Live Virtual Medicare Boot Camp®—Critical Access Hospital and Rural Health Clinic Version

Course Overview

Master Medicare rules for critical access hospitals and rural health clinics

Join our industry-leading instructors as they lead a LIVE virtual class covering Medicare coverage, coding, billing, and payment for critical access hospitals (CAH) and rural health clinics (RHC). This course prepares you to better manage your revenue cycle in your unique setting by focusing on actual guidance from CMS. You’ll leave class ready to make improvements that will strengthen reimbursement and compliance for your CAH and RHC.

This one-of-a-kind class designed specifically for CAHs and RHCs shows 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. You’ll have the research tools and skills at your fingertips to answer your own Medicare questions long after the virtual event is over.

Live Virtual Medicare Boot Camp®—Critical Access Hospital and Rural Health Clinic Version will give you the knowledge to:

• Find the answers to your specific Medicare questions relating to CAHs and RHCs
• Understand outpatient observation, inpatient status rules, and utilization review (UR) requirements at CAHs
• Submit accurate claims to Medicare, including CAH Part B inpatient billing
• Ensure appropriate reimbursement from Medicare for outpatient, inpatient, and swing bed services, including the application of the patient’s financial responsibility
• Research and resolve claim edits that cause denials and delay revenue in your CAH and RHC
• Understand RHC reporting of revenue codes, Healthcare Common Procedure Coding System (HCPCS) codes, and related charges for all services provided
• Explain the all-inclusive rate (AIR) payment in independent and provider-based RHCs, including the application of Medicare Part B deductible and coinsurance
• Implement best practices to receive the revenue you deserve for your CAH and RHC while staying in compliance with the regulations

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?
This course is best for healthcare staff looking to strengthen their knowledge of Medicare coding, billing, and reimbursement in both the CAH and RHC settings.

• Auditors and analysts
• Billing specialists
• CAH revenue cycle, compliance, case management, and clinical personnel
• Chargemaster coordinators and managers
• Chief financial officers
• Clinic managers and department heads
• Clinical documentation integrity specialists
• Coding specialists
• Compliance officers
• Finance and reimbursement managers
• Health plan financial analysis, claims processing, and provider relations professionals
• Healthcare consultants, CPAs, and lawyers
• HIM directors and managers
• Medicare Administrative Contractors
• Patient access/admitting staff
• Physician advisors
• Provider-based clinical personnel
• Recovery audit coordinators
• RHC revenue cycle, compliance, case management, and clinical personnel

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®—Critical Access Hospital Version
Live Virtual Medicare Boot Camp®—Rural Health Clinic Version

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.
• Hands-on learning: Attendees work a set of case studies within  each module to ensure they 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®—Critical Access Hospital and Rural Health Clinic Version work?

Class is held Mondays – Thursday for 2 weeks from 1:00 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 – Thursday from August 5 – August 15. Registration cut-off date: 7/29/2024

Class is held Monday – Thursday from November 4 – November 14. Registration cut-off date: 10/28/2024

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

Classes will be held Monday – Thursday week 1 and Monday – Tuesday week 2 from 12:30 p.m. – 4:30 p.m. Eastern Time (6 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 – Thursday, then Monday – Tuesday from August 5 – August 13. Registration cut-off date: 7/29/2024

Class is held Monday – Thursday, then Monday – Tuesday from November 4 – November 12. Registration cut-off date: 10/28/2024

How does the Live Virtual Medicare Boot Camp®—Rural Health Clinic Version work?

Class is held Wednesday – Thursday for 1 week from 12:30 p.m. – 4:30 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.

