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Medicare Boot Camp - Utilization Review (RIS Pre-conference) (BLR)

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Location

The Wigwam Hotel

300 East Wigwam Blvd

Litchfield Park, AZ 85340

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No Refunds

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Medicare Boot Camp - Utilization Review (RIS Pre-conference) (BLR)
Course Overview
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 2018, 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 2018
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

Course 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)

Learning 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

Please contact the event manager Marilyn (marilyn.b.turner(at)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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Date and Time

Location

The Wigwam Hotel

300 East Wigwam Blvd

Litchfield Park, AZ 85340

View Map

Refund Policy

No Refunds

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