Live Virtual Medicare Boot Camp®—Hospital Version

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Live Virtual Medicare Boot Camp®—Hospital Version

Product Code: MBCV

1st Attendee $999.00*
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* Next registration cut-off date: 1/17/2022

To register multiple attendees, please call our sales team at 615-724-7200.

Live Virtual Medicare Boot Camp®—Hospital Version

Course Overview

Join our widely renowned Medicare regulatory specialists for a live virtual class covering Medicare edits, claims processing issues, the latest changes to the inpatient-only list, prior authorizations, and the latest guidance on COVID-19 issues, including coding and billing. The virtual Medicare Boot Camp—Hospital Version unlocks the answers to all of your Medicare questions right from your office or home.

This class provides insights into the CMS initiatives affecting your revenue. We delve into the details of regulatory changes and how to apply them. You’ll leave class understanding the revenue implications and ready to make improvements that will strengthen reimbursement and compliance for your hospital or health system. We also give you the research tools and skills to navigate Medicare's resources so that you can answer your own questions long after class is over.

Medicare Boot Camp—Hospital Version includes comprehensive sections explaining the complexities of:

  • The 2-midnight benchmark and presumption
  • Coverage under NCDs, LCDs, and CED
  • Inpatient order requirements
  • Inpatient-only procedures, including changes for 2020
  • 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

How does the Live Virtual Medicare Boot Camp—Hospital Version work?

Class is held Mondays – Friday for 2 weeks from 12:30 p.m. – 4:30 p.m. Eastern Time (10 classes).

Please Note: Four days before class starts, you will receive a welcome email that includes the dial-in information for the class.

Class is held Monday – Friday from January 24 – February 4. Registration cut-off date: 1/17/2022

Looking to train your whole team? We can bring our expert instructors to you! Learn more here!

Live Virtual Medicare Boot Camp®—Hospital Version

Meet Our Instructor

Kimberly Hoy, JD, CDC, is the Director of Medicare and Compliance for HCPro, Inc. She oversees HCPro’s Medicare Boot Camps® and is the lead instructor for HCPro’s Medicare Boot Camp®—Hospital Version, Utilization Review Version, and Provider-Based Department Version. Kimberly serves as a Regulatory Specialist for HCPro’s Medicare Watchdog services, specializing in regulatory guidance on coverage, billing and reimbursement. She is a frequent expert on HCPro’s audio-conferences and has been a speaker at national conferences on patient status and observation.

Live Virtual Medicare Boot Camp®—Hospital Version


Medicare Resources and Coverage

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
  • Links to Medicare resources and resources for staying current

Module 3:  Medical Necessity and Limitation on Liability Notices

  • Medicare Coverage Center, including LCDs, NCDs, CED and Lab Coverage Manual
  • Prior authorization for specified outpatient procedures and services
  • Limitations of liability statute and notice requirements
  • The Advance Beneficiary Notice (ABN) form and instructions

Medicare Claims, Edits and Billing

Module 4:  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 5:  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 6:  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


Medicare Outpatient Payments and Surgery Claims Issues

Module 7:  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
  • Surgical C-APCs, including complexity adjustment
  • Payment under the OPPS, including outlier
  • Part B deductible and coinsurance

Module 8:  Outpatient Surgical Services, including Implantable Devices

  • Inpatient-only procedures
  • Multiple procedure discount for minor surgical services
  • Modifiers for terminated, discontinued and bilateral procedures
  • Device intensive procedures and procedure-to-device edits
  • Pass-through devices
  • Free and reduced-cost device reporting


Visits and Ancillary Issues

Module 9:  Outpatient Visits and Provider Based Departments

  • Incident-to coverage of outpatient therapeutic services
  • Defining on- and off-campus departments, proper use of modifiers -PO and -PN
  • Coding for clinics, emergency departments, critical care and trauma activation
  • Proper use of modifier 25
  • Payment for off-campus department services
  • Therapy coding, including “sometimes” and “always” therapy codes
  • Payment for therapy under the Physician Fee Schedule, including therapy caps

