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Medicare Boot Camp®—Critical Access Hospital Version (blr) S

Medicare Boot Camp®—Critical Access Hospital Version (blr) S

Medicare Boot Camp®—Critical Access Hospital Version


Course Overview

Master Medicare rules for critical access hospitals

Medicare Boot Camp—Critical Access Hospital Version is a three-day intensive course on Medicare coverage, billing, coding, and payment for critical access hospitals. It gives you the knowledge and tools to find the answers to your most pressing Medicare coding, billing, and reimbursement questions pertaining to this unique setting.

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

This one-of-a-kind, custom class will show you which rules apply to you so you can successfully process claims and get paid. It will also teach you how to prepare and respond to recovery audits by mastering the key concepts behind what the Recovery Auditors have audited so far.

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

Find the answers to your specific Medicare questions relating to CAHs Understand outpatient observation and inpatient status rules and UR requirements Submit accurate claims to Medicare, including Part A to B rebilling Ensure appropriate reimbursement Avoid compliance pitfalls Identify risks for recovery audits and other government audits

Who should attend?

Auditors and analysts

Billing specialists

Chargemaster coordinators and managers

Clinical documentation improvement specialists

Clinical 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

See the HCPro difference for yourself!

Focus on the actual rules: Learn how to find and apply CMS rules and guidelines to ensure hospital services furnished to Medicare beneficiaries are billed accurately and appropriately.

Tools and skills to navigate Medicare rules: Our instructors provide valuable tools and resources that will help you prioritize and research Medicare questions long after the Boot Camp ends.

Hands-on learning: Attendees work a set of exercises/case studies after each module to ensure they understand the concepts and know how to apply them to real-world situations.

Small class size: A low participant-to-teacher ratio is guaranteed.

Highly rated, well-established program: Participants consistently give the course an overall rating of 4.75 or higher (on a 5.0 scale). We currently conduct more than 30 Medicare Boot Camp courses each year.

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

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

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