Live Virtual Medicare Boot Camp®—Physician Services Version

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Live Virtual Medicare Boot Camp®—Physician Services Version

Product Code: MBPV


1st Attendee $999.00*
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Save $0.00$999.00 each

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$999.00
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* Registration cut-off date: 6/7/2021

To register multiple attendees, please call our sales team at 615-724-7200.

Medicare Boot Camp®—Physician Services Version

Course Overview

Physician practices are under increasing financial pressure, and Medicare accounts for a large portion of their revenue. The Medicare Boot Camp®—Physician Services Version teaches you the basics of navigating Medicare regulations and guidelines applicable to professional services.

Whether you’re in a physician practice or a hospital that is taking on a larger role in managing physician practices, the Medicare Boot Camp®—Physician Services Version will help you avoid basic compliance pitfalls and costly mistakes. Apply concepts learned immediately with true-to-life case studies that accompany each module. Instructors teach directly from the Medicare regulations and provide full citations so that you can find the rules yourself after the Boot Camp is over.

You’ll walk away from this live virtual course with a complete understanding of the unique nuances of documentation and billing topics, including:

  • E/M services
  • "Incident to" billing and reimbursement for nonphysician practitioner services
  • How to research Medicare regulations and guidance
  • Participation in Medicare
  • Understanding the mechanics of the Medicare Physician Fee Schedule
  • Completion of the CMS-1500 claim form
  • Advance beneficiary notices (ABN)
  • National Correct Coding Initiative (NCCI)
  • Global surgery rules
  • Diagnostic testing rules
  • Medicare coverage of preventative and screening services
  • Teaching physician rules
  • Appeals process
  • Medicare Quality Payment Programs for Physicians


You will leave this program knowing how to:

  • Employ CMS guidelines to ensure proper reporting
  • Explain appropriate billing for professional services in many different scenarios
  • Identify compliance pitfalls and prepare for potential audits
  • Describe requirements for efficient processes that lead to increased productivity
  • Examine Medicare coverage guidelines, including the general types of physician services covered
  • Recognize specific Medicare coverage requirements for certain services
  • Interpret payment principles for physician services, allowing for a reasonably anticipated projected income stream


How does the Medicare Boot Camp®—Physician Services Version work?

You will attend 8 live virtual sessions. Class is held Mondays – Thursdays. Class times are as follows:
Mondays and Wednesdays: 1:00 p.m. – 3:30 p.m. Eastern Time
Tuesdays and Thursdays: 1:00 p.m. – 4:00 p.m. Eastern Time
The December class starts mid-week on a Wednesday.

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 June 14 – June 24. Registration cut-off date: 6/7/2021

Medicare Boot Camp®—Physician Services Version

Course Outline/Agenda

Module 1: Medicare Overview and Resources

  • Overview of Medicare Part A, B, C, and D
  • Medicare Contractors, including MAC, RAC, and QIO
  • Finding Medicare source laws, including statutes, regulations and final rules
  • Finding Medicare sub-regulatory guidance, including manuals and transmittals
  • Medicare Coverage Center, including LCDs, NCDs, CED and Lab Coverage Manual
  • Links to Medicare resources and resources for staying current


Module 2: Medicare Participation

  • Medicare physician/supplier enrollment process.
  • Medicare enrollment form to use – which form is appropriate?
  • Reporting NPIs on Medicare claims
  • Participation and non-participation in the Medicare program
  • “Opting out” of the Medicare program
  • Assigned versus non-assigned claims
  • “Limiting charge” rules and the implications assigned and non-assigned claims


Module 3: CMS Quality/Value Based Payment Incentives

  • Quality programs, Value Based Payment, and the CMS Quality Initiative
  • Current quality programs under Medicare for physician practices: PQRS, Meaningful Use, & Value-Based Payment Modifier
  • MACRA and the associated value based payment programs (MIPS, APM’s, PFPM’s)


