Boot Camps

Live Virtual Medicare Boot Camp®—Hospital Version

Course Overview

Medicare Explained: Understand the latest CMS rules and their application 

Join our Medicare experts for a course exploring Medicare coverage, billing, and coding. This comprehensive course includes in-depth discussions of Medicare’s coverage rules, claims and billing guidelines, hospital-based department reimbursement, drug and device billing and modifiers, 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.  We provide you an extensive manual, research tools, and skills to navigate Medicare’s resources and find the information you need. You’ll leave this course ready to make improvements that will strengthen reimbursement and compliance for your hospital or health system.  

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

• Coverage, including NCDs, LCDs, and Prior Authorization 
• Outpatient coverage and physician supervision in the hospital setting 
• NCCI edits, including PTP edits and MUEs 
• Billing and coding for hospital-based clinics and departments 
• Observation coverage, billing, and payment 
• The 2-midnight benchmark 
• Inpatient order and certification requirements 
• 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 Secondary Payer 
• Medicare websites and resources 

 Whats new?

• New modifier JZ for reporting single use packaged drugs and clarifications on the use of JW.
• Updates to supervision regulations to allow non-physician practitioners to provide supervision of diagnostic services.  
• New benefit for remote mental health services for patients in their homes.  
• Inpatient Part B billing clarifications and new manual sections. 
• Prior authorizations required for joint injection procedures beginning July 1, 2023. 

You will leave this program knowing how to: 

• Research and resolve claim edits that delay revenue 
• Prevent claim delays and missed revenue 
• Resolve claim denials and prevent them in the future 
• 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. Individuals that may benefit from attending this boot camp include: 

• 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 

See the HCPro difference for yourself! 

Focus on the actual rules:  We provide references for all the information provided, giving you confidence, you are getting accurate, timely information. 

Tools and skills to navigate Medicare rules: Our instructors provide valuable understanding, tools, and resources to make you more efficient finding the answers to your Medicare questions long after the course 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—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 October 30  – November 10. Registration cut-off date: 10/23/2023

Class is held Monday – Friday from December 4  – December 15. Registration cut-off date: 11/27/2023

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: Hospital-Based Departments, including Clinics 

• 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 Diagnostic 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 and Notices 

• Utilization review determinations 
• Condition code 44 and self-denials with inpatient part B coverage 
• Important Message from Medicare (IMM) and Detailed Notice of Discharge 
• Hospital Issued Notices of Non-Coverage (HINN) 

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

October / November — Class Schedule (Eastern time)

December — Class Schedule (Eastern time)

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 a facility exclusive program (with a substantial discount) for organizations that have a number of employees who need training. For more information on hosting a facility exclusive virtual 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? 

• 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 

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 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 is an important part of the learning experience for the course. Students are expected to attend scheduled classes whenever possible. 

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

There are no manuals required for participation in this 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. 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.  

Copyright Protection of Course Materials  

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  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.  

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

If you have any question about the virtual boot camp program, please contact Customer Service at (800) 650-6787 or email customerservice@hcpro.com.

We Look Forward to Having You In Class!

Live Virtual Medicare Boot Camp®—Hospital Version

Learning Objectives

At the completion of this Boot Camp, participants will be able to: 

• Navigate the CMS and FedSys websites to locate key sources of Medicare authority
• Apply Medicare guidance and to the services provided
• Articulate how Medicare covers inpatient and outpatient services at hospitals
• Analyze limitations on coverage under the Medicare program and how they affect the services provided
• Assess the effect of coding rules on reporting hospital services and hospital reimbursement
• Convey how Medicare pays for inpatient and outpatient services
• Quantify Medicare deductibles and copayments for hospital inpatient and outpatient services
• Comply with rules and regulations for inpatient and observation status

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 34.75 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 34.75 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 34.75 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.

NAHRI
This program has been approved for 34.75 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.