Boot Camps

Revenue Integrity and Chargemaster Boot Camp

Course Overview

Chargemaster and Revenue Integrity is critical for cash flow. Let our expert instructors help you understand what you need to know for chargemaster and revenue integrity performance. This Boot Camp provides formal, organized education and training for revenue integrity and chargemaster staff. 

The Revenue Integrity and Chargemaster Boot Camp provides education on chargemaster and revenue integrity concepts with classroom discussions on best practice plans of action to navigate common issues. The Boot Camp relates the chargemaster function to revenue cycle and revenue integrity functions, including key operational issues, such as eligibility, coverage, documentation requirements, charge capture, and coding guidelines. 

It also provides context for chargemaster set-up and maintenance following HIPAA transaction set requirements with an objective to help avoid pre- and post-billing edits and payer denials. 

You will leave this program knowing how to: 

• Understand the intersection of the chargemaster with clinical/revenue departments, charge capture, coding, finance, and patient access and billing 
• Explain the legal authorities for HIPAA transaction sets that govern key fields in the chargemaster and revenue cycle functions 
• Breakdown CMS regulatory requirements for pricing and charging patients 
• Identify key relationships between the chargemaster and provider cost reporting 
• Describe detailed instructions for the majority of revenue codes for optimal chargemaster setup, maintenance, charge capture, and documentation issues  
• Review chargemaster issues for commercial/managed care versus CMS requirements 

Whats new?

• CMS introduced modifier -JZ when billing for drugs from single-dose containers with no discarded amounts and clarified requirements for