Annual HFMA Region 2 Fall Institute

October 19-21, 2016

Turning Stone Resort & Casino, Verona, NY 13478

Central New York Chapter • Hudson Valley NY Chapter

Metropolitan New York Chapter • Northeastern New York Chapter

Puerto Rico Chapter • Rochester Regional Chapter • Western New York Chapter

“THE FUTURE OF HEALTHCARE:ADAPT TODAY, THRIVE TOMORROW"

Who Should Attend:CFOs, VPs of Finance, Controllers, Department Heads, Administrators, Revenue Cycle Leaders,

Chargemaster Coordinators, Directors of Finance, Budget Analysts, Managed Care Contractors, Reimbursement Managers, Denial Management Specialists, Patient Financial Service Managers and Supervisors, Accountants and Compliance Staff

Session Levels:Strategic general sessions and breakout sessions that address many of the issues and

trends occurring in the healthcare industry today.

12.5 CPE Credits

Wednesday, October 19, 2016Pre-Conference Session: Included in Region 2 Conference Fee

1:00 PM - 5:00 PM HFMA CHFP Certification Review Class:Prerequisite: It is strongly suggested that you review the CHFP study guide prior to this session. If you donot currently have a study guide, and would like one, they are available through Michele Mecomonaco atmmecomonaco@fcc-cpa.com at a discounted rate.Course Instructors:RACHelle FletCHeR, MSHSA, FHFMA; Account executive/Director of Revenue Cycle; Navigant Healthcare Cymetrix/Cayuga Medical CenterMICHele MeCoMoNACo, CPA, FHFMA; Senior Consulting Manager, Fust Charles Chambers, llP

This session will connect the CHFP study guide concepts to practical applications in order to help youprepare for the CHFP test. Taught by subject matter experts, this course will utilize high level real-worldexamples, giving you the opportunity to ask questions and hone your knowledge. Each of the experts arealso CHFPs or FHFMAs, so they have experience with the test questions. Note: This session will require a minimum of 10 registrants to be held.

5:30 PM – 8:30 PM Pre-Conference Cocktail Reception for All Registered Conference Attendeesthe Clubhouse at Shenendoah Golf Course

Thursday, October 20, 20167:00 AM – 8:00 AM Registration and Breakfast in the Vendor Fair

8:00 AM Welcome & opening Remarks eRIC FeHRMAN, CPA, Regional executive 2016-17, HFMA Region 2

8:00 AM – 9:15 AM Get Into the Goal-Setting MindsetSpeaker:DAYMoND JoHN, Founder and Ceo of FUBU, Investor on ABC’s Shark tank

In this keynote, "The Shark" Daymond John shares with audiences how he went from driving cabs andwaiting tables to creating a global fashion empire with retail sales exceeding four billion dollars to date anda starring role on ABC's hit reality business show, Shark Tank. John awes audiences with true-life tales ofhis incredible successes -- and several teachable failures. He motivates, inspires, and instructs them onhow to set their own goals and go after them with renewed focus, zeal, and determination.

9:15 AM – 9:45 AM Meet and Greet Daymond John & Networking Break in the Vendor Fair

9:45 AM – 11:15 AM executive Panel Discussion – Affiliations: Merely Surviving or thriving?Moderator:AllAN P. DeKAYe, President and Ceo, DeKAYe Consulting, Inc.

Panel Members:MeReDItH PRICe, CFo, St. Joseph's Hospital Health Center

JoYCe ZIMoWSKI, Sr. VP, Rochester Regional Health Medical Group

JoSePH GUARRACINo, Sr. VP and CFo, White Plains Hospital

Representatives from the Medical School and long term Care communities are currently being sought to

participate in the panel discussion

This year's panel discussion will examine the effect "affiliations" are having on the healthcare landscape.Given the enhanced emphasis on quality care and outcomes, providers and other organizations havelooked to alliances, acquisitions and mergers as strategies to bend the cost curve in order to moreeffectively compete in the marketplace. With a diverse panel representing different geographic regions andprofessional responsibilities, the discussion will engage in a dialogue to present these perspectives fromvarying vantage points, and allow the audience to learn about the successes and challenges.

