August 31, Dear Medical Staff Professional,

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1 August 31, 2012 Dear Medical Staff Professional, You are invited to attend the Wyoming Association of Medical Staff Services (WyAMSS) Fall Education Conference on Wednesday, September 26 and Thursday, September 27, 2012 in Cheyenne, Wyoming. This will be the second gathering of 2012 that WyAMSS has held since our kickoff in May Since then, we have created bylaws, elected Officers, introduced a state website, formed a membership application (see attached), and created a valuable connection with the National Association of Medical Staff Services (NAMSS). Most importantly, we have organized another great conference in order to learn and network with new found friends and colleagues. You can look forward to another great slate of speakers as well as the opportunity for you to participate at the Wyoming Hospital Association Convention at discounted registration fees. In addition, we will be moving ahead with the ideas, visions and professional goals we have for the WyAMSS association. All pertinent details including times, location, agenda, and fees are attached for your review. We hope you will take this opportunity to participate and share your expertise in these active discussions and education. Best Regards, ~Amy Ligocki, President, Sheridan Memorial Hospital ~Tracey Welch, President Elect, Memorial Hospital of Sweetwater County, ~Teeka Robertson, Secretary/Treasurer, Ivinson Memorial Hospital ext Wyoming Association of Medical Staff Services (WyAMSS) Fall Education Conference Wednesday, September 26 Thursday 27, 2012 Wyoming Board of Medicine office 320 W. 25th Street, Suite 200 Cheyenne, Wyoming in conjunction with the Wyoming Hospital Association convention at Little America Hotel WyAMSS Membership Dues: $50.00 Conference Registration Fee: Member $25 / Non-Member $100 WHA: 9/26 Vendor Fair & Lunch 9/27 Featured Speaker Presentation = $25 RSVP Deadline: Monday, September 17, 2012 amyligocki@sheridanhospital.org

2 Meeting Information LOCATIONS: Wyoming Board of Medicine Office 320 W. 25th Street Suite 200, 2 nd Floor Cheyenne, Wyoming Little America Hotel & Convention Center 2800 West Lincolnway Cheyenne, WY DATE / TIME: Wednesday, September 26 Thursday September 27, :00am 4:30pm RSVP: Please RSVP by Monday, September 17 th to amyligocki@sheridanhospital.org or ATTIRE: We suggest comfortable, casual, business attire. ACCOMODATIONS: A block of guest rooms have been reserved at The Springhill Suites at 612 North Main Street, Cheyenne, WY at a rate of $ (per room/per night) plus tax with a cut-off date of Monday, September 17 th. To receive this rate, you must identify that you are part of the WyAMSS block listed under Amy Ligocki. To make reservations, you may call FEES/REGISTRATION: Conference Registration fee is $100 for non-members. Submit your membership application (see attached) and dues ($50) and the conference registration fee is discounted to only $25.00 (Total = $75). WHA event fee is $25.00 (paid separately to WHA-see attached registration form). You will also need to cover your personal costs for travel, hotel and meal arrangements outside of the scheduled events. Please make conference registration and membership checks payable to WyAMSS and mail with registration and/or application to: Teeka Robertson, WyAMSS Secretary/Treasurer 255 N. 30 th St. Laramie, WY Please make WHA checks payable to: Wyoming Hospital Association Attn: Rose Fishback 2005 Warren Avenue Cheyenne, WY NETWORKING DINNER: Join attendees the evening of Tuesday, September 25 th at 2 Doors Down Downtown Restaurant, located at 118 East 17th Street, Cheyenne, WY ( at 6:00PM to meet, greet, eat, and socialize with your fellow attendees. Please let us know with your RSVP if you plan to attend this dinner. Spouses, Speakers, and Guests welcome! A Special Thanks to Our Sponsors and Speakers: -Wyoming Board of Medicine Office -Susan Miller, CLU -Kevin Bohnenblust, J.D. -Nick Healey, J.D.

AGENDA Day 1 WEDNESDAY 9/26 Board of Medicine office, 2 nd floor 8am 8:30am Continental Breakfast: Name badges & photo taken for directory Welcome and Officer Introductions Meet n greet staff of the

