Medicare Boot Camp®—Critical Access Hospital Version (ahm) S

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Hilton Garden Inn Portland Airport

12048 NE Airport Way

Portland , OR 97220

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Medicare Boot Camp®—Critical Access Hospital Version

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Course Overview

Master Medicare rules for critical access hospitals

Medicare Boot Camp—Critical Access Hospital Version is a three-day intensive course on Medicare coverage, billing, coding, and payment for critical access hospitals. It gives you the knowledge and tools to find the answers to your most pressing Medicare coding, billing, and reimbursement questions pertaining to this unique setting.

Find the answers to all of your coding, billing, and reimbursement questions pertaining to your unique position in the healthcare industry—the CAH.

This one-of-a-kind, custom class will show you which rules apply to you so you can successfully process claims and get paid. It will also teach you how to prepare and respond to recovery audits by mastering the key concepts behind what the Recovery Auditors have audited so far.

The Medicare Boot Camp—Critical Access Hospital Version will give you the knowledge and confidence to:

  • Find the answers to your specific Medicare questions relating to CAHs
  • Understand outpatient observation and inpatient status rules and UR requirements
  • Submit accurate claims to Medicare, including Part A to B rebilling
  • Ensure appropriate reimbursement
  • Avoid compliance pitfalls
  • Identify risks for recovery audits and other government audits

Who should attend?

  • Auditors and analysts
  • Billing specialists
  • Chargemaster coordinators and managers
  • Clinical documentation improvement specialists
  • Clinical 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

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 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

Course Outline-Agenda subject to change.


Coming Soon!

"Please contact the community 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


Service fees included in this listing.








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Hilton Garden Inn Portland Airport

12048 NE Airport Way

Portland , OR 97220

View Map

Refund Policy

No Refunds

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