10:15 AM – 11:45 AM Networking Break in the Vendor Fair

11:45 AM – 12:45 PM BReAKoUt SeSSIoNS

Using Data Analytics to Improve ACo PerformanceSpeaker:IDette elIZoNDo, MBA, Manager - Veralon

Based on publicly available results there is significant evidence that ACOs are not succeeding. So, howdoes one go about assessing an ACO for performance improvement opportunities? The presenters willuse a case study example of how its firm assessed one underperforming ACO using advanced dataanalytics and an in-depth review of its ACO reports. They will share analytic findings, recommendedinitiatives, and delve deeply into some of the key initiatives to demonstrate the potential impact on anACOs’ performance.

Understanding Hierarchical Condition Categories (HCCs) and Risk Adjustment in the Shift to Value-Based CareSpeaker: DoNNA SMItH, RHIA, Senior Consultant and Project Manager - 3M Health Information Systems

This presentation will provide attendees with an in-depth understanding of Hierarchical ConditionCategories (HCCs), including how and why they are employed today, with special emphasis on the use ofHCCs to drive value-based care. The session will help attendees ensure that the health of a population isaccurately reflected in clinical documentation and help reduce overall cost across the continuum of care.

targeting Self-Pay Patients for enrollment in NY Medicaid expansion and Health Insurance Marketplace PlansSpeaker:tINA elleR, VP & Global Head of RCMS Healthcare – Sutherland Healthcare Solutions

Using case studies, this session will provide an overview of the statistics and behaviors of the AffordableCare Act population. It will also highlight the application of analytics to target specific Self-Paypopulations, and utilizing multi-channel communication tools to engage them to enroll in appropriatecoverage so as to improve access to care for the uninsured; reduce Self-Pay exposure; create brandloyalty; and protect and increase market share.

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long term Care UpdateSpeaker:DARIUS KIRSteIN, Director of Financial Policy & Analysis – leadingAge New York

This session will provide the attendees with an update on key New York State Medicaid and federalMedicare issues for Long Term Care providers. The speaker will review the latest developments ininfluencing Long Term Care reimbursement to New York providers. The speaker will also provide anoverview of various alternative payment initiatives of which providers need to be aware.

12:45 PM - 1:45 PM lunch in the Vendor Fair

1:45 PM – 2:45 PM BReAKoUt SeSSIoNS

the $10,000 Question: tackling the Complexities of Value-Based Physician CompensationSpeaker:KARIN CHeRNoFF KAPlAN, MBA, CVA, Director - VeralonJeSSICA e. StACK, MBA, Manager - Veralon

New revenue models for health systems call for new compensation models for physicians – models thatprovide incentives for quality as well as productivity. The session will address the design of value-basedcompensation models to minimize the pain of potential risks (e.g., disgruntled physicians, impact onphysicians who “take a hit,” lower productivity, and high compensation levels) while maximizing results.The speakers will discuss a number of the practical, regulatory and fair market value considerationsrelated to value-based physician compensation.

How Well Will Your organization Perform Under Comprehensive Care for Joint Replacement (CJR) Mandatory Bundled Payments? Speaker: MARIA C. MIRANDA, FACHe, Director, Reimbursement Services - BeSleR Consulting

The Comprehensive Care for Joint Replacement (CJR) bundled payment model became effective onApril 1, 2016. It is crucial that participants determine what value can be gained from different data setsincluding quality data, readmissions, and complication rates. Participant hospitals will also need toidentify and work closely with Post-Acute providers, including them not only in care redesign but sharingin the success or failures of the program. In this session, the speakers will discuss how to implementbest practices for Financial Analysis, Care Redesign, Network Development and Episode Tracking forCJR bundled payments.