Module 4: Medical Necessity and Non-Coverage

  • Social Security Act “Limitation on Liability” provisions and when it applies
  • Situations in which ABN is necessary to hold the patient responsible for non-covered services
  • Circumstances under which an ABN would be ineffective/invalid
  • When is it inappropriate to present an ABN to a patient
  • Circumstances where a routine ABN is permitted
  • Appropriate reporting of ABN modifiers


Quiz 1: Overview, Participation, VBP Incentives and Medical Necessity

Module 5: CMS 1500, ICD-10-CM, NPI and other must-know billing fundamentals

  • Role and functions of the Medicare Administrative Contractor (MAC)
  • MAC jurisdiction for services furnished to a Medicare beneficiary
  • CMS-1500 data set instructions and proper reporting of services provided
  • Proper reporting of site of service and the effect on payment
  • Overview of how SNF consolidated billing and how it effects billing for professional services furnished to SNF residents
  • Reassignment relationships and when they are permissible under the Medicare reassignment regulations/guidelines


Module 6: Overview of the Resource Based Relative Value Scale (RBRVS)

  • Medicare payment and the physician fee schedule
  • Using relative value file/physician fee schedule database to make operational decisions
  • Medicare’s annual deductible and coinsurance and the effect on beneficiary liability and payment to practitioners-22
  • Proper use of modifier -22 and -52 and the effect on reimbursement


Module 7: NCCI, MUEs, Modifiers and Other Must-Know Billing Fundamentals

  • NCCI edits, composition and application
  • Differentiate between the Column 1/Column 2 and the Mutually Exclusive code edits.
  • Determine special considerations and practical issues for practitioners related to NCCI edits.
  • Determine when an NCCI edit will apply to a claim.
  • Determine the correct way to bill for a code pair that is subject to an NCCI edit including appropriate use of modifiers.


Quiz 2: CMS 1500, RBRVS and NCCI

Module 8: Evaluation and Management Services: The Most Commonly Billed Physician Service

  • Appropriate billing for E/M services furnished to a hospital inpatient
  • Determine the appropriate way to bill for E/M services furnished to a hospital observation patient.
  • Appropriate reporting of E/M services furnished in an emergency department
  • Appropriate reporting of E/M services furnished to a nursing facility patient
  • Medicare’s approach to consultations
  • Appropriate billing for critical care, concurrent care, care management, behavioral integration and care plan oversight services


Module 9: Surgical services for physicians: Modifiers and More

  • Global surgical package –inclusion and exclusion of services
  • Determine the applicable postoperative period of a procedure
  • Appropriate billing for services furnished during the postoperative period that are not included in the surgical package, including the use of appropriate modifiers
  • Multiple procedure reduction and its application to a particular Medicare claim
  • Appropriate billing for bilateral surgeries, assistant surgeons, co-surgeons and team surgeons
  • Determine the appropriate way to bill for assistant surgeons, co-surgeons and team surgeons


Module 10: Clinical Lab, Radiology and Other Diagnostic Services

  • Determine when the professional and technical component services for a diagnostic test are separately billable
  • Determine when and how to use modifiers to appropriately bill for professional and technical component services
  • Physician supervision required for a particular diagnostic test
  • Bill appropriately for diagnostic radiology services in a professional practice setting
  • Application of multiple procedure payment reduction and calculation of its effect on reimbursement
  • CLIA requirements applicable for laboratory services furnished in a professional practice setting
  • Locate and effectively use the clinical diagnostic laboratory services fee schedule and the national coverage determinations (NCDs) applicable to clinical laboratory services


Quiz 3: E/M, Surgical and Diagnostic Services

Module 11: Non-Physician Practitioner and Therapist Services

  • Medicare’s recognition of Non-physician practitioners
  • “Incident to” and “split/shared” coverage of NPPs services
  • NPP services that qualify for “incident to” coverage
  • Circumstances when NPP services may appropriately billed under “split/shared” coverage rules


