Medicare Boot Camp Critical Access Hospital and Rural Health Clinic Version

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1 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 fourday 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

2 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

3 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

4 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 ) 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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