Boot Camps

Live Virtual 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 course covering Medicare coverage, billing, coding, NCCI edits, claims processing, and the latest changes to the inpatient-only list, prior authorizations, and more. The Live Virtual Medicare Boot Camp—Hospital Version unlocks the answers to all of your Medicare questions.

This course 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 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 Live Virtual 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.

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—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 June 5 – June 16. Registration cut-off date: 5/29/2023

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

Live Virtual 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.

Live Virtual Medicare Boot Camp®—Hospital Version

Schedule

June — Class Schedule (Eastern time)

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

Questions/Answers

What is the focus of the Live Virtual Medicare Boot Camp®—Hospital Version?
The Live Virtual 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 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 "on-site" Medicare Boot Camps?
In addition to our open registration courses, we also offer the Live Virtual 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 Live Virtual Medicare Boot Camp®—Hospital Version?

• 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 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 hands-on exercises.

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 breakout 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?
The Live Virtual 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 customerservice@hcpro.com or 800-650-6787.

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 PD-IS@SimplifyCompliance.com.

Live Virtual Medicare Boot Camp®—Hospital 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 of where these materials should be shipped to. 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 4 business days prior to the class start and again 1 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 two business days following the first session. 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 PD-IS@SimplifyCompliance.com.

We Look Forward to Having You In Class!

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

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.