Live Virtual Medicare Boot Camp®—Denials and Appeals & Healthcare Claims Audit

Course Overview

Develop a strategic risk-based audit process, reduce claim denials, and win appeals

With the evolution of reimbursement models, healthcare legislation, and CMS policies, organizations cannot afford to write off appealable denials. Live Virtual Medicare Boot Camp®—Denials and Appeals & Healthcare Claims Audit provides an in-depth look at denials management and appeal processes. In addition, this Boot Camp teaches you how to develop a meaningful claims audit process from beginning to end, incorporating official guidance and regulations needed for an effective compliance program. You’ll leave this class armed with a thorough understanding of these processes, ready to translate your new knowledge into tangible results.

You will leave this program knowing how to:

• Prepare for CMS audits
• Implement policies to identify disputable denials and support appeals
• Navigate the appeals process up through and beyond the Administrative Law Judge level
• Research upcoming audit focus areas
• Assess areas of risk within your organization
• Develop an effective risk-based audit process

Leave this course with an understanding of:

• RHC reporting of revenue codes, HCPCS codes, and related charges for all services provided
• Outpatient observation, inpatient status rules, and UR requirements at CAHs
• How to process claims, get paid, and manage your revenue cycle through CMS guidance

Who should attend?

The course is fit for any member of your billing, revenue, or clinical team who wants to learn more about navigating appeals, denials, or audits, including:

• Revenue cycle directors and managers
• Revenue integrity directors, managers, and staff
• HIM directors, managers, and staff
• CDI directors, managers, and specialists
• Compliance directors, officers, and auditors
• Business office managers
• Case management directors and managers
• Case managers
• Utilizations review staff
• Utilization management staff
• Physician advisors
• Audit directors and coordinators
• Auditors
• Appeals coordinators
• Patient financial services directors
  
  

Want to attend only the Denials and Appeals modules, or only the Healthcare Claims Audit modules? You can! Make your selection of class preference at the top of this page – take the individual class that is most relevant to you, or take the combined class! For more information, visit these individual pages:

Live Virtual Medicare Boot Camp®—Denials and Appeals Version
Live Virtual Medicare Boot Camp®—Healthcare Claims Audit

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).

How does the Live Virtual Medicare Boot Camp®—Denials and Appeals & Healthcare Claims Audit work?

Class is held Monday – Friday for 1 week: 11:00 p.m. – 3:30 p.m. on Monday and Tuesday, and 11:00 p.m. – 5:00 p.m. Wednesday – Friday Eastern Time (5 classes).

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

Monday – Wednesday from July 31 – August 4. Registration cut-off date: 7/24/2023

Monday – Wednesday from October 2 – October 6. Registration cut-off date: 9/25/2023

How does the Live Virtual Medicare Boot Camp®—Denials and Appeals Version work?

This class is three sessions. Class is held Wednesday – Friday from 11:00 p.m. – 5:00 p.m. Eastern Time.

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 – Wednesday from August 2 – August 4. Registration cut-off date: 7/26/2023

Class is held Monday – Wednesday from October 4 – October 6. Registration cut-off date: 9/27/2023

How does the Live Virtual Medicare Boot Camp®—Healthcare Claims Audit work?

Class is held Monday – Tuesday for 1 week from 11:00 p.m. – 3:30 p.m. Eastern Time (2 classes).

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

Thursday – Friday from July 31 – August 1. Registration cut-off date: 7/24/2023

Thursday – Friday from October 5 – October 6. Registration cut-off date: 9/28/2023

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

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

Live Virtual Medicare Boot Camp®—Denials and Appeals & Healthcare Claims Audit

Outline/Agenda

Day 1 & 2

Overall Learning Objectives:

• Equip denials and appeal staff with effective and efficient strategies to effectively review and respond to denials and appeals.
• Gain a working understanding of the Medicare appeals levels.
• Gain a working understanding of Commercial appeals processes and strategies.
• Understand various areas of research necessary to respond and effectively draft an appeal.
• Gain an understanding of common commercial contractual clauses that impact audits and appeals.
• Gain a solid understanding how to construct a solid appeal letter and the necessary components to include in appeal letters.

Module 1: Denials and Appeals Overview

• Understanding the types of denials
• Steps involved when handling denials
• The main structure of appeals
• Timeline associated with appeals

Module 2: Medicare Overview and Contractors

• The Four Parts of Medicare
• Medicare Contractors
• Independent Government Agencies-Medicare Involvement

Module 3: Medicare, Medicaid, and Commercial Research and Resources

• Web-Based Resources
• Key Sources of Authority
• Medicare Coverage Center, including LCDs NCDs, CED and Lab Coverage Manual
• Medicaid Manual Research
• Commercial Payor Research
• Common Contractual Language in Commercial Contracts
• Ways to Stay Current

Module 4: Prepayment Claim Reviews/Audits

• Prepayment Reviews Overview
• Automated Prepayment Reviews
• Prepayment Non-Medical Record Reviews
• Prepayment Medical Record Reviews

Module 5: Postpayment Claim Reviews/Audits

• Establishment of Postpayment Claim Review/Audits Process
• Postpayment Claim Reviews/Audits Overview
• Postpayment Non-Medical Record Reviews
• Statistical Sampling and Extrapolations
• Postpayment Medical Record Reviews

