Medicare Boot Camp®—Utilization Review Version
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Master Medicare rules for utilization review
Medicare Boot Camp®—Utilization Review Version is an intensive two-day course focusing on the Medicare regulatory requirements for patient status and the role of the utilization review (UR) committee.
Managing patient status plays a critical role in proper compliance, correct reimbursement, and stabilizing inpatient payments for the hospital. In 2019, CMS made significant changes to the inpatient-only list and continues to change its strategies for auditing patient status. Don’t become a target or leave money on the table—ensure the UR committee is ready to implement and leverage the regulatory requirements.
Medicare Boot Camp—Utilization Review Version also answers all your questions about navigating the CMS website and finding Medicare requirements. You will be able to find answers to your questions long after the Boot Camp is over.
You will leave this program knowing:
How to apply the 2-midnight benchmark and 2-midnight presumptions
Implement changes to the inpatient-only list for 2019
The differences between post-discharge versus concurrent patient status reviews
When self-denial is appropriate to take advantage of Part B payment for an inpatient case
How NCDs, LCDs, and coverage with evidence development (CED) affect coverage of cases that meet the 2-midnight benchmark
The observation coverage rules and how they interact with the 2-midnight benchmark
When ABNs and HINNs should be used for stays that don’t meet medical necessity requirements
Who should attend?
Utilization review coordinators
Utilization management managers and directors
Utilization review committee members
UR physician advisors
Revenue cycle staff
Compliance officers and auditors
CFOs, CNOs, and VPs
Fiscal intermediary personnel
Healthcare lawyers and consultants
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.
Medicare Boot Camp®—Utilization Review VersionLearning Objectives
At the conclusion of this educational activity, participants will be able to:
Define observation coverage, billing, coding, and payment rules
Discuss the appropriate application of ABNs for observation patients
State the new/revised inpatient order and certification requirements
Explain CMS’ 2-midnight rule benchmark
Describe the effect of hospital practice patterns on the 2-midnight presumption
Recognize exceptions to the 2-midnight benchmark
Describe the impact of LCD/NCD/CED criteria on inpatient coverage
State the rules for "inpatient-only" procedure billing and reimbursement
Describe the differences between condition codes 44 and W2
Use appropriate billing codes for full Part B payment for inpatient cases, including for "self-denials"
Differentiate inpatient and outpatient deductibles and co-payments
Medicare Boot Camp®—Utilization Review VersionCourse Outline/Agenda
Module 1: Medicare Overview and Contractors Overview of Medicare Part A, B, C, and D Medicare contractors, including the MAC, RAC and QIO Module 2: Medicare Research and Resources Finding Medicare source laws, including statutes, regulations and final rules Finding Medicare sub-regulatory guidance, including manuals and transmittals Medicare Coverage Center, including LCDs, NCDs, CED and Lab Coverage Manual Limitations of Liability and notice requirements for non-covered services Links to Medicare resources and resources for staying current Module 3: Outpatient Observation Coverage of observation services The Medicare Outpatient Observation Notice (MOON) Advanced Beneficiary Notice (ABN) for non-covered observation Coding and billing of observation Payment for observation under the Observation Comprehensive APC (C-APC) Module 4: Coverage of Inpatient Admissions Inpatient order and certification requirements Inpatient criteria and the 2-Midnight Benchmark Inpatient-only procedures Admission on a case-by-case basis Documentation and use of screening tools QIO short stay audits Module 5: Inpatient Utilization Review and Notices Utilization review requirements and self-denials Concurrent review and billing with condition code 44 Inpatient Part B payment and billing with condition code W2 Important Message from Medicare (IM) Detailed Notice of Discharge (DN) Hospital Issued Notice of Non-Coverage (HINN) for non-covered inpatient services Module 6: Medicare Payment Fundamentals and Patient Responsibility Basics of the Outpatient Prospective Payment System (OPPS) Patient coinsurance under Part B Basics of the Inpatient Prospective Payment System (IPPS) Three-day payment window and pre-admission services Medicare-severity diagnosis related groups (MS-DRGs) Payment for transfers and post-acute care transfers Inpatient deductible, coinsurance, and lifetime reserve days (LRDs)
Course Outline/Agenda subject to change.
Please contact the event manager Marilyn (bWFyaWx5biAhIGIgISB0dXJuZXIgfCBueWV2ZW50c2xpc3QgISBjb20=
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|Ticket Information ||Ticket Price |
| Registration fee || USD 1,089|