Lunch and Learn

Lunch and Learn

2005 Managed Care Series

Meet the Faculty

Edward M. "Mickey" Duke

The ABCs and XYZs of Managed Care

Al Speisman, JD, MBA

Denials Management

Maria K. Todd, MHA, PhD

The ABCs and XYZs of Managed Care

Managed Care Contracting Basics

Dealing with New Technology, Implants and Supplies in Managed Care Contracts

Ellen Stewart, MSHA, JD, FHFMA

Getting What’s Yours:

Enforcing your Managed Care Agreements

What to do When Managed Care Says "It''s not Covered"

Coordinating Managed Care with Third Party Liability Benefits

David I Samuels, FHFMA, MPA

Managed Care Reimbursement Methods

Jack Duffy, MBA, MPA, FHFMA

Preparing for Re-negotiation:

Decision Support and Financial Modeling

Auditing Payments and EOBs: Focus on the ANSI 835

Phone: 702-222-3525

Email: emduke@aol.com

Website:

Mickey Duke is the CEO of Oasis Health System in Las Vegas, Nevada and also maintains a private consulting practice. Oasis is an alliance of acute / sub-acute care facilities that have joined with ancillary services providers to successfully contract as a group with multiple PPOs, HMOs and self-insured payors. Mr. Duke has presented before HFMA and other associations, both nationally and locally. He has held a variety of executive positions in the healthcare industry over the past 30 years, including regulatory health planning agencies, a medical society, HMOs and PPOs and hospital management companies.

He has served on the national HFMA Managed Care Forum Advisory Council, is currently President-elect of the HFMA Nevada Chapter, and is adjunct faculty at several universities. Mr. Duke holds a Masters Degree in Urban Planning.

With more than 20 years in the healthcare industry, Dr. Todd is a nationally recognized consultant, speaker and author of five books, including: The Managed Care Contracting Handbook, IPA, PHO and MSO Development Strategies, and the Physician Employment Contract Handbook, al published by McGraw Hill. She speaks frequently for both HFMA and MGMA as well as many other state and national organizations on managed care and other related issues. She is both a health law paralegal and certified mediator specializing in resolutions of managed care payer-provider disputes.

In addition to her training and education, her professional experience includes serving as a provider relations coordinator for a large Colorado HMO and chief of operations of a Denver-based MSO and IPA. She holds a Masters and Doctor in Health Administration. Dr. Todd has served as adjunct faculty at several Medical Schools and Residency training programs. She currently serves the chapter as a member of the Program Committee and is a HFMA Follmer Bronze Recipient.

David I. Samuels, FHFMA, MPA

Phone: 800-856-8703

Mr. Samuels has 25 years'' experience including consulting and hospital patient financial services assessments, process re-engineering, and accelerated collections. His expertise spans all aspects of the healthcare industry, including medical practices, MSOs, MCOs, hospitals, and the long-term care industry. Mr. Samuels has held a variety of strategic and administrative assignments across the US with Tenet HealthCare, as marketing manager for UCLA Medical Center and its faculty practice plan, director of branded product development for a then 11-hospital system and VP of development for a well-known, publicly-traded behavioral healthcare management enterprise.

Mr. Samuels holds a BS in Gerontology and MPA (with dual certificates in Health Services Administration and Comprehensive Health Planning) and is has a FHFMA and a CHFP with specialization in Managed Care. He is the author of four books, including two editions of Managed Care, The Healthcare Financial Management & Budgeting Toolkit and Capitation: New Opportunities in Healthcare Delivery, the latter two published by McGraw Hill. He taught as Program Faculty for the Center Of Excellence in Health Care Management of the School of Pharmacy at the University of Southern California, and taught accounting, health management, and healthcare finance core courses for the MHA program at Chapman University as Adjunct Faculty. He also served a 3-year appointment to HFMA’s Board of Examiners, culminating as Chair of Managed Care exams. He is currently a member of the Board of Directors of the HFMA/Nevada Chapter, from 2002-2004.

Phone: 847- 681-8880

Email:

Ellen Stewart, MSHA, JD, FHFMA

Phone: 303-760-5050

Ms. Stewart has expertise in all areas of health care law including Medicare and Medicaid reimbursement, managed care contracting, development and general contracting services including information technology contracting, large equipment purchases and leases and supply agreements. Ms. Stewart has assisted clients with the drafting of medical staff bylaws, rules and regulations to meet JCAHO and changes in the law.

Currently, Ms. Stewart represents hospitals, physicians, preferred provider organizations, PHO''s, MSO''s and other forms of alternative delivery systems and health-related entities in transactional and litigation matters (including PRRB and State Medicaid appeals).

Additionally, Ms. Stewart has assisted clients in the development and implementation of corporate compliance programs to meet the requirements of Health and Human Services, the Department of Justice, Federal Trade Commission and the Internal Reveune Service. She has designed corporate policies and procedures for corporate compliance, and has assisted corporate compliance officers in discharging their corporate duties concerning compliance issues, including HIPAA.

Ms. Stewart holds a MSHA and JD degrees, has a FHFMA, and is a regular speaker at the HFMA Educational Clusters and Annual National Institute and many other state and national associations and an author of numerous articles in her areas of expertise.

Mr. Duffy possesses more than 30 years’ experience in the collection of consumer and medical debt. His expertise in best practices in audit and reimbursement operations was honed at San Diego’s five-hospital Scripps Health system where, focusing on the entire revenue continuum, Jack and his team successfully helped Scripps achieve total net revenue in excess of $1-billion a year.

During the past 25 years, Mr. Duffy has been a member of four Healthcare Financial Management Association chapters in Michigan, Ohio, and California, and has been a certified member since 1981. He has chaired various committees, served on the board of directors, and served as President-Elect and President of the San Diego and Imperial County chapters.

Mr. Duffy holds MBA and MPA degrees, has a FHFMA, and is a member of the HFMA PFS Advisory Board.

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