Module 11:  Outpatient Drugs

  • Coverage of drugs, including self-administered drugs
  • Packaged, pass-through and non-pass-through drugs and biologicals
  • Payment of 340B purchased drugs, including proper use of modifier JG and TB
  • Discarded Drugs
  • Biological skin substitutes

Module 12:  Outpatient Radiology and Laboratory Services

  • Coverage requirements for outpatient diagnostic services
  • Appropriate Use Criteria for Advanced Imaging Services
  • Imaging Family Composite APCs
  • Special Radiology Modifiers
  • Radiation Therapy
  • Laboratory billing and coding issues, including date of service
  • Payment for labs under the Laboratory Fee Schedule, including reference lab
  • Blood and blood products


Medicare Patient Status Issues

Module 10:  Observation Services

  • Coverage of observation services
  • Delivery of the Medicare Outpatient Observation Notice (MOON)
  • Billing of observation services
  • Observation Comprehensive APC Payment

Module 13:  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 billing and payment


Medicare Inpatient Notices and Payment

Module 14: Inpatient Utilization Review, Notices and Billing Issues

  • Important Message from Medicare (IMM) and Detailed Notice of Discharge
  • Hospital Issued Notices of Non-Coverage (HINN)

Module 15:  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 16:  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 subject to change

Live Virtual Medicare Boot Camp®—Hospital Version


January/February — Class Schedule (Eastern time)

January 24 12:30 p.m. – 4:30 p.m.
January 25 12:30 p.m. – 4:30 p.m.
January 26 12:30 p.m. – 4:30 p.m.
January 27 12:30 p.m. – 4:30 p.m.
January 28 12:30 p.m. – 4:30 p.m.
January 31 12:30 p.m. – 4:30 p.m.
February 1 12:30 p.m. – 4:30 p.m.
February 2 12:30 p.m. – 4:30 p.m.
February 3 12:30 p.m. – 4:30 p.m.
February 4 12:30 p.m. – 4:30 p.m.

Live Virtual Medicare Boot Camp®—Hospital Version

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

Live Virtual Medicare Boot Camp®—Hospital Version

Continuing Education

This program has been approved by the AAPC for 34.5 continuing education hours. Granting of prior approval in no way constitutes endorsement by AAPC of the program content or the program sponsor.

American Health Information Management Association (AHIMA)
This program has been approved for 34 CE credits for use in fulfilling the continuing education requirements of the American Health Information Management Association (AHIMA).

American Nurses Credentialing Center (ANCC)
HCPro is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.

This educational activity for 34.5 nursing contact hours is provided by HCPro.

Association of Clinical Documentation Integrity Specialists (ACDIS)
This program has been approved for 34.5 continuing education units towards fulfilling the requirements of the Certified Clinical Documentation Specialist (CCDS) certification, offered as a service of the Association of Clinical Documentation Integrity Specialists (ACDIS).

California Board of Registered Nursing
HCPro is approved by the California Board of Registered Nursing to provide 41.4 nursing contact hours. California BRN Provider #CEP 14494.

Commission for Case Manager Certification (CCMC)
This program has been pre-approved by The Commission for Case Manager Certification to provide 34.5 hours of continuing education credit to CCM board certified case managers.

Compliance Certification Board (CCB)
The Compliance Certification Board (CCB) has approved this event for up to 41.4 CCB CEUs. Continuing Education Units are awarded based on individual attendance records. Granting of prior approval in no way constitutes endorsement by CCB of this program content or of the program sponsor.

National Association of Healthcare Revenue Integrity (NAHRI)
This program has been approved for 34.5 continuing education units towards fulfilling the requirements of the Certification in Healthcare Revenue Integrity (CHRI), offered as a service of the National Association of Healthcare Revenue Integrity (NAHRI).

