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Critical Access Hospital and Rural Health Clinic Version(blr) S

Critical Access Hospital and Rural Health Clinic Version(blr) S


Medicare Boot Camp®—Critical Access Hospital and Rural Health Clinic Version

*** LIMITED TIME OFFER: FREE $100 AMAZON GIFT CARD! ***REGISTER TODAY!

Course Overview

Master Medicare rules for critical access hospitals and rural health clinics

Medicare Boot Camp—Critical Access Hospital and Rural Health Clinic Version is a four-day intensive course on Medicare coverage, billing, coding, and payment for critical access hospitals (three days) and rural health clinics (1 day). It gives you the knowledge and tools to find the answers to your most pressing Medicare coding, billing, and reimbursement questions pertaining to these unique settings.

Find the answers to all of your coding, billing, and reimbursement questions pertaining to your unique position in the healthcare industry.

This one-of-a-kind, custom class will show you which rules apply to you so you can successfully process claims and get paid without disruption to your revenue stream. It will also teach you how to research Medicare regulations to resolve billing issues and respond to denials and audits.

The Medicare Boot Camp—Critical Access Hospital and Rural Health Clinic Version will give you the knowledge and confidence to:

Find the answers to your specific Medicare questions relating to CAHs and RHCs Understand outpatient observation and inpatient status rules and UR requirements at CAHs Submit accurate claims to Medicare, including CAH Part A to B rebilling, and from both independent and provider-based RHCs Ensure appropriate reimbursement from Medicare and application of the patient’s financial responsibility Avoid compliance pitfalls Identify risks for recovery audits and other government audits Understand RHC reporting of revenue codes, HCPCS codes, and related charges for all services provided

Who should attend?



Auditors and analysts



Billing specialists



Chargemaster coordinators and managers



Clinical documentation improvement specialists



Clinic managers and department heads



Compliance officers



Finance and reimbursement managers



Healthcare consultants, CPAs, and lawyers



Health plan financial analysts, claims processing, and provider relations professionals



HIM directors and managers



Medicare administrative contractors



Patient access/admitting staff



Provider-based clinical personnel



Physician advisors



Recovery audit coordinators



Coding specialists



Rural Health Clinic revenue cycle, compliance, case management, and clinical personnel



Critical Access Hospital revenue cycle, compliance, case management, and clinical personnel



Learning Objectives

At the conclusion of this educational activity, participants will be able to:



Locate key sources of Medicare authority on the Internet



Interpret Medicare guidance and apply it to the services provided



Describe how Medicare covers inpatient and outpatient services at CAHs



Describe limitations on coverage under the Medicare program



Explain when the beneficiary is financially responsible for services provided



Discuss how documentation of patient care affects billing of the services the provider renders



Explain how Medicare pays for inpatient and outpatient services



Employ outpatient and inpatient status rules and regulations



Course Outline/Agenda

Module 1: Overview of Critical Access Hospital (CAH) Designation

Requirements for CAH designation Limitations on acute care beds and length of stay Inpatient Rehabilitation and Psychiatric Distinct Part Units (DPU)

Module 2: Medicare Overview, Contractors, Research and Resources

Overview of Medicare Part A, B, C, and D Medicare Contractors, including the MAC, RAC and QIO Medicare source laws, including statutes, regulations and final rules Medicare sub-regulatory guidance, including manuals and transmittals Medicare Coverage Center, including LCDs, NCDs, CED, and Laboratory Manual Links to Medicare information and resources for staying current

Module 3: Coverage of Hospital Outpatient Services

Incident-to coverage of outpatient therapeutic services Physician supervision requirements and definitions Coverage of observation services Coverage of drugs, including self-administered drugs Coverage requirements for outpatient diagnostic services

Module 4: Medicare Notices

Delivery of the Medicare Outpatient Observation Notice (MOON) Limitations of liability statute and notice requirements The Advance Beneficiary Notice (ABN) form and instructions Important Message from Medicare (IMM) Hospital Issued Notices of Non-Coverage (HINN)

Module 5: Medicare Claims Submission Fundamentals and Billing Issues

UB-04 claim form and key fields applicable to a CAH Medicare claims flow, including timely filing Outpatient repetitive, non-repetitive and recurring services Outpatient services billed separately from inpatient claims Billing of non-covered outpatient services Treatment of conditions arising during or from a non-covered stay

