Jim Whicker, CPAM, Principal Technology Consultant, Health I.T. Strategy and Policy, Kaiser Permanente Information Technology

Bob Poiesz, Vice Chair, ASC X12N (Insurance), Consultant, Washington Publishing Company

The session will describe the transactions and primary actors involved. We will review the impacts of 5010 compliancy on the system and the industry impact on providers and health plans. We will also define a road map for preparing for 5010 testing and compliancy across the primary stakeholders - providers, financial systems, banks and health plans.

Stuart Hanson, Vice President, Healthcare Treasury Product Management, Fifth Third Bank, St. Louis, MO

Based on the discussion around our current administrative system in the last session, we will now add on the banking component. Where and how do banks add value to the current system? What are the features and benefits of medical banking innovation? What are the future trends around convergence of banking and healthcare systems?

Todd Berkley, HSA Business Leader, OptumHealth Financial, Minnetonka, MN

As more consumers engage in healthcare, new programs are leading the way to equip consumers with health information, health information technology and funds management around the family's and/or individual's healthcare expense. Banks have lead the way with Health Savings Accounts (HSAs) and other account-based plans that empower consumer choice in their healthcare services. Enabling tools will be reviewed as well as a detailed look at industry growth and future trends that bring patients, providers and their banks into a cooperative framework for better health and health value innovation.

Janet O. Estep, President and CEO, NACHA - The Electronic Payments Association, Washington, DC

In the past, banks have collaborated with other industries to create new systems and add value across multiple actors. One of the forms of this collaboration is the creation of "inter-organizational systems" or IOS. An IOS is much more than a technological configuration of assets across different companies. The IOS represents a new channel for growth, a new platform for innovation and is often a game changer. This is also true as banks engage healthcare. In this session, we'll hear from the CEO of one of America's top banking groups about how banks have fostered innovation, the regulatory mandates that are setting the stage for convergence of banking and healthcare systems, why banks are investing in healthcare. the challenges and benefits of linking with banking platforms and finally, future milestones.

Howard A. Burde, Howard Burde Health Law, LLC, Westchester, PA

The legislative landscape continues to be dynamic, however, today this is more true that at other point in history as multiple critical mandates come into effect, including the Affordable Care Act, Section 1104 that outlines new operating rules for healthcare that will usher in electronic business transformation, "meaningful use" definitions under ARRA that will impact investment in administrative technology and HITECH privacy regulations that increase risk in medical banking programs. We will also look at the emerging issue of adoption of insurance exchanges. This session, presented by a HIMSS Board of Directors member, will provide an overview of each of these areas as well as a legislative update of what lies next.

Moderator: Joseph Miller, Director, E-Business AmeriHealth Mercy, Philadelphia, PA

Panelists:

Healthcare Provider: Laurie Darst, Sr. External Relations/HIPAA Coordinator, Mayo Clinic, Rochester, MN

Operating Rules Author: Gwen Lohse, Deputy Director, CAQH/CORE, Washington, DC

Clearinghouse: Sal Novin, CEO, Healthcare Productivity Automation, Franklin, TN

Bank: Ralph Bernstein, SVP and Senior Lead, U.S. Bank Healthcare Payments Solutions, Minneapolis, MN

This specialized program organized by HIMSS MBProject offers critical thought leadership around pressing business information technology issues in healthcare. Program 2 of our 9-part production will examine the new federal effort to implement operating rules in conjunction with the HIPAA-mandated electronic health data transactions.

• What are operating rules? How do they differ from the HIPAA transactions? Why do we need them?
• What is the impact of operating rules on the primary actors?
• How do operating rules evolve and how will they be changed in lockstep with the transactions they support?
• What is the ROI of operating rules around eligibility (a Case Study)? Others?
• What are realistic timelines for adoption of operating rules in healthcare?

Notes: HIMSS Testimony before NCVHS on Operating Rules for Electronic Funds Transfers and Electronic Remittance Advices, December 3, 2010 in Washington, DC.

John Phelan, Ph.D., Technology and Management Consultant, Technology and Operations Solutions, Milliman, Westlake Village, CA

In October, United HealthGroup delayed providing financial guidance to the investment community until "MLR is defined", according to industry reports. What is the Medical Loss Ratio and why is it important to healthcare? Is it important to providers and health plans who are being mandated to comply with electronic business transformation along a number of fronts - 5010 compliancy, ICD-10 transformation and ACA, Section 1104 Operating Rules? This session will define MLR, why its causing substantial issues among health plans and how it might affect investment in the administrative technologies that control payments for healthcare.