Clinical Documentation IntegritySpeaker:CYNtHIA PICKNeY, Do, Associate Director - Navigant Consulting, Inc.

This presentation highlights key strategies that will help organizations put ICD-10 and its role in value-based healthcare into perspective for clinicians. It will demonstrate how accurate specificdocumentation can help affect the organization in several ways, ranging from quality reporting, accuratereimbursement, and efficient delivery of healthcare, hence, providing measurable value to the patient.

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legal UpdateSpeakers:MARGUeRIte A. MASSett, CHC, Partner – Hancock estabrook, llPGReGoRY A. MAttAColA, CHC, Counsel – Hancock estabrook, llPMARY M. MINeR, Associate – Hancock estabrook, llP

The Hancock Health Lawyers will provide a brief summary of important developments in the health carelegal world over the last year, focusing on those with the greatest potential impact on financial issuesfacing health care providers. The topics covered will include a status report on HIPAA Phase 2 audits andenforcement activities, including financial ramifications, the priorities of the NYS Office of the InspectorGeneral (OMIG) and the US Attorney for the Northern District of New York as well as other criticalchanges to the health care legal landscape.

2:45 PM - 3:15 PM Networking Break in the Vendor Fair

3:15 PM – 4:15 PM BReAKoUt SeSSIoNS

Riding the Wave of Provider ConsolidationsSpeakers:SUSAN A. BeNZ, Partner, Barclay Damon, llPARtHUR W. ADelBeRG, Partner, Barclay Damon, llP

The speakers will discuss regulatory issues that can make for rough sailing in the provider consolidationprocess. In our current environment provider consolidation activity continues unabated despite manyregulatory hurdles posed by state and federal agencies. This presentation will explore the regulatoryhurdles that can delay or doom a deal with a special emphasis on anti-trust issues.

HCRA Surcharge ReportingSpeakers: JeSSe SCHUlMAN, Senior Associate – KPMGMING HAN, Senior Associate – KPMG

Provider HCRA audits will include a review of the amounts paid into the Public Goods Pool, and in thecase of hospital audits the 1% Statewide Assessment, for surcharge obligations for the selected yearsunder review. This presentation will provide a summary and clarification on common HCRA auditchallenges and explain what you can expect if you are selected or already under a HCRA audit.

What’s New in the World of 340B? Are You Prepared? (Part 1)Speaker:JIM DoNNellY, VP 340B Pharmacy Services – Hudson Headwaters Health Network

The 340B program has recently undergone significant changes that could have material impacts onyour operations. Get in the know and get up-to-date with the revised program. Learn about the current340B environment and covered entity specific issues. This session is Part 1 of a two-session series.

Managing Information Security in a Ransomware WorldSpeaker:CARl G. CADReGARI, executive Vice President - Bonadio & Co., llP

In this presentation participants will learn what Ransomware is, where information security and controlsneed to be in place for effective Ransomware control, where the types of malware can infect yourenvironment, how to effectively detect, prevent and control outbreaks and when and how to respond to anoutbreak when it is raised to the level of a breach. In addition participants will understand the impacts toinformation security with respect to “bringing your own device”, vendor controls, and breach management.

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4:15 PM - 4:30 PM Networking Break in the Vendor Fair

4:30 PM – 5:30 PM BReAKoUt SeSSIoNS

trends in Commercial Plans & their Impact on Your Financial HealthSpeaker:FRANK loNARDo, Partner – Cammack Health llC

Plan sponsors have to rein in their healthcare spending. In the long term, effective population healthmanagement should lead to quality improvements and cost reductions. Pricing and network strategieswill have a more immediate impact on your bottom line and the financial well-being of a healthcaredelivery system. These strategies are being implemented and explored now and this session will help youunderstand how these initiatives will play out in your organization.