Class is held Wednesday – Thursday from August 14 – August 15. Registration cut-off date: 8/7/2024

Class is held Wednesday – Thursday from November 13 – November 14. Registration cut-off date: 11/6/2024

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

Live Virtual Medicare Boot Camp®—Critical Access Hospital and Rural Health Clinic Version

Course Outline/Agenda

Critical Access Course Agenda

Module 1: Overview of Critical Access Hospital (CAH) Designation

• General requirements for CAH designation
• Limitations on acute care beds and length of stay
• Identification of and use of beds excluded from licensure limitations

Module 2: Medicare Overview, Contractors, Research, and Resources

• Overview of Medicare Parts A, B, C, and D
• Medicare contractors, including Medicare Administrative Contractors (MAC), Recovery Auditors (RAC), and Quality Improvement Organizations (QIO)
• Medicare source laws, including statutes, regulations, and final rules
• Medicare sub-regulatory guidance, including manuals and transmittals
• Links to Medicare information and resources for staying current

Module 3: Medical Necessity, Limitation on Liability Notices, and Medicare Advantage Plans

• Medicare Coverage Center, including local and national coverage determinations (LCD/NCD), coverage with evidence development (CED), and Lab Coverage Manual
• Prior authorization for specified outpatient procedures and services
• Limitation on liability statute and notice requirements
• Medicare Advantage Plans

Module 4: Medicare Claim Submission Fundamentals and Billing Issues

• UB-04 claim form and key fields applicable to a CAH
• Outpatient repetitive, non-repetitive, and recurring services
• Outpatient services billed separately from inpatient claims
• Advance Beneficiary Notice (ABN) form and instructions
• Billing of non-covered outpatient services

Module 5: Medicare Edit Systems

• Medicare Code Editor (MCE) and Outpatient Code Editor (OCE)
• 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 6: Overview of the Cost-Based Reimbursement System

• Components of the cost-based system
• Method I and Method II billing
• Quality Payment Program under Method II billing
• CRNA pass-through exemption
• Price transparency
• Patient responsibility, including outpatient and inpatient deductible and coinsurance

Module 7: Outpatient Visits and Provider-Based Departments

• Incident-to coverage of outpatient therapeutic services
• Defining on- and off-campus departments
• Mental Health Telehealth Services
• Coding for clinics, emergency departments, critical care, and trauma activation
• Proper use of modifier -25

Module 8: Mental Health Services

• Partial Hospitalization Programs and Intensive Outpatient Programs
• Certification and Covered Services
• Billing of services
• Telehealth Services

Module 9: Observation Services

• Coverage of observation services
• Delivery of the Medicare Outpatient Observation Notice (MOON)
• Billing and payment of observation services

Module 10: Special Billing and Payment Topics for Outpatient Surgery and Therapy Services

• Multiple-procedure discounting for surgical services for Method II billing
• Global surgery concepts for Method II billing
• Reporting modifiers for terminated/discontinued and bilateral procedures
• Special consideration for inpatient-only procedures
• Payment for therapy, including therapy thresholds
• “Sometimes” and “always” therapy

Module 11: Special Billing and Payment Topics for Outpatient Diagnostic Services and Drugs

• Coverage requirements for outpatient diagnostic services
• Appropriate Use Criteria (AUC) for advanced imaging services
• Multiple-procedure discounting for radiology services for Method II billing
• Exclusion from reporting certain imaging modifiers
• Laboratory coding, billing, and payment, including reference labs
• Blood and blood products
• Coverage, billing, and payment for drugs, including self-administered drugs and discarded drugs

Module 12: Coverage, Notices, and Billing for Inpatient Services

• Inpatient order and certification requirements
• Inpatient criteria and the 2-midnight benchmark
• Treatment of conditions arising during or from a non-covered inpatient stay

Module 13: Inpatient Utilization Review, Billing, and Notices

• Utilization review determinations for non-covered inpatient cases
• Inpatient Part B billing and payment
• Important Message from Medicare (IMM) and Detailed Notice of Discharge
• Hospital Issued Notices of Non-Coverage (HINN)

Module 14: Coverage, Notices, and Billing for Swing Bed Admissions in a CAH

• Coverage for swing beds
• Level of care and documentation requirements
• SNF ABN notice requirements
• Reimbursement methodology and patient coinsurance
• Exclusion from SNF PPS consolidated billing rules

Rural Health Class Agenda

Module 1: Designation as a Rural Health Clinic, including 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 2: Medicare Claims Fundamentals

• Claims processing requirements, including type of bill, revenue codes, HCPCS codes, modifiers, and charge reporting
• RHC practitioners and Appropriate Use Criteria (AUC)
• Three day window applicability