Module 6: Medicare Edit Systems

Outpatient Code Editor (OCE) and Medicare Code Editor (MCE) National Correct Coding Initiative (NCCI); including Procedure to Procedure (PTP) Edits, Medically Unlikely Edits (MUE), and Add-on code edits Modifiers used with NCCI edits

Module 7: Outpatient Visits and Observation Services

Coding for clinics, emergency departments, critical care and trauma activation Proper use of modifier -25 Billing and payment for observation services

Module 8: Outpatient Surgery and Radiology Services

Multiple procedure discounting for surgical and radiology services for Method II billing Terminated/discontinued and bilateral procedures Special considerations for inpatient-only procedures and reduced cost devices and items

Module 9: Special Billing and Payment Issues for Drugs, Outpatient Diagnostics, and Therapy

Discarded Drugs Laboratory billing and coding issues Blood and blood products Payment for lab services, including reference lab Outpatient therapy functional status reporting Payment for therapy, including therapy caps “Sometimes” and “always” therapy

Module 10: Overview of the Cost-Based Reimbursement System

Components of the cost-based system Method I and Method II billing CRNA pass-through exemption Patient responsibility, including outpatient and inpatient deductible and coinsurance

Module 11: Coverage, Notice Requirements and Billing for Inpatient Services

Inpatient criteria and the 2-Midnight Benchmark Inpatient order and certification requirements Utilization review determinations for non-covered inpatient cases Inpatient Part B billing requirements

Module 12: Coverage and Billing for Swing Bed Admissions

Coverage for CAH swing beds Level of care and documentation requirements Reimbursement methodology and patient coinsurance Exclusion from SNF consolidated billing rules

(Optional 4th Day) Medicare Boot Camp®—Rural Health Clinic Version

Module 1: Medicare Overview, Contractors, Research, and Resources

Overview of Medicare Part A, B, C, and D Role of Medicare contractors Medicare source laws, including statutes and regulations Medicare sub-regulatory guidance, including manuals and transmittals Links to Medicare information and resources for staying current

Module 2: Designation as a Rural Health Clinic (RHC) and Required Practitioners and Services

Definition and purpose of an RHC Certification criteria, including location, staffing, and required services Basic requirements for services furnished by RHC practitioners or incident to an RHC practitioner, including requirements for direct supervision Services that are excluded from the RHC benefit Distinguish between an independent and provider-based RHC

Module 3: Application of Medicare Coverage and the Advance Beneficiary Notice

Medicare Coverage Center, including LCDs and NCDs, and Laboratory Manual Coverage of drugs, including self-administered drugs Coverage requirements for outpatient diagnostic services, including laboratory services Limitations of liability statute and notice requirements Advance Beneficiary Notice (ABN) form and instructions

Module 4: General Billing Requirements for Rural Health Clinic (RHC) Services

Claims processing requirements, including type of bill, revenue codes, HCPCS codes, modifiers, and charge reporting Coverage and billing for a medical visit and mental health visit Coverage and billing for preventive services Coverage and billing for special services, including diagnostic services, vaccines, injections, and other incident-to services Coverage and billing for laboratory services Special circumstances for billing transitional care management (TCM), chronic care management (CCM), and telehealth

Module 5: Basic Reimbursement Principles for Rural Health Clinic (RHC) Services

Identification of an "encounter" for payment purposes Basic all-inclusive rate (AIR) reimbursement methodology for provider-based and independent RHCs Application of upper payment limit for freestanding and provider-based RHCs Application of Part B deductible and coinsurance

Module 6: Appendixes of Source Authority

Key government documents to support appropriate billing

Course Outline-Agenda subject to change.


Please contact the event manager Marilyn (bWFyaWx5biAhIGIgISB0dXJuZXIgfCBueWV2ZW50c2xpc3QgISBjb20= ) below for:- Multiple participant discounts- Price quotations or visa invitation letters- Payment by alternate channels (PayPal, check, Western Union, wire transfers etc)- Event sponsorshipsNO REFUNDS ALLOWED ON REGISTRATIONSService fees included in this listing.-----------------------------------------------------------------BUSINESS & LEGAL RESOURCES-BLR - New York Events List http://www.NyEventsList.com http://www.BostonEventsList.com http://www.SFBayEventsList.com-----------------------------------------------------------------MYL190123CEV



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