Financial Strength through Consumerism and Pricing transparencySpeaker: DeloItte llP

As consumers assume more personal responsibility for improving their health and covering their healthcare costs, and gain increased awareness of treatment options, provider quality and outcome andpricing transparency, they will want to take even greater control of their health care decisions.Representatives from the Deloitte healthcare practice will discuss the trends and tools which will enable,empower, and support health care seekers in identifying, comparing and determining a provider thatmeets their needs.

What’s New in the World of 340B? Are You Prepared? (Part 2)Speaker:JIM DoNNellY, VP 340B Pharmacy Services – Hudson Headwaters Health Network

The 340B program has recently undergone significant changes that could have material impacts onyour operations. Get in the know and get up-to-date with the revised program. Learn about 340B auditreadiness and the potential impact of the proposed mega-guidance. This session is Part 2 of a two-session series.

Accounting & Audit UpdateSpeaker:MICHAel J. lAQUIDARI, CPA, Audit Senior Manager – Fust Charles Chambers llPMelISSA A. PANGARo, CPA, Audit Senior Manager - Fust Charles Chambers llP

This session will provide a discussion of current issues in accounting and auditing, focusing specificallyon new pronouncements that will impact healthcare organizations. In addition, the speakers will focus onother important healthcare topics that will affect providers in this rapidly changing healthcareenvironment.

5:30 PM - 6:30 PM Networking Reception in the Vendor Fair

Enjoy appetizers and cocktails while having an opportunity to network with your colleagues, speakersand vendors.

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Friday, October 21, 20167:00 AM – 8:00 AM Breakfast in the Vendor Fair

8:00 AM – 9:15 AM the Future of Health Care is NowSpeaker: CeCI CoNNollY, President and Ceo – Alliance of Community Health Plans

Technological advances, discerning consumers and innovative entrepreneurs are upending America’s $3trillion health industry. Care is now available with the swipe of a finger on any mobile device. Keynotespeaker Ceci Connolly analyzes the latest trends hitting health care and what they mean for consumers,businesses and the industry itself.

9:15 AM – 10:30 AM New York State Reimbursement UpdateSpeaker: HeAltHCARe ASSoCIAtIoN oF NeW YoRK StAte (HANYS)

Representatives from HANYS will present a New York State reimbursement and managed care updatethat will set the stage for the upcoming budget negotiations. HANYS presenters from Economic, Financeand Information and Managed Care divisions will provide attendees with the latest insight into theimportant issues that will impact providers throughout New York State.

10:30AM – 11:00AM Networking Break - Hotel Check out

11:00 AM – 12:15 PM DSRIP Update - Next StepsSpeakers: JoHN W. GAHAN, JR., Healthcare Financial ConsultantWIllIAM N. WIlDRIDGe III, CPA, Partner – Fust Charles Chambers llP

This session will provide updates and insight into the Delivery System Reform Incentive Payment(DSRIP) program. The speakers will describe the process of transformation from pay for reporting to payfor performance including funds flow, value based payment, sustainability and midpoint assessment.

12:15 PM – 1:00 PM Closing Remarks and Raffle Drawings (must be present to win raffle prizes)

HFMA Region 2 Annual Fall Institute, october 19-21, 2016 • Schedule at a Glance

WeDNeSDAY, oCtoBeR 19th

1:00 pm - 5:00 pm HFMA CHFP Certification Review Class:RACHelle FletCHeR, MSHSA, FHFMA; Account executive/Director of Revenue Cycle; Navigant HealthcareCymetrix/Cayuga Medical CenterMICHele MeCoMoNACo, CPA, FHFMA; Senior Consulting Manager, Fust Charles Chambers, llP

5:30 pm - 8:30 pm Pre-Conference Cocktail Reception for All Registered Conference Attendees - The Clubhouse atShenendoah Golf Course

tHURSDAY, oCtoBeR 20th

7:00 am - 8:00 am Registration and Breakfast in the Vendor Fair

8:00 am Welcome and opening RemarkseRIC FeHRMAN, CPA, Regional executive 2016-17, HFMA Region 2

