Medicare Boot Camp®—Utilization Review Version (blr) S

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Renaissance Orlando at SeaWorld®

6677 Sea Harbor Drive

Orlando, FL 32821

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Medicare Boot Camp®—Utilization Review Version


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 2019, 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 2019

  • 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

Who should attend?

  • Utilization review coordinators

  • Utilization management managers and directors

  • Utilization review committee members

  • UR physician advisors

  • Case managers

  • Care coordinators

  • Revenue cycle staff

  • Nurse managers

  • Compliance officers and auditors

  • CFOs, CNOs, and VPs

  • Fiscal intermediary personnel

  • Healthcare lawyers and consultants

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.

Medicare Boot Camp®—Utilization Review Version
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

Medicare Boot Camp®—Utilization Review Version
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)

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

Service fees included in this listing.


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Renaissance Orlando at SeaWorld®

6677 Sea Harbor Drive

Orlando, FL 32821

View Map

Refund Policy

No Refunds

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