Module 6: Medicare FFS Claim Appeals Process

• Initial Determinations
• Reopenings and Overlap with Appeals Process
• Level 1 Appeal Process: Redetermination
• Level 2 Appeal Process: Reconsideration
• Level 3 Appeal Process: Administrative Law Judge (ALJ) Hearing
• Level 4 Appeal Process: Medicare Appeals Council
• Level 5 Appeal Process: Judicial Review in U.S. District Court

Module 7: Commercial Audit and Appeals Process

• Audit Overview
• Appeals Process
• Strategies for Appeals
• Common appeal levels

Module 8: No Surprises Act Appeal Process

• Overview of the No Surprises Act
• Qualifying Payment Amount
• Good faith negotiation
• Arbitration

Module 9: Drafting and Constructing an Appeal Letter

• Overview of common elements of appeal letter
• Specific items to address in an appeal letter
• Structure of an effective appeal letter
• Identifying proper sources

Day 3
Overall Learning Objectives

• Understand the overall framework of conducting a claims audit
• Learn various steps needed based on the type of claims audit
• Understand how to examine and determine risk areas
• Learn how to pull a relevant audit sample and different methods for doing so
• Learn how to draft a comprehensive and meaningful audit report

Module 1: Audit Framework Overview and Resources

• Compliance plan
• Internal policies and procedures
• Scheduling
• Review and final sign-off
• Overall scope and objective

Module 2: Sources of Authority

• Medicare and Medicaid manuals
• Provider manuals
• NCDs and LCDs
• Transmittals

Module 3: Assessing Areas of Risk

• OIG Work Plan
• CERT, RAC, and TPE audit topics
• Comparative Billing Report
• Third-party audit requests
• Denial trends
• New services
• New and changed payment policies

Module 4: Risk-Based Audits

• Overall structure
• Benefits
• Identifying unique risks to an organization
• PEPPER reports
• Targeting outliers

Module 5: Selecting an Audit Sample

• Identifying the purpose and objective
• Volume and dollar selection
• Payer type and relevance
• Determining what to omit
• Randomized versus statistical sample

Module 6: Managing Audit Details

• Organization structure and impact
• Required documentation
• Electronic versus paper files
• End deliverables
• Managing voluminous audits

Module 7: Drafting an Audit Report

• Executive summary
• Background
• Scope and objectives
• Sample methodology
• Error rate calculation
• Regulatory criteria
• Detailed findings

Module 8: Audit Findings and Follow-Up

• Meaningful audit findings
• Communication of findings
• Ownership and action plan
• Education and training
• Follow-up process and necessity

Module 9: Remittance and Payer Communication

• How to read a remittance/EOB
• Meanings of remittance/EOB terms
• Different payer communications
• Remittance Advice Remark Codes

Course Agenda/Outline is subject to change.

Live Virtual Medicare Boot Camp®—Denials and Appeals & Healthcare Claims Audit

Schedule

July / August — Class Schedule (Eastern time)

October — Class Schedule (Eastern time)

Live Virtual Medicare Boot Camp®—Denials and Appeals Version

Schedule

August — Class Schedule (Eastern time)

October — Class Schedule (Eastern time)

Live Virtual Medicare Boot Camp®—Healthcare Claims Audit

Schedule

July / August — Class Schedule (Eastern time)

October — Class Schedule (Eastern time)

Live Virtual Medicare Boot Camp®—Denials and Appeals & Healthcare Claims Audit

Questions/ Answers

What is the focus of the Medicare Boot Camp®—Denials and Appeals & Healthcare Claims Audit Version?
The Medicare Boot Camp®—Denials and Appeals & Healthcare Claims Audit version is an intensive, three-day course on Medicare appeals and denials management, covering the Medicare claims review processes, types of audits and how providers should respond to them, and the different levels of the appeals process. The goal of the course is to provide participants with a sound understanding of the audit, denial, and appeal processes, including the payer perspective, based directly upon current regulations.

Where is the course offered?
Open registration sessions 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 courses, click on "Locations/Dates" above.

Does HCPro offer an "on-site" version of this Boot Camp?
In addition to our open registration courses, we also offer this boot camp 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?
To view our cancellation policy, click here.

Who typically attends the Medicare Boot Camp®— Denials and Appeals & Healthcare Claims Audit Version?

• Revenue cycle directors and managers
• Revenue integrity directors, managers, and staff
• HIM directors, managers, and staff
• CDI directors, managers, and specialists
• Compliance directors, officers, and auditors
• Business office managers
• Case management directors and managers
• Case managers
• Utilizations review staff
• Utilization management staff
• Physician advisors
• Audit directors and coordinators
• Auditors
• Appeals coordinators
• Patient financial services directors

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.

How is the course taught?
The course is taught using a combination of lecture, class discussion, and hands-on exercise/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, please bring the following to all classes:

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

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.

Live Virtual Medicare Boot Camp®—Denials and Appeals & Healthcare Claims Audit

Learning Objectives

*Coming Soon!

Continuing Education

* Coming Soon! 

Live Virtual Medicare Boot Camp®—Denials and Appeals Version

Continuing Education

AAPC
This program has been approved by the AAPC for 16 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 16 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).

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 16 nursing contact hours.

CCB
The Compliance Certification Board (CCB) has approved this event for up to 19.2 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.

CCMC
This program has been pre-approved by The Commission for Case Manager Certification to provide 15 hours of continuing education credit to CCM board certified case managers.

NAHRI
This program has been approved for 16 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.

Live Virtual Medicare Boot Camp®—Healthcare Claims Audit

Continuing Education

Coming Soon!