8:00 am - 9:15 am Get Into the Goal-Setting MindsetDAYMoND JoHN, Founder and Ceo of FUBU, Investor on ABC’s Shark tank

9:15 am - 9:45 am Meet and Greet Daymond John & Networking Break in the Vendor Fair

9:45 am - 11:15 am executive Panel Discussion – Affiliations: Merely Surviving or thriving?MoDeRAtoR: AllAN P. DeKAYe, President and Ceo, DeKAYe Consulting, Inc. PANel MeMBeRS:MeReDItH PRICe, CFo, St. Joseph's Hospital Health Center JoYCe ZIMoWSKI, Sr. VP, Rochester Regional Health Medical Group JoeSPH GUARRACINo, Sr. VP and CFo, White Plains Hospital

11:15 am - 11:45 am Networking Break in the Vendor Fair

A1 Using Data Analytics to Improve ACo PerformanceIDette elIZoNDo, MBA, Manager, Veralon

A2 Understanding Hierarchical Condition Categories (HCCs) and Risk Adjustment in the Shift to Value-Based CareDoNNA SMItH, RHIA, Senior Consultant and Project Manager, 3M Health Information Systems

A3 targeting Self-Pay Patients for enrollment in NY Medicaid expansion and Health InsuranceMarketplace PlanstINA elleR, VP & Global Head of RCMS Healthcare – Sutherland Healthcare Solutions

A4 long term Care UpdateDARIUS KIRSteIN, Director of Financial Policy & Analysis – leadingAge New York

12:45 pm - 1:45 pm lunch in the Vendor Fair

11:45 am -12:45 pm BReAKoUt SeSSIoNS

B1 the $10,000 Question: tackling the Complexities of Value-Based Physician CompensationKARIN CHeRNoFF KAPlAN, MBA, CVA, Director - Veralon

JeSSICA e. StACK, MBA, Manager - Veralon

B2 How Well Will Your organization Perform Under Comprehensive Care for Joint Replacement (CJR)Mandatory Bundled Payments? MARIA C. MIRANDA, FACHe, Director, Reimbursement Services - BeSleR Consulting

B3 Clinical Documentation IntegrityCYNtHIA PICKNeY, Do, Associate Director - Navigant Consulting, Inc.

B4 legal UpdateMARGUeRIte A. MASSett, CHC, Partner – Hancock estabrook, llPGReGoRY A. MAttAColA, CHC, Counsel – Hancock estabrook, llPMARY M. MINeR, Associate – Hancock estabrook, llP

2:45 pm - 3:15 pm Networking Break in the Vendor Fair

C1 Riding the Wave of Provider ConsolidationsSUSAN A. BeNZ, Partner – Barclay Damon, llPARtHUR W. ADelBeRG, Partner – Barclay Damon, llP

C2 HCRA Surcharge ReportingJeSSe SCHUlMAN, Senior Associate – KPMGMING HAN, Senior Associate – KPMG

C3 What’s New in the World of 340B? Are You Prepared? (Part 1)JIM DoNNellY, VP, 340B Pharmacy Services – Hudson Headwaters Health Network

C4 Managing Information Security in a Ransomware WorldCARl G. CADReGARI, executive Vice President - Bonadio & Co., llP

4:15 pm - 4:30 pm Networking Break in the Vendor Fair

1:45 pm - 2:45 pm BReAKoUt SeSSIoNS

3:15 pm - 4:15 pm BReAKoUt SeSSIoNS

D1 trends in Commercial Plans & their Impact on Your Financial HealthFRANK loNARDo, Partner – Cammack Health llC

D2 Financial Strength through Consumerism and Pricing transparencyDeloItte llP

D3 What’s New in the World of 340B? Are You Prepared? (Part 2)JIM DoNNellY, VP, 340B Pharmacy Services – Hudson Headwaters Health Network

D4 Accounting & Audit UpdateMICHAel J. lAQUIDARI, CPA, Audit Senior Manager – Fust Charles Chambers llP

