Boot Camps

Medicare Boot Camp®—Hospital Version

Course Overview

Medicare Explained: Understand the latest CMS rules and their application

Join our widely renowned Medicare regulatory specialists for a class covering Medicare coverage, billing, coding, NCCI edits, claims processing, and the latest changes to the inpatient-only list, prior authorizations, and more. The Medicare Boot Camp—Hospital Version unlocks the answers to all of your Medicare questions.

This class provides insights into the CMS initiatives affecting your revenue. We delve into the details of Medicare regulations 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 a resource manual and research tools and skills to navigate Medicare's resources so that you can answer your own questions long after class is over.

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

• Coverage under NCDs, LCDs, and CED
• Outpatient coverage and physician supervision
• NCCI edits, including PTP edits and MUEs
• Provider-based department and clinic billing and coding
• Observation coverage, billing, and payment
• The 2-midnight benchmark
• Inpatient order and certification requirements
• Inpatient-only procedures, including recent audit changes
• Inpatient Part B reimbursement for non-covered inpatient stays
• Payment under the OPPS and IPPS
• Patient deductible and copayment amounts
• ABNs, HINNs and billing non-covered services
• Medicare websites and resources
• Changes to the inpatient-only list, with a new auditing strategy by CMS
• COVID billing, coding, and payment changes
• Changes to prior authorization and appropriate use criteria programs
• Medicare Secondary Payer

You will leave this program knowing how to:

• Understand the basis for denials and prevent them
• 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 claim delays and missed revenue
• Implement best practices to get the revenue you deserve while staying in compliance

Who should attend?

Whether you are looking to get up to speed with the newest CMS initiatives or put all the pieces together for a better understanding of Medicare, this course is the right fit for you. Our students range from people new to their job just making their way through the tangle of Medicare requirements to people with years of experience looking to keep up to date and improve their understanding of the most complex Medicare issues. During this Boot Camp, you will learn more about current Medicare rules and their operational application.

• Compliance officers and staff
• Business office managers and staff
• Revenue Integrity managers and staff
• Chargemaster personnel
• Billers and coders
• Claims auditors
• Denials management and appeals staff
• 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.

Applied learning: Case studies throughout each module ensure participants 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).

For more information about our Boot Camps, contact us at 615-724-7200 or email PD-IS@SimplifyCompliance.com.

Medicare Boot Camp®—Hospital Version

Course Locations & Dates

Below is the current course schedule for upcoming classes of Medicare Boot Camp—Hospital Version. We update this schedule on a regular basis.

Registrations are processed in the order received. Class size is limited and classes often sell out. We recommend against making travel arrangements until after we have confirmed your course registration.

To register for a class, click the "Register" button. If you would like to register multiple attendees, fill in the "Additional Attendees" box or call our sales team at 615-724-7200 or email us at PD-IS@SimplifyCompliance.com.

Locations marked as "Tentative" are subject to change.

To view our cancellation policy, click here.

November 2023

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Medicare Boot Camp®—Hospital Version

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
• 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

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

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

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 10:  Observation Services

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

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

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

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)
• Utilization review determinations and short stay audits
• Inpatient Part B billing and payment

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/Outline is subject to change.

Medicare Boot Camp®—Hospital Version

Things to Know Before Attending Class

Directions and Hotel Information

The hotel address, phone number, URL, room rate and room rate cut-off date are posted on the Locations/Dates tab. The hotel websites give detailed directions to the hotel as well as information about the location. Please call the hotel directly to make a room reservation. Be sure to identify yourself as an HCPro Boot Camp participant. Please be sure to make your reservation before the cut-off date. After the cut-off date, contact the hotel to determine room availability and rates.

Course Materials

When you arrive at class, you will receive extensive workbooks containing the class materials utilized throughout the boot camp. The workbooks will be yours to keep, so plan accordingly in allowing enough room in your luggage on the return trip home. Workbooks may also be shipped from the hotel at your own expense.

Classroom Time

It is an understatement to say that this course is intense. Other than breaks, we will be in class from 8:00am to 5:00pm. Monday-Thursday, and from 8:00am to 1:00pm on Friday. There will be about a one hour lunch break each day. If the class gets behind, class may run later than 5:00pm.  

Lunch

We will take about a one hour break for lunch each day. Although we typically provide coffee in the morning and drinks and snacks in the afternoon, everyone is on their own for lunch. Note that many hotels do not have restaurants on-site. If you are flying to the course, we generally recommend renting a car.

What to Bring to Class

We recommend you bring the following to all classes:

• Your current ICD-10-CM manual is highly suggested
• Notepaper
• Sticky Notes/flags
• Pen/Pencil
• Highlighter
• Layered clothing (e.g., light sweater, light jacket, etc.)

