Medicare Boot Camp®—Hospital Version (AHM) S

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Hilton Garden Inn Orlando International Drive North

5877 American Way

Orlando, FL 32819

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Medicare Boot Camp® - Hospital Version


Course Overview

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

  • 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


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.

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

Service fees included in this listing.

MYL190123CEV MYL190719CHK

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Date and Time


Hilton Garden Inn Orlando International Drive North

5877 American Way

Orlando, FL 32819

View Map

Refund Policy

No Refunds

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