MelISSA A. PANGARo, CPA, Audit Senior Manager – Fust Charles Chambers llP

5:30 pm - 6:30 pm Networking Reception in the Vendor Fair

FRIDAY, oCtoBeR 21st

7:00 am - 8:00 am Breakfast in the Vendor Fair

8:00 am - 9:15 am the Future of Health Care is NowCeCI CoNNollY, President and Ceo – Alliance of Community Health Plans

9:15 am - 10:30 am New York State Reimbursement UpdateHeAltHCARe ASSoCIAtIoN oF NeW YoRK StAte (HANYS)

10:30 am - 11:00 am Networking Break - Hotel Check out

11:00 am - 12:15 pm DSRIP Update - Next StepsJoHN W. GAHAN, JR., Healthcare Financial ConsultantWIllIAM N. WIlDRIDGe III, CPA, Partner – Fust Charles Chambers llP

12:15 pm - 1:00 pm Closing Remarks and Raffle Drawings (must be present to win raffle prizes)

4:30 pm - 5:30 pm BReAKoUt SeSSIoNS

ANNUAl HFMA ReGIoN 2 FAll INStItUte:oCtoBeR 19-21, 2016, turning Stone Resort & Casino, Verona, NY

SPoNSoRS Reflects sponsors as of August 2, 2016

KeYNote SPeAKeRSApex Revenue technologies

ReCePtIoNHealthcare Management Solutions, llC

lUNCHeoNCommerce BankProMedical llC

RtR Financial Services

BReAKFASt & BReAKSZirMed, Inc.

Russell Friedman & Associates, llPParallon

eXHIBItoRS

eDUCAtIoN

INStItUte BAGS BADGe HolDeRS NotePADSFust Charles Chambers llP tritech Healthcare Management Summit Health

Care Solutions

AccuRegAsset Maximization Group, Inc.Aurora Healthcare Resources

CBHVCBIZ-KA Consulting Services, llC

CCSClearbalance

Cleverley + AssociatesCPSI

enableComp, llCexperian Health

Hospital Billing Collection ServiceIMS, Inc

Jzanus Consulting, Inc.McKay Consulting

MDSaveMedAssist Solutions

MedeAnalytics

MedFinancial ServicesMedical Management Resources

Med-MetrixNavigant/Cymetrix

Ntt Dataoptum executive Health Resources

PNC HealthcarePoM Recoveries, Inc.

R-C Healthcare ManagementRevSpring

Rycan/truBridgeSentry Data Systemsthe RoI Companiesthe SSI Group, Inc.

United Collection Bureau, Inc.Washington & West llC

Xtend Healthcare

MDS

Physicians Reciprocal Insurers

the Bonadio Group llP

ANNUAl HFMA ReGIoN 2 FAll INStItUte ReGIStRAtIoN

ReGIStRAtIoN FeeS:

Hotel INFoRMAtIoNturning Stone Resort & Casino, 5218 Patrick Road, Verona, NY 13478www.turningstone.com Hotel Booking Reservations: 1-800-771-7711

Single/Double: $139.00 ($185.00 Fri/Sat), the lodge: $265.00 ($339.00 Fri/Sat)

Rates available october 18-20, Rates will be held until 5:00pm, September 19, 2016

HFMA has reserved blocks of rooms in this hotel. Preferred rates will be held until September 19, 2016 while rooms areavailable. Please call the hotel directly and mention HFMA Region 2 to ensure your preferred rate. You are responsible formaking your own hotel reservations, including changes and cancellations.

IF YoU HAVe to CANCelA refund of the seminar registration fee (less a $50.00 processing fee) will be granted if cancellation is received at least

10 days prior to the event date. Substitutions are permitted. Cancellations must be submitted in writing by fax to 708-531-0665 or via email to memberservices@hfma.org.

ReGISteR eARlY!Please submit your registration early in order to allow ample processing time. You will receive written confirmation at

least two weeks prior to the event.