Use of Laptop Computers or Electronic Devices

Our instructors demonstrate where to find many resources on the CMS website. If you have access to a laptop or tablet you may bring it to class to follow along, but you may wish to consider the power and wireless needs of your device. Many conference rooms do not have plugins situated conveniently to the tables so you may wish to ensure you have sufficient battery power. HCPro does not purchase group wireless access for the conference rooms, but many hotels provide free wireless access. You may wish to confirm your connectivity options prior to arriving at the hotel. Please be courteous in your use of electronic devices. Use of electronic devices should not disrupt the class or disturb other participants. HCPro is not responsible for lost, stolen or damaged devices. Maintaining the security and safety of your device is your responsibility. Cell phone use during class is strictly prohibited.

Dress

Business attire is not necessary. Please dress comfortably. Also, we find that the classrooms are sometimes on the cool side, even during the warmer months. You may be more comfortable if you bring a sweater or sweatshirt in case you get cold.

Copyright Protection of Course Materials

You will receive a complete copy of our course materials at the beginning of class. The materials used in connection with this course were custom designed by our company specifically for use in connection with this course. We have invested a tremendous amount of time, money and effort in developing, refining and maintaining these materials and they are protected by copyright laws. Course materials may not be duplicated. You may use the materials (i) in direct connection with the course or (ii) as a personal reference in your day-to-day work. No claim is asserted to any U.S. Government, American Medical Association or American Hospital Association works included in the course materials workbook. 

Cancellation and Transfer Policy

For our cancellation and transfer policy, visit our website: http://hcmarketplace.com/cancellations

COVID Safety

Simplify Compliance and HCPro place the highest priority on the safety of our guests. In preparation for attendance at our events, we want to share the following measures to promote health and well-being:

• If the region where our event is located is deemed by the CDC to be within the substantial or high-risk category, we will require all attendees, regardless of vaccination status, to wear masks when indoors except while actively eating or drinking. 
• Meeting rooms will be set to support social distancing when necessary.
• Food service will follow the safety guidelines implemented by the hotel. 

To view all the safety measures that a specific hotel has implemented, please see the information listed on their website.

Simplify Compliance and HCPro will continue to monitor the COVID-19 environment and the recommended guidelines, and will communicate adjustments to the onsite policies and procedures as necessary.

Contact Information

For more information about our Boot Camps, contact us at 615-724-7200 or email PD-IS@SimplifyCompliance.com.

We Look Forward to Having You In Class!

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

Continuing Education

AAPC
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.

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 Improvement Specialists (ACDIS).

AHIMA
This program has been approved for continuing education unit(s) (CEUs) for use in fulfilling the continuing education requirements of the American Health Information Management Association (AHIMA). Granting of Approved CEUs from AHIMA does not constitute endorsement of the program content or its program provider.

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

This activity is available for 22.5 nursing contact hours.

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.

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.

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).

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.

Medicare Boot Camp®—Hospital Version

Questions/Answers

What is the focus of the Medicare Boot Camp®—Hospital Version?
The Medicare Boot Camp®—Hospital Version is an intensive four-and-a-half-day 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.

Where is the course offered?
Open registration Medicare Boot Camps are offered at various locations around the country, typically at mid-priced business hotels such as Hyatt Place or Hilton Garden Inn. For a current schedule of upcoming open registration Medicare Boot Camps, click on "Locations/Dates" above.

Does this course prepare participants for coding certification?
The 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 please contact us at 615-724-7200 or email pd-is@simplifycompliance.com.

Does HCPro offer "on-site" Medicare Boot Camps?
In addition to our open registration courses, we also offer the Medicare Boot Camp®—Hospital Version 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?

• Chargemaster personnel
• Billers and coders
• Medical records/health information personnel
• Compliance officers
• Registration personnel
• Medicare Advantage and MAC personnel
• Healthcare lawyers, consultants, and CPAs
• Legal department personnel

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.

How is the course taught?
The course is taught using a combination of lecture, class discussion, and case studies.

What do I need to bring to class?
When you arrive at class, you will receive an extensive notebook of course materials. In addition, you may want to bring the following to all classes:

• A highlighter
• A notebook for taking notes
• Sticky notes/flags

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 us at 615-724-7200 or email PD-IS@SimplifyCompliance.com.

Medicare Boot Camp®—Hospital Version

COVID Safety

Simplify Compliance and HCPro place the highest priority on the safety of our guests. Simplify Compliance and HCPro will continue to monitor the COVID-19 environment and the recommended guidelines and will communicate adjustments to any onsite policies and procedures outlined in the Getting Ready for Class document that will be emailed to attendees one week and one business day prior to the class.