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

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The Coeur d'Alene Resort

115 S. 2nd Street

Coeur d’Alene, ID 83814

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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 (marilyn.b.turner@nyeventslist.com ) below for:
- Multiple participant discounts
- Price quotations or visa invitation letters
- Payment by alternate channels (PayPal, check, Western Union, wire transfers etc)
- Event sponsorships

NO REFUNDS ALLOWED ON REGISTRATIONS
Service fees included in this listing.
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The Coeur d'Alene Resort

115 S. 2nd Street

Coeur d’Alene, ID 83814

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