3 AGENDA Day 1 WEDNESDAY 9/26 Board of Medicine office, 2 nd floor 8am 8:30am Continental Breakfast: Name badges & photo taken for directory Welcome and Officer Introductions Meet n greet staff of the Wyoming Board of Medicine What NAMSS has to offer Synergy Magazine! Speaker: Nick Healey JD, Healthcare Attorney Expand on Code Words when sharing information on a practitioner MSP s role in quality and patient safety How to handle disruptive practitioners &/or substance abuse The use of Code of Conduct 11:30am - LUNCH BREAK Travel to Little America Hotel Wyoming Hospital Association Vendor Show & Lunch 1:30 pm - Business Meeting w/ Healthcare Executive Assistants at Little America Business Meeting minutes from past meetings Needs Assessment for future speakers, continuing education Roundtable bring your favorite form &/or policy Future WyAMSS Committees; bylaws, fund-raising, website, conference planning, membership, etc. 4:30 pm - Day 1 Meeting Adjournment Enjoy all Cheyenne has to offer AGENDA Day 2 THURSDAY 9/27 Board of Medicine Office, 2 nd floor 8am 8:30am - 9:30am - Continental Breakfast Network, Network, Network Susan Miller, CLU, President, The Doctors Agency of WY Certificates of Medical Malpractice Insurance Coverage (COI): How to read them, what they mean, limits of liability, diluting a policy, certificate holder, nose and tail coverage, etc. Kevin Bohnenblust, Exec Director Wyoming Board of Medicine The difference between applying for licensure through the WY BOM vs. the FCVS in TX, and the advantages and disadvantages of both avenues. The FCVS packet!! What having a Medical License means to the public, aka: the difference between licensing and privileging. The process on filing a complaint on a doctor with the BOM; what happens once the complaint is filed. Examples of types of complaints received. What are the reporting requirements to the Board of Medicine from the hospitals, clinics, surgery centers, etc. 11:30am Catered Lunch in the Board Room 12:30pm Leave for Little America Hotel 1:30pm WHA FEATURED SPEAKER DIANE KELLY

THURSDAY 9/27 Little America Hotel 1:30-4:30 pm WHA FEATURED SPEAKER DIANE KELLY The opportunity to attend the vendor fair & luncheon and featured speaker, Diane Kelly has been extended to us by WHA,

4 THURSDAY 9/27 Little America Hotel 1:30-4:30 pm WHA FEATURED SPEAKER DIANE KELLY The opportunity to attend the vendor fair & luncheon and featured speaker, Diane Kelly has been extended to us by WHA, and the attendance/registration fee has been very generously discounted to only $25.00 per person. Register in advance using this form. EVENTS: WYOMING HOSPITAL ASSOCIATION REGISTRATION FORM 9/26 WHA VENDOR FAIR & LUNCH -11:30-1:30pm 9/27 FEATURED SPEAKER DIANE KELLY, DrPH, RN 1:30-4:30PM WYAMSS Participant Information Name: Title: Address: City: State: Zip: Institution: address: Please submit this form and enclose a check for $25.00 to: Wyoming Hospital Association Attn: Rose Fishback 2005 Warren Avenue Cheyenne, WY Phone: Fax: NO ADDITIONAL MEETING FOLLOWING DIANE KELLY. WYAMSS IS ADJOURNED UNTIL SPRING!

5 2012 Fall Education Conference Registration Form Non-WyAMSS Member Registration* $100 WyAMSS Member *$25 * Submit your new membership application (see attached) and $50 dues with your Fall Conference registration form and your conference fee is only $25. Name: Organization: Title: Address: City: State: Zip: Contact Phone: Fax: First time attendee? YES NO Will you be joining us as our guest at 2 Doors Down Downtown Restaurant for the networking dinner Tuesday, September 25 6:00pm YES NO *Registration RSVP and payment deadline: September 17, 2012 RSVP to amyligocki@sheridanhospital.org or *Make checks payable to WyAMSS *Return completed registration form and payment to: Teeka Robertson, WyAMSS Secretary/Treasurer Ivinson Memorial Hospital 255 N. 30th Street Laramie, WY Phone ext Fax teekar@ivinsohospital.org

2012 MEMBERSHIP APPLICATION WYOMING ASSOCIATION of MEDICAL STAFF SERVICES (WyAMSS) MEMBERSHIP APPLICATION Application for initial membership Application for renewal of membership ACTIVE MEMBERSHIP