SCHeDUle CHANGeSAlthough we do our best to avoid schedule changes, occasionally it may be necessary to re-schedule or cancel

programs. Registrants will receive advance notice of such changes. HFMA Region 2 cannot be responsible for anypenalties incurred as a result of any changes.

CPe ACCReDItAtIoN HFMA Metro New York Chapter is approved as a New York State CPe Provider in the area of specialized knowledge and

applications, Provider Number: 000813.12.50 CPe CReDItS

Participants will receive a certificate of attendance at the completion of the overall institute reflecting the number ofinstructional hours presented. CPe requirements may differ by jurisdiction; therefore, participants should consult their

reporting jurisdiction. All HFMA Region 2 education programs earn points toward HFMA Certification, Certificationmaintenance requirements, and Founders Awards.

QUeStIoNS???If you have additional questions please contact eric Fehrman at efehrman@fcc-cpa.com

early Bird (Before or on September 19, 2016)HFMA Members $350.00 Certified Members $325.00 Non-members $400.00

on or after September 19, 2016HFMA Members $400.00 Certified Members $375.00 Non-members $450.00

ANNUAl HFMA ReGIoN 2 FAll INStItUte ReGIStRAtIoN3 WAYS to ReGISteR

1. FAX this form to 708-531-0665

2. MAIl the form with payment: HFMA, 5195 eagle Way, Chicago, Il 60678-1051

3. oNlINe CReDIt CARD ReGIStRAtIoN: www.hfma.org/region2

1. Badge Information (Please print)

Are you a current HFMA Member? □ Yes (Member #___________________) □ No (see section 4)

□ Mr. □ Mrs. □ Miss □ Ms. □ other________

________________________________________ __________________________________________

First Name/Middle Initial/last Name Nickname for Badge

________________________________________ __________________________________________

Job title employer

________________________________________ __________________________________________

organization type employer’s City/State

2. Mailing Information: Send mail to: □ Business □ Home □ Update my records

________________________________________ __________________________________________

Business Address (No P.o. Boxes please) e-Mail Address

________________________________________ __________________________________________

City/State/Zip Code Home Address (No P.o. Boxes please)

________________________________________ __________________________________________

Business telephone/extension City/State/Zip Code

________________________________________ __________________________________________

Business Fax Home telephone

3. Course Selection enter course numbers you will be attending for the break out sessions. (located on the program schedule)

□ I will be attending the Wednesday HFMA CHFP Certification Class from 1-5pm

thursday 11:45-12:45pm thursday 1:45-2:45pm thursday 3:15-4:15pm thursday 4:30-5:30pm(A1, A2, A3, or A4) (B1, B2, B3, or B4) (C1, C2, C3, or C4) (D1, D2, D3, or D4)

_________ _________ _________ _________

4. Member Dues/Fees (non-members only) HFMA members receive a $50 discount on conference

Begin My Membership the month of _________________________ (Month joined: August $182 September $159)Membership rates apply to new member only, not reinstated member.

Dues (expires May 31, 2017) $_______

Application Fee $_______

total - Membership dues/fees $_______

5. Payment Information early Bird* Registration fee *Register by September 19, 2016

early Bird: Members $350/Non-Members $400 $_______

Registration After September 19, 2016 add $50 $_______

Certified Members Registration: early Bird $325 / After September 19, 2016 $375 $_______

total Conference Fees $_______

□ Charge my: □ Visa □ MasterCard □ American express □ Discover

Card No. ______________________________________ exp. Date __________ Security Code __________

Cardholder’s Name ______________________________________ Cardholder’s Signature ____________________________________

□ Check enclosed (Payable to HFMA education Foundation) □ Check being sent under separate cover (Payable to HFMA education Foundation)

choice choice choice choice

30.00

I affirm that the information I have given is true to the best of my knowledge, and I agree to

abide by the HFMA Code of Ethics, and the Constitution and Bylaws of the Association.

Signature Date