Medicare Mastery Workshop Series

The Medicare Mastery Series Workshops offer a variety of in-depth courses exploring niche or challenging topics within the Medicare billing and compliance world. Each course is led by one of HCPro's Medicare boot camp instructors and uses a variety of reference materials, case studies, regulatory education, and best practices to ensure learners have a thorough understanding of each topic and leave knowing how to transform this knowledge into real-world action.

Topics include: Medicare, billing, compliance, medical necessity, observation, utilization review, rural health clinics, medical necessity, coverage, Medicare regulations, IPPS, OPPS, Physician Fee Schedule

Course Objective

Upon completion of this library, learners will be able to:

• Describe rural health clinic payment, billing, and reimbursement concepts
• Understand Medicare patient status designations and requirements
• Navigate and apply various NCCI and I/OCE edits and modifiers
• Explain the intricacies of incident-to and split-shared billing

Course List

• Medical Necessity and NCD/LCDs
• Rural Health Clinic Designation
• Correcting Patient Status
• Incident-to and Split-Shared Billing
• NCCI, I/OCE, Modifiers, and Edits
• Understand the Framework of Medicare Contractors to Reduce and Preserve Revenue

Medical Necessity and NCD/LCDs

Overview: In this module, we will discuss how to use National and Local Coverage Determination Policies to improve documentation within medical records to meet medical necessity guidelines. Additionally, we will discuss how to complete and distribute the Advance Beneficiary Notice (ABN) and the Hospital-Issued Notice of Non-Coverage (HINN) to be compliant with patient rights. Lastly, will discuss the Limitation of Liability (LOL) for patients.

Objectives:

• Understand and use a National or Local Coverage Determination Policy to improve documentation of medical necessity.
• Explain how to complete and distribute the ABN.
• Explain when to provide a HINN Notice.
• Discuss the Limitations of Liability for a Medicare patient.

Audience:

• Medicare
• Revenue Cycle
• Revenue Integrity
• Compliance

Duration: 67 minutes

Rural Health Clinic Designation

Overview: This course is designed to provide a broad overview of the requirements that a clinic must meet in order to be designated a Rural Health Clinic (RHC) for purposes of participating in the Medicare Program and receiving reimbursement for covered services provided to Medicare beneficiaries.

Objectives:

• Define the purpose of an RHC
• Explain key certification criteria, including location, staffing, and required services
• Understand basic requirements for services furnished by RHC practitioners or incident to an RHC practitioner, including supervision requirements
• Identify services that are excluded from the RHC benefit
• Distinguish between an independent and provider-based RHC

Audience:

• Medicare
• Revenue Cycle
• Revenue Integrity
• Compliance

Duration: 66 minutes

Correcting Patient Status

Overview: This course reviews Medicare patient status designations and Medicare Hospital Conditions of Participation for Utilization Review. The course details the requirements for utilization review determinations and how they act as the basis for condition code 44 changes and self-denial processes, as well as the billing and payment implications of each.

Objectives:

• Differentiate Medicare status designations and hospital status designations
• Comply with Hospital Conditions of Participations for Utilization Review determinations
• Evaluate the advantages and disadvantages of the condition code 44 and self-denial processes from a clinical and revenue cycle perspective

Audience:

• Medicare
• Revenue Cycle
• Revenue Integrity
• Compliance

Duration: 103 minutes

Incident-to and Split-Shared Billing

Overview: This course will explain Medicare’s most recent guidance regarding appropriate billing of evaluation and management (E/M) services.

Objectives:

• Identify new/revised/deleted AMA CPT codes
• Apply recent E/M guidance changes
• Differentiate between AMA and CMS guidance
• Use CMS-created Level II HCPCS evaluation and management codes when appropriate

Audience:

• Medicare
• Revenue Cycle
• Revenue Integrity
• Compliance

Duration: 98 minutes

NCCI, I/OCE, Modifiers, and Edits

Overview: This course will cover the specifics of the National Correct Coding Initiative (NCCI) and the Integrated Outpatient Code Editor (I/OCE) used for claims processing. Understanding the intent and application of the NCCI and I/OCE will help providers submit more clean claims the first time and decrease the amount of rework required to receive reimbursement. Knowing this information will also help reduce denials and preserve revenue.

Objectives:

• Describe the rationale behind the National Correct Coding Initiative and its importance and impact on reimbursement.
• Understand how to resolve the edits and submit a compliantly coded claim.
• Describe Medicare’s Integrated Outpatient Code Editor’s functions during claims processing.
• Identify strategies for identifying root causes and addressing edits prior to the claim being created and submitted.

Audience:

• Medicare
• Revenue Cycle
• Revenue Integrity
• Compliance

Duration: 120 minutes

Understand the Framework of Medicare Contractors to Reduce and Preserve Revenue

Overview: This course will cover the various Medicare contractors and the multiple functions each contractor performs. Understanding the different types of contractors can help providers shape their internal auditing and monitoring functions by utilizing information available from the different contractors.  Knowing this information can help practices reduce denials and preserve revenue.