Module 12: Physicians at teaching hospitals: Teaching physician issues

  • Overview of Medicare coverage of services provided by interns and residents.
  • Situations in which a teaching/attending physician’s presence is required when residents are involved in patient care.
  • Appropriate billing for resident involvement of patient care (including the appropriate use of modifiers).
  • Documentation requirements applicable to teaching/attending physician services when residents are involved in patient care.
  • Appropriately bill for services furnished by an intern or resident functioning as an assistant surgeon.
  • Determine if Medicare payment is available for services furnished by a particular moonlighting resident


Module 13: When the Medicare payment is not what you expect: audits and appeals

  • Overview of the Medicare program integrity function applicable to services furnished in a professional practice setting.
  • Comprehensive Error Rate Testing program.
  • Proper Response for Audit and Record Request
  • Overview of the Medicare Part B appeals process


Module 14: Medicare coverage of preventive health services

  • Initial Preventive Physical Exam
  • Annual Wellness Visits
  • Medicare Coverage of Screening Services
  • Medicare Diabetes Prevention Program


Quiz 4: Non-Physician Practitioner services; audit and appeals, teaching physicians and preventive services

Medicare Boot Camp®—Physician Services Version

Schedule

June — Class Schedule (Eastern time)

June 14 1:00 p.m. – 3:30 p.m.
June 15 1:00 p.m. – 4:00 p.m.
June 16 1:00 p.m. – 3:30 p.m.
June 17 1:00 p.m. – 4:00 p.m.
June 21 1:00 p.m. – 3:30 p.m.
June 22 1:00 p.m. – 4:00 p.m.
June 23 1:00 p.m. – 3:30 p.m.
June 24 1:00 p.m. – 4:00 p.m.

Medicare Boot Camp®—Physician Services Version

Learning Objectives

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

  • Employ CMS guidelines to ensure proper reporting
  • Explain appropriate billing for professional services in many different scenarios
  • Identify compliance pitfalls and prepare for potential audits
  • Describe requirements for efficient processes that lead to increased productivity
  • Examine Medicare coverage guidelines, including the general types of physician services covered
  • Recognize specific Medicare coverage requirements for certain services
  • Interpret payment principles for physician services, allowing for a reasonably anticipated projected income stream

Medicare Boot Camp®—Physician Services Version

Questions/Answers

What is the focus of the Medicare Boot Camp®—Physician Services Version?
Medicare Boot Camp—Physician Services Version is technically oriented and focuses on the Medicare regulations and guidelines applicable to professional services. The course is taught using a combination of lecture, class discussion, and hands-on exercises. The objective of the course is to provide course participants with a detailed understanding of the Medicare "rules," with a particular emphasis on the real-world 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 Medicare 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 Medicare 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 Medicare Boot Camp—Physician Services Version?

  • Medical practice managers
  • Billers and coders
  • Medical records/health information managers/staff
  • Clinical managers and department heads
  • Finance and reimbursement managers/staff
  • Physicians, nurse practitioners, and physician assistants
  • Compliance officers and auditors
  • Medicare carrier personnel
  • Healthcare consultants, CPAs, and lawyers
  • 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?
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 professional practice setting. Familiarity with the CPT® coding system will be particularly helpful.

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

What do I need to bring to class?
When you arrive at class, you will receive an extensive binder of course materials. However, in order to get the most out of the course, you should bring a current CPT manual to class. Any current version of the CPT manual will be fine so long as it is published by the American Medical Association (AMA). (Our instructors use and recommend the AMA's CPT Professional Edition.)

Optum publishes a manual called CPT Expert. We recommend against using it for this course because CPT Expert does not contain all of the official CPT guidelines.

Please bring the following to all classes:

  • Your CPT manual
  • A handheld calculator
  • Note paper


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 customer service at 800-650-6787 or email customer@simplifycompliance.com.