Medicare Boot Camp® - Hospital Version
Gain insight into the CMS initiatives affecting your revenue in 2019 by joining the nation’s leading Medicare experts for the Medicare Boot Camp®—Hospital Version.
From changes to the inpatient-only list to new guidance on charity care and pressure on drug payments, it’s the finest details of recent CMS updates that may cause compliance traps in 2019. Delve into the details of regulatory changes to understand the revenue implications and implement the new guidance. Medicare Boot Camp—Hospital Version unlocks all of the answers to your Medicare questions by teaching you the latest rules and their application.
Medicare Boot Camp—Hospital Version prepares you to better manage your revenue cycle and government audits by focusing on real guidance from CMS. You’ll leave class ready to make improvements that will strengthen reimbursement and compliance for your hospital or health system. And you’ll have the research tools and skills at your fingertips to answer your own Medicare questions long after the Boot Camp is over.
Comprehensive sections explain the complexities of:
The 2-midnight benchmark and presumption
Coverage under NCDs, LCDs, and CED
Inpatient order requirements
Inpatient-only procedures, including changes for 2019
Outpatient coverage and physician supervision
Observation coverage, billing, and payment
Correct use of condition codes 44 and W2
NCCI edits, including PTP edits and MUEs
Payment under the OPPS and IPPS
Patient deductible and copayment amounts
ABNs, HINNs and billing non-covered services
Medicare websites and resources
You will leave this program knowing how to:
Prevent inpatient denials
Conduct compliant "self-audits" for Part B inpatient payment
Properly use and bill for observation services
Research and resolve claim edits that delay revenue
Prevent outpatient denials and missed revenue
Implement best practices to get the revenue you deserve while staying in compliance
Who should attend?
Finance and reimbursement personnel
Billers and coders
Medical records/health information personnel
Clinical department personnel
Provider-based clinic personnel
Compliance officers and auditors
Medicare Advantage and MAC personnel
Healthcare lawyers, consultants, and CPAs
Legal department personnel
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.
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 hospitals Describe limitations on coverage under the Medicare program Recognize the effect of coding rules on the services the provider reports Explain how Medicare pays for inpatient and outpatient services Explain Medicare deductibles and copayments for hospital inpatient and outpatient services Employ inpatient and outpatient status rules and regulations
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 Links to Medicare resources 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: Coverage of Hospital Inpatient Services Inpatient order and certification requirements Inpatient criteria and the 2-Midnight Benchmark Admission on a case-by-case Basis Documentation and use of screening tools Utilization review determinations and short stay audits Inpatient Part B payment Module 5: Medicare Notices Delivery of the Medicare Outpatient Observation Notice (MOON) Important Message from Medicare (IMM) and Detailed Notice of Discharge Limitations of liability statute and notice requirements The Advance Beneficiary Notice (ABN) form and instructions Hospital Issued Notices of Non-Coverage (HINN) Module 6: Medicare Claims Submission Fundamentals Claim fields with special instructions Medicare Secondary Payer principles, including liability claims Adjustment claims and automated reopenings Medicare claims flow Module 7: Medicare Edit Systems Outpatient Code Editor (OCE) and Medicare Code Editor (MCE) National Correct Coding Initiative (NCCI) Procedure to Procedure (PTP) edits and modifiers Medically Unlikely Edits (MUE) and Add-on code edits Module 8: Medicare Billing Issues Outpatient repetitive, non-repetitive, and recurring services Three-day payment window; outpatient services billed on inpatient claims Billing of non-covered outpatient services Treatment of conditions arising during or from a non-covered stay Module 9: Medicare Outpatient Payment Systems Outpatient Prospective Payment System (OPPS) Addendum B and D to determine the payment status of a HCPCS code Addendum A and Ambulatory Payment Classifications (APCs) Comprehensive APC (C-APC) basic rules Payment under the OPPS, including patient coinsurance and outlier Payment for therapy under the Physician Fee Schedule, including therapy caps “Sometimes” and “always” therapy codes Payment for labs under the Laboratory Fee Schedule, including reference lab Module 10: Outpatient Surgical Services, including Implantable Devices Inpatient-only procedures Surgical C-APCs, including complexity adjustment Multiple procedure discount for minor surgical services Terminated/discontinued and bilateral procedures Device intensive procedures and procedure-to-device edit Pass-through devices Value code FD for free and reduced-cost devices Module 11: Outpatient Visits and Observation Services Coding for clinics, emergency departments, critical care and trauma activation Proper use of modifier 25 Payment for off-campus “non-excepted” department services Billing of observation services Observation Comprehensive APC Payment Module 12: Special Billing Issues for Outpatient Diagnostics, Drugs and Therapy Packaged, pass-through and non-pass-through drugs and biologicals Proper use of modifier JG and TB Discarded Drugs Biosimilar products Biological skin substitutes Radiation Therapy Imaging Family Composite APCs Special Radiology Modifiers Laboratory billing and coding issues, including date of service Blood and blood products Outpatient therapy functional status reporting Module 13: Inpatient Payment and Patient Responsibility Inpatient Part A payment and the Inpatient Prospective Payment System (IPPS) Medicare-severity diagnosis related groups (MS-DRG) Complications and co-morbidities and the effect of a hospital-acquired condition (HAC) Inpatient deductible, coinsurance, and lifetime reserve days Module 14: Inpatient Prospective Payment System (IPPS) Adjustment Factors Standardized amount adjustments: Hospital Quality Reporting Program and Electronic Health Record (EHR) Meaningful Use Quality adjustments: Value-Based Purchasing (VBP) Program, Hospital Readmissions Reduction Program (HRRP), and HAC Reduction Program Payment add-on for New Technology Medicare inpatient pricer Payment for transfers and post-acute care transfers
Course Agenda/Outline is subject to change.