ICD-10 Transformational Strategies and Impacts to the Stakeholders

Joseph Miller, Director, E-Business AmeriHealth Mercy, Philadelphia, PA

In 2010, HIMSS organized two surveys that tested market readiness for 5010 compliancy, that will impact all the health data transactions including remittance advises, and ICD-10 transformation. This session will explore the common pain paints in a dual transformation. We will be able to provide guidance from the surveys on ICD-10 projects: where the industry stands, ICD-10 strategy and tactics, new tools for providers, plans and supporting IT partners and what the industry must do to meet looming deadlines across all the stakeholders in business-centered systems in healthcare.

Reference Materials: HIMSS 5010/ICD10 Survey

The Medical Banking Networking Gala continues to be an invaluable forum for networking that has created industry changing partnerships and new relationships. Held outside (weather permitting) at the Peabody Hotel, the Networking Reception will offer a place to relax and get acquainted with the senior executives attending the Institute.

TBA: Speaker from the World Bank

World Bank Forum: Pushing Medical Banking to the Ends of the World

Objective: Explore areas of common interest in The World Bank Group's development agenda and HIMSS global development programs in order to create a 2011-2013 framework for engagement around the use of information technology to improve health outcomes in support of the Millennium Development Goals (MDGs).

Alexander Preker, Senior Health Economist, World Bank Group (Chair)

Overview of World Bank Group strategy and investments in healthcare with a focus Romania and Hungary, Latin America, Africa, Russia and China.

John Casillas, Senior Vice President, HIMSS Medical Banking Project (Co-Chair)

Provide overview of the convergence of banking and healthcare in the area of transactions and how this approach has successfully engaged commercial bank and/or private sector groups. Current/future state in industry architecture for the healthcare financial network and global touch points.

Fernando Montenegro Torres, Senior Economist, Human Development Department, Latin America and the Caribbean, The World Bank
Regional challenges for improving health outcomes will be explored including the state of EMR adoption in the Latin American Countries, the need to support claims processing programs in national health plans and the creation of a development agenda for the HIMSS/World Bank Collaboration in the Latin American region.

Others TBA

Guiding principles:

• Explore common points of interest in the HIMSS / World Bank dialogue that can be used to develop a strategic agenda for the two organizations 
• Seek audience participation to enhance issues development around environmental factors that can be impacted by The World Bank with emphasis on the use of the HIMSS G7 platform for advancing cross-industry collaborations 
• Create a framework for World Bank/HIMSS engagement in the 2011-2013 time horizon that includes WoHIT and a prospective G7 meeting at The World Bank Boardroom in DC in June 2011

RACs: CMS' Electronic Approach to Documentation

Melanie Combs-Dyer, Health Insurance Specialist, Centers for Medicare and Medicaid Service (CMS), Washington, DC

Three Recovery Audit Contractors (RACs) for CMS will begin accepting electronically submitted medical documentation (esMD) in 2011. The new “esMD” program at CMS can help to dramatically streamline the claims review process within this federal program. The session will review the program, where it will be implemented and how you can prepare for automation of this increasingly important area of the revenue cycle.

Richard Marks, President , Patient Command, Inc., McLean, VA; Adjunct Professor, Media Studies, University of Virginia, Charlottesville, VA

Even as Health Information Exchanges evolve, new pilot programs will test the Health Record Banking (HRB) model and its adaptation in the marketplace. A key proponent of the HRB model will outline the current technology needs that can be addressed by banking systems, including a discussion of Ultra-Large Scale Systems (ULS) theory, why ULS is a key strategic initiative within the defense department, how it relates to information aggregation across multiple systems and why he is a believer that commercial banks will one day offer these new services for consumers.

Moderator: Jim St. Clair, President and Founder, Compass Rose Solutions, LLC, Biloxi, MS

Panel:

Eric E. Cohen, XBRL Global Technical Leader, PwC, Rochester, NY

Peter Lang, President/Principal, Trellis Integration Partners, Seattle, WA (representing SWIFT)

David Fortney, SVP, Product Development and Management, The Clearing House, NYC, NY

The landscape for healthcare payments will likely be very different over the next 5-7 years. A key part of this is moving the healthcare payment, and its associated remittance data, in a single transaction as envisioned by the HIPAA 835 transaction. Eyeing a new market in the making as ACA, Section 1104 operating rules are adopted, major banking platforms are creating new capabilities to move funds and data together through the system, thus helping providers to avoid the complexities of re-assocation of funds with remittance information as well as speeding bank reconciliation. Hear a roundtable of how the major platforms are approaching this issue, the creation of "profiles" for health payments portability, why the Securities Exchange Commission mandates XBRL for public financial reporting and how it could hold the key for health payments interoperability.