Medicare Boot Camp®—Hospital Version

Medicare Boot Camp® - Hospital Version
About this Event
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Course Overview

Gain insight into the CMS initiatives affecting your revenue in 2020 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 2020. 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 2020
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
Case Managers
Chargemaster personnel
Billers and coders
Medical records/health information personnel
Clinical department personnel
Provider-based clinic personnel
Revenue managers
Compliance officers and auditors
Registration personnel
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.

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 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

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

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.

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