA Better Performer recognition. He continues to be driven to seek new and better ways to improve financial performance.
Part IV – Session III: Audit Management
Steven K. Sinclair, CPA, CMPE
Part IV – Session IV: Corporate Tax Reporting
Steven K. Sinclair, CPA, CMPE