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1 2014 Call for Speakers Information APPLICATION To be considered as a speaker for AAPC s 2014 Webinars, complete and submit the following speaker application by September 30, Incomplete applications will not be considered. Applications are reviewed by a speaker selections committee for topics that will be fresh, relevant, and engaging to the intended audience. your completed application to webinars@aapc.com no later than September 30, CONSIDERATIONS WHEN SUBMITTING Focus On the Following Topics: Coding Sessions can be either general or specialty-specific. Auditing Sessions can be either general or specialty-specific. Practice Management Billing Compliance Revenue Cycle Management Present Hot Issues Our members rely on us to keep them informed of the changes they need to know to be the most knowledgeable professionals in their healthcare vocations. Understand Difficulty Requirements All sessions need to be presented on an advanced level and cover topics in significant detail. Nonadvanced topics, such as E/M, can still be presented on an intermediate to advanced level. These topics should still be presented in a clear, understandable format, despite their advanced nature. Be Clear About What the Session Will Include If you plan to show an operative video, or otherwise involve your attendees, include this detail in your application. More interactive sessions foster better understanding.

2 2014 Call for Speakers Information Be Concise About Your Goals Clearly describe your teaching objective. What will make your presentation stand out from the rest? Example: Attendees will gain insight as to why the 2011 ICD-9-CM code changes were made and what impact these changes will have on coding and billing. Hidden changes from the index, often overlooked when coders update their superbills, will be addressed as well. SPEAKER COMPENSATION Speakers will select between a $500 honorarium or a complimentary webinar subscription. Compensation is given per presentation. NOTIFICATION You will receive an notification when we receive your application (call Torry Cowdell if you have not received this within five business days of submission ). All applicants will receive further information on the decision of the speaker selections committee no later than November 1, 2013, via the address listed in the application. QUESTIONS Questions concerning the speaker selection process or the speaker application should be addressed to the webinar department at webinars@aapc.com.

3 2014 Call for Speakers Completing this application indicates interest in presenting a 2014 webinar webinars will be presented weekly on Wednesdays, 1/8/14-12/17/14. If there is a Wednesday when you cannot present, please list it as a conflict: Conflict Dates PRESENTER INFORMATION (as it would appear in program and all marketing materials) Name Title Credentials (if applicable) Address Cell Phone Biography (50 words or less) Highlight career and/or educational experience, awards, etc., in 50 words or less. Do not describe your organization s products or services. Speaking Experience List 2-3 professional presentations you ve given to groups of 50 or more. Topic Audience # of Attendees Rating

4 Head Shot To be considered as a speaker, you must a head shot to. Please the photo file as last name and first initial (i.e., Nestman S). Applications will not be processed without photos. PRESENTATION INFORMATION Discuss in detail the content of your presentation. Be as accurate and specific as possible. Title Executive Summary (no more than 100 words) Objectives List 3-5 learning objectives that attendees will take away from the presentation

5 DISCLOSURE Declare any relevant conflict of interest. In an effort to openly identify any potential conflict so that the listeners may form their own judgments of the presentation with the full disclosure of the facts, AAPC requires that all speakers disclose in advance any relevant conflict(s) of interest that may have a direct bearing on the subject matter of the continuing education program. I do not have any relevant conflicts of interest. I do have a conflict of interest: Relevant conflict: Organization: Relationship: Commercial Interest: A commercial interest is defined as any proprietary entity producing healthcare goods or services, used on, or consumed by, patients, with the exemption of non-profit or government organizations and non-healthcare related companies. Financial Relationships: Financial relationships are those in which the individual benefits by receiving a salary, royalty, intellectual property rights, consulting fee, honoraria, ownership interest (e.g., stocks, stock options or other ownership interest, excluding diversified mutual funds), or other financial benefit. Financial benefits are usually associated with roles such as employment, management position, independent contractor (including contracted research), consulting, speaking and teaching, membership or advisory committees or review panels, board membership, and other activities from which remuneration is received, or expected. We consider relationships of the person involved in the CME activity to include financial relationships of a spouse or partner. Relevant Financial Relationships: We focus on financial relationships with commercial interests in the 12-month period preceding the time that the individual is being asked to assume a role controlling content of the CME activity. A minimal dollar amount has not been set for relationships to be significant. Inherent in any amount is the incentive to maintain or increase the value of the relationships. We define relevant financial relationships as financial relationships in any amount occurring within the past 12 months that create a conflict of interest. Conflict of Interest: Circumstances create a conflict of interest when an individual has an opportunity to affect CME content about products or services of a commercial interest with which he/she has a financial relationship.