6 2012 MEMBERSHIP APPLICATION WYOMING ASSOCIATION of MEDICAL STAFF SERVICES (WyAMSS) MEMBERSHIP APPLICATION Application for initial membership Application for renewal of membership ACTIVE MEMBERSHIP Active members shall consist of individuals actively involved in credentialing, privileging, practitioner or provider organizations, administrative support functions and/or regulatory compliance in the healthcare industry. Active members shall pay annual dues. They shall be eligible to vote and hold office as defined within WyAMSS Bylaws (see for full Bylaws document) Name Employer Certification Title Mailing Address City State Zip Phone # Fax # address Signature Date Dues are $50. Please make checks payable to WyAMSS. Return the completed application and dues check to: Teeka Robertson, WyAMSS Secretary/Treasurer Ivinson Memorial Hospital 255 N. 30th Street Laramie, WY Phone ext Fax teekar@ivinsohospital.org The Wyoming Association of Medical Staff Services (WyAMSS) recruits and processes its own membership and dues independently from the National Association of Medical Staff Services (NAMSS). While NAMSS membership is not a condition of WyAMSS membership, it has its own benefits. Are you a member of NAMSS? Yes No If not, and if you are interested in joining, please visit the NAMSS website at How many years have you been working in the medical staff services/credentialing service or related activities? Less than one year 6 10 years 1 2 years More than 10 years 3 5 years Type of health care entity employed in: Acute hospital Psychiatric facility Ambulatory surgery center Armed Forces (branch ) Skilled nursing facility Credentialing verification organization Managed Care/Health Plan Insurance company PPO Medical group MSO Other Do you know someone in a health-related field who performs activities as outlined in the Active membership category that might benefit from WyAMSS membership? If so, please share their name(s) and we will send them an application for membership. Name Title Employee Mailing Address, City, State, Zip

Nick regularly counsels a broad range of entities in the health care industry, including hospitals, physician groups, diagnostic testing companies, nursing homes, ambulatory surgery centers,

7 Guest Speakers Nick Healey, J.D. Healthcare Attorney -Dray, Dyekman, Reed & Healey, P.C. Law firm in Cheyenne Nick represents and advises a wide variety of businesses, with a specific emphasis on the health care industry and taxexempt entities. Nick regularly counsels a broad range of entities in the health care industry, including hospitals, physician groups, diagnostic testing companies, nursing homes, ambulatory surgery centers, pharmacies, and health care payers, on various aspects of health care law and regulation. These include: Medicare and Medicaid participation and reimbursement regulations, the impact of state and federal fraud and abuse laws and regulations, such as the Anti-kickback Law, Stark Law, False Claims Act and civil monetary penalties provisions, HIPAA and the Wyoming Hospital Records Information Act, peer review, reimbursement and licensing and other aspects of regulation by government. With respect to public hospitals, Nick has particular experience advising on the impact of the Wyoming Public Records Act and Public Meetings Act. Nick graduated from Acadia University in Nova Scotia, Canada in 1995, with a honors degree in Political Science. Nick received his J.D. from the University of Wyoming College of Law in 1999, where he was inducted into the Order of Barristers. After graduation, Nick practiced for three years in Oklahoma in corporate law and litigation before returning to Wyoming, and joining the firm. Nick is admitted to the Wyoming Bar and to the Federal District Courts of Wyoming. Kevin Bohnenblust, J.D. Executive Director of the Wyoming Board of Medicine Kevin also serves on the AIM Board of Directors as AIM Western Region Representative. Prior to his appointment to the Wyoming Board, he was with the firm of Hathaway & Kunz, P.C. He came to the firm after having served as principal inside counsel for Blue Cross Blue Shield of Wyoming. His prior experience includes serving as Legislative Director and Legal Counsel for Congressman Craig Thomas, and as Special Assistant to U.S. Senator Malcolm Wallop. Mr. Bohnenblust received a B.A. in journalism with honors from the University of Wyoming in 1982 and obtained his J.D. from the University of Wyoming College of Law in Susan Miller, CLU President, The Doctors Agency of Wyoming Susan D. Miller is the president of The Doctors Agency of Wyoming. She has more than 35 years of wideranging insurance experience. Besides holding insurance licenses in multiple states, she is a member of several national insurance associations. Her career in insurance began as an agent with the Farmers Insurance Group of companies. She also worked as a property and casualty Underwriter for Continental Insurance Companies, and has owned insurance agencies in Minnesota, North Dakota Colorado and Wyoming. Since 1983, her current insurance agency has specialized in providing professional liability insurance to physicians, surgeons, dentists, hospitals and other healthcare facilities and professionals in Wyoming. Susan is a graduate of the University of Wyoming with Bachelor of Science degree and has earned a Chartered Life Underwriter designation. Susan has been active in many community organizations, where her service has earned her many awards, including the JC Penny Golden Rule award for her work with United Way and the Workhorse Award for her dedication to Meals on Wheels. Governor Gerringer appointed her to the Wyoming State Board of CPAs where she served as the public member for two terms. She is the past president of the Casper Chapter of Business and Professional Women, Casper Meals on Wheels and Natrona County United Way where she also served as fundraising chair. First appointed in 1992, Susan is currently in her fourth elected term on the Casper College Board of Trustees. She also serves as the chairman of the Natrona County Board of Cooperative Education Service (BOCES a joint board for advancement of education between Casper College and the Natrona County School District). Susan has been married to Charlie Miller, a retired Wyoming rancher, for 39 years. They have 3 children and 9 grandchildren. Raffles, Giveaways, and Drawings planned as well!

MCPI Annual Conference Tuesday, September 19, 2017

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