Module 3: The Qualifying Visit and Related Services

• Qualifying visit definition
• Coding and charging for the qualifying visit, including proper use of modifier -CG
• Mental health qualifying visits by telecommunication technology
• Preventative services provided with or as a qualifying visit, including vaccines
• Incident to services, including drugs and drug administration services
• Global Surgery Concepts for RHCs

Module 4: Special RHC Billing Issues

• Transitional Care Management (TCM)
• General Care Management (GCM), including Chronic Care Management (CCM), Principal Care Management (PCM), General Behavioral Health Integration (BHI) services, Principal Illness Navigation (PIN), Community Health Integration (CHI), Remote Physiological Monitoring (RPM), and Temote Therapeutic Monitoring (RTM)
• Psychiatric Collaborative Care Model (CoCM)
• Telehealth, including originating and distant site services
• Virtual Communication Services
• Mental Health Services
• Services for hospice patients
• Visiting Nurse services
• Laboratory services and technical components of diagnostic service

Module 5: Reimbursement for Rural Health Clinic Services

• Identification of a qualifying visit for payment purposes
• Basic all-inclusive rate reimbursement methodology for provider-based and independent RHCs
• Application of upper payment limit
• Application of Part B deductible and coinsurance

Module 6: Supplemental Review of Medicare Contractors, Research, and Resources

• Overview of Medicare Parts A, B, C, and D
• Role of Medicare contractors
• Medicare source laws, including statutes and regulations
• Medicare sub-regulatory guidance, including manuals and transmittals
• Links to Medicare information and resources for staying current

Module 7: Supplemental Review of Medicare Coverage Guidance and the Advance Beneficiary Notice

• Medicare Coverage Center, including NCDs, LCDs, and Laboratory Manual
• Coverage of drugs, including self-administered drugs
• Limitations of liability statute and notice requirements
• Advance Beneficiary Notice (ABN) and instructions

Resources

Module 8: Appendices of Source Authority

• Regulations for Conditions for Certification (CfC) for RHC
• Regulations with requirements for provider-based departments
• Regulations defining RHC services and payment
• Medicare Benefit Policy Manual, Chapter 13 for RHCs
• Medicare Claims Processing Manual, Chapter 9 for RHCs
• Medicare State Operations Manual, Appendix G, RHC CfC survey standards
• RHC MLN Booklet
• Integrated Outpatient Code Editor, RHC excerpts

*Course outline/agenda subject to change.

Live Virtual Medicare Boot Camp®—Critical Access Hospital and Rural Health Clinic Version

Schedule

August — Class Schedule (Eastern time)

November — Class Schedule (Eastern time)

Live Virtual Medicare Boot Camp®—Critical Access Hospital Version

Schedule

August — Class Schedule (Eastern time)

November — Class Schedule (Eastern time)

Live Virtual Medicare Boot Camp®—Rural Health Clinic Version

Schedule

August — Class Schedule (Eastern time)

November — Class Schedule (Eastern time)

Live Virtual Medicare Boot Camp®—Critical Access Hospital and Rural Health Clinic Version

Learning Outcomes

At the conclusion of this educational activity, participants will be able to:

• Navigate the CMS and FedSys website to locate key sources of Medicare authority
• Interpret Medicare guidance and apply it to the services provided
• Identify how Medicare covers outpatient, inpatient, and swing bed services at CAHs
• Analyze limitations on coverage under the Medicare program and how they affect the services provided
• Quantify beneficiary liability under Medicare Part A and B for CAH services
• Analyze how Medicare pays for outpatient, inpatient, and swing bed services
• Comply with observation and inpatient status rules and regulations
• Break down the definition of an RHC and the criteria for certification 
• Differentiate covered RHC services provided by physicians, physician assistants, nurse practitioners, clinical nurse midwives, clinical psychologists, and social workers, as well as services provided “incident to” 
• Develop policies for billing requirements related to medical visits, preventive services, laboratory services, and other special services offered by RHCs 
• Identify what constitutes an “encounter” for payment purposes 
• Calculate the AIR payment in independent and provider-based RHCs, including the application of Medicare Part B deductible and coinsurance

Continuing Education

AAPC
This program has prior approval of the AAPC for 30 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 30 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 30 nursing contact hours.