Objectives:

• Identify Federal and State Auditors, their purpose and contribution to safeguarding funds
• Understand CMS Educational Objectives
• Understand the extent of the contractor’s use of data analytics
• Understand where to access audit contractor reports

Audience:

• Medicare
• Revenue Cycle
• Revenue Integrity
• Compliance

Duration: 109 minutes

Continuing Education

Full Library 

AAPC
This program has prior approval of the AAPC for 8.5 Continuing Education Units. Granting of this approval in no way constitutes endorsement by the AAPC of the program, content or the program sponsor. 

ACDIS
This program has been approved for 8.75 continuing education units towards fulfilling the requirements of the Certified Clinical Documentation Specialist (CCDS) certification and CCDS-O (outpatient) certification, offered as a service of the Association of Clinical Documentation Integrity Specialists (ACDIS).

AHIMA
This program has been approved for 8.5 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.

CCB
The Compliance Certification Board (CCB) has approved this event for up to 9.0 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.

NAHRI
This program has been approved for 8.25 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).

Medical Necessity and NCD/LCDs 

AAPC
This program has prior approval of the AAPC for 1.0 Continuing Education Units. Granting of this approval in no way constitutes endorsement by the AAPC of the program, content or the program sponsor.

ACDIS
This program has been approved for 1.0 continuing education units towards fulfilling the requirements of the Certified Clinical Documentation Specialist (CCDS) certification and CCDS-O (outpatient) certification, offered as a service of the Association of Clinical Documentation Integrity Specialists (ACDIS).

AHIMA
This program has been approved for 1.0 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. 

CCB
The Compliance Certification Board (CCB) has approved this event for up to 1.2 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. 

NAHRI
This program has been approved for 1.0 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).

Rural Health Clinic Designation

AAPC
This program has prior approval of the AAPC for 1.0 Continuing Education Units. Granting of this approval in no way constitutes endorsement by the AAPC of the program, content or the program sponsor.

ACDIS
This program has been approved for 1.5 continuing education units towards fulfilling the requirements of the Certified Clinical Documentation Specialist (CCDS) certification and CCDS-O (outpatient) certification, offered as a service of the Association of Clinical Documentation Integrity Specialists (ACDIS).

AHIMA
This program has been approved for 1.0 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.

CCB
The Compliance Certification Board (CCB) has approved this event for up to 1.2 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.

NAHRI
This program has been approved for 1.0 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).

Correcting Patient Status

AAPC
This program has prior approval of the AAPC for 1.5 Continuing Education Units. Granting of this approval in no way constitutes endorsement by the AAPC of the program, content or the program sponsor.

ACDIS
This program has been approved for 1.5 continuing education units towards fulfilling the requirements of the Certified Clinical Documentation Specialist (CCDS) certification and CCDS-O (outpatient) certification, offered as a service of the Association of Clinical Documentation Integrity Specialists (ACDIS). 

AHIMA
This program has been approved for 1.5 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. 

CCB
The Compliance Certification Board (CCB) has approved this event for up to 1.2 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.

NAHRI
This program has been approved for 1.5 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).

Incident-to and Split-Shared Billing

AAPC
This program has prior approval of the AAPC for 1.5 Continuing Education Units. Granting of this approval in no way constitutes endorsement by the AAPC of the program, content or the program sponsor.

ACDIS
This program has been approved for 1.5 continuing education units towards fulfilling the requirements of the Certified Clinical Documentation Specialist (CCDS) certification and CCDS-O (outpatient) certification, offered as a service of the Association of Clinical Documentation Integrity Specialists (ACDIS). 

AHIMA
This program has been approved for 1.5 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.

CCB
The Compliance Certification Board (CCB) has approved this event for up to 1.8 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.

NAHRI
This program has been approved for 1.5 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).

CCI, I/OCE, Modifiers, and Edits

AAPC
This program has prior approval of the AAPC for 2.0 Continuing Education Units. Granting of this approval in no way constitutes endorsement by the AAPC of the program, content or the program sponsor.

ACDIS
This program has been approved for 2.25 continuing education units towards fulfilling the requirements of the Certified Clinical Documentation Specialist (CCDS) certification and CCDS-O (outpatient) certification, offered as a service of the Association of Clinical Documentation Integrity Specialists (ACDIS).

AHIMA
This program has been approved for 2.0 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. 

CCB
The Compliance Certification Board (CCB) has approved this event for up to 2.4 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.

NAHRI
This program has been approved for 2.25 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).

Understand the Framework of Medicare Contractors to Reduce and Preserve Revenue

AAPC
This program has prior approval of the AAPC for 1.5 Continuing Education Units. Granting of this approval in no way constitutes endorsement by the AAPC of the program, content or the program sponsor. 

ACDIS
This program has been approved for 1.5 continuing education units towards fulfilling the requirements of the Certified Clinical Documentation Specialist (CCDS) certification and CCDS-O (outpatient) certification, offered as a service of the Association of Clinical Documentation Integrity Specialists (ACDIS).

AHIMA
This program has been approved for 1.5 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. 

CCB
The Compliance Certification Board (CCB) has approved this event for up to 1.2 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. 

NAHRI
This program has been approved for 1.0 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.