National Association of State Boards of Accountancy (NASBA)
Earn up to 41 CPE Credits!
Program Level: Basic
Delivery Method: Group-Live
Field of Study: Specialized Knowledge

HCPro is registered with the National Association of State Boards of Accountancy (NASBA) as a sponsor of continuing professional education on the National Registry of CPE Sponsors. State boards of accountancy have final authority on the acceptance of individual courses for CPE credit. Complaints regarding registered sponsors may be submitted to the National Registry of CPE Sponsors through its website:

Disclosure Statement:

HCPro has confirmed that none of the faculty/presenters, planners, or contributors have any relevant financial relationships to disclose related to the content of this educational activity.

Live Virtual Medicare Boot Camp®—Hospital Version


What is the focus of the Medicare Boot Camp?
Medicare Boot Camp—Hospital Version is an intensive course on Medicare coverage, billing, coding, and payment for hospital outpatient and inpatient services. The course is technically oriented and focuses on the Medicare regulations and guidelines applicable to hospital services. The objective of the course is to provide participants with a detailed understanding of the Medicare "rules," placing a particular emphasis on the operational application of those rules.

What computer set-up do I need to attend this class?
This will be hosted on the GoToMeeting platform. Attendees should have access to a computer that has a microphone and speakers to participate, there is also an option to dial-in over a phone line if you need to connect on your phone. You can read the full system requirements for GoToMeeting by visiting You can also test your system by visiting

What material does the course cover?
To view the course outline, click on "Course Outline" above.

Does the course require any previous experience or training?
No. The course starts with Medicare fundamentals and does not assume that participants have any particular background or experience. However, because of the fast-paced nature of the course, it is recommended (but not required) that participants have at least one year of experience working in a hospital. Familiarity with the ICD-10-CM and CPT coding systems is helpful, but not required.

What should I have available for each session?
For each class, participants should have their packet of materials and may wish to also have available a highlighter, notebook for taking notes, and sticky notes/flags.

Are there recordings of the sessions?
In the event a participant is unable to attend a particular session, recordings will be made available for the duration of the course and a limited time after to allow the participant to complete the quiz required for CEUs.  Class participation and break out sessions are an important part of the learning experience for the course. Students are expected to attend scheduled classes whenever possible.

What if I have a question that didn’t get addressed in class?
The course offers open office hours each week to address topics related to the course materials and class discussion.  Questions should be related to the course and topics discussed throughout the course.  Instructors are not able to address questions outside the scope of the course.

Does this course prepare participants for coding certification?
Medicare Boot Camp—Hospital Version contains a review of pertinent coding issues as they relate to Medicare coverage, billing, and payment; however, it is not primarily designed as a coding course. HCPro does offer two courses focused on coding fundamentals: The Certified Coder Boot Camp®—Original Version focuses on coding for physician and hospital outpatient services, while the Certified Coder Boot Camp®—Inpatient Version focuses on hospital inpatient facility services. These courses may assist participants in preparation for national coding certification. For more information, please review the information for these courses using the links above, or contact customer service at or 800-650-6787.

Does HCPro offer "on-site" Medicare Boot Camps?
In addition to our open registration courses, we also offer the Medicare Boot Camp—Hospital Version Virtual as an on-site program (with a substantial discount) for organizations that have a number of employees who need training. For more information on hosting an on-site Boot Camp, click on Host an On-Site Course.

What if I need to cancel or transfer my registration?
Cancellation Policy
Please click here to view our cancellation policy.

Who typically attends the Medicare Boot Camp?

  • 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

What do I need to know prior to attending?
Please read further with our Get Ready for Class outline.

Does HCPro ever share contact information (e.g., name, address, phone number, email address, etc.) with other companies?
Historically, we have not shared contact information with anyone outside of our company. However, it is possible that at some point we might share contact information with other companies that offer products and services that we think would be of interest to our customers. If you would like us to keep your contact information confidential, please let us know so that we can flag your information in our customer database as "Do Not Share."

How do I get more information:
Contact our sales team at 615-724-7200 or email