NAHRI
This program has been approved for 30 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®—Critical Access Hospital Version

Continuing Education

AAPC
This program has prior approval of the AAPC for 22.5 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 22.5 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.

CCMC
This program is approved by the Commission for Case Manager Certification for 22.5 Continuing Education Units.

NAHRI
This program has been approved for 22.5 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.

Live Virtual Medicare Boot Camp®—Rural Health Clinic Version

Continuing Education

AAPC
This program has prior approval of the AAPC for 7.5 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 7.5 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.

CCMC
This program has been pre-approved by the Commission for Case Manager Certification to provide continuing education credit to CCM board certified case managers. The course is approved for 7.5 CE contact hours.

NAHRI
This program has been approved for 7.5 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.

Live Virtual Medicare Boot Camp®—Critical Access Hospital and Rural Health Clinic Version

Things to Know Before Attending Class

What is Included with Your Purchase

When you purchase a seat for our live virtual Boot Camps, you get online access for one participant to the live sessions, a hard copy of our printed workbook materials, and access to the recordings of the sessions. HCPro reserves the right to revoke your access if we find that you are sharing your login or any of the class information.

Course Materials

You will receive a hard copy of the class materials. These will be shipped to you via UPS. If ordering on our website, please be sure to enter the physical address where these materials should be shipped. If you order over the phone or if you are unsure of what address we have on file, please ask the person you are speaking with to verify your address information and update accordingly or call our customer service department. Materials should arrive approximately two business days prior to the start of class.

Virtual Boot Camp Platform

We use GoToMeeting to present our virtual Boot Camps. To ensure your system supports GoToMeeting, use this link: https://support.goto.com/meeting/system-check. We will send out access information for the class four business days prior to the class start and again one business day prior.

Session Recordings

You will have access to the recordings of each class session via a password-protected page on our website. You will be given the page location in the welcome email. Recordings will be added to the page within one business day following the live session. You will have access to this page for 60 days after the final live session.

Continuing Education Credits

To receive continuing education credits, you will be required to successfully complete a 40-question quiz that is based off of the content covered throughout the course. Successful completion is achieved by getting at least 80% of the multiple-choice questions correct.

What to Bring to Class

We suggest that you have the following available during the class:

• Highlighter
• Notepaper
• Sticky Notes/flags
• Pen/Pencil

Contact Information

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

We Look Forward to Having You In Class!

Live Virtual Medicare Boot Camp®—Critical Access Hospital and Rural Health Clinic Version

Questions/Answers

What is the focus of Live Virtual Medicare Boot Camp®—Critical Access Hospital and Rural Health Clinic Version?
Live Virtual Medicare Boot Camp®—Critical Access Hospital and Rural Health Clinic Version is an intensive course on Medicare coverage, billing, coding, and payment for critical access hospital and/or rural health clinic services, depending on the specific version of the Boot Camp. The course is technically oriented and focuses on the Medicare regulations and guidelines applicable to these unique settings. 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 setup do I need to attend this class?
This class 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 https://support.goto.com/meeting/help/system-requirements-for-attendees-g2m010003. You can also test your system by visiting https://support.logmeininc.com/gotomeeting/get-ready.

Does HCPro offer an on-site version of this Boot Camp?
In addition to our open registration and live virtual 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 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 with coding, billing, and reimbursement. 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. 

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, a notebook for taking notes, and sticky notes/flags.

What if I have a question that didn’t get addressed in class?
The course offers open office hours 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?
Live Virtual Medicare Boot Camp®—Critical Access Hospital and Rural Health Clinic Version contains a review of pertinent coding issues as they relate to Medicare coverage, billing, and payment; however, the course is not designed as a coding course. HCPro does offer two courses focused on coding fundamentals. The Certified Coder Boot Camp®—Original focuses on coding for physician and hospital outpatient services. 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 details, please review the information for these courses using the links above or contact customer service at customer@simplifycompliance.com or 800-650-6787.

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

Who typically attends a 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

How is the course taught?
The course is taught using a combination of lecture, class discussion, and hands-on exercise/case studies.

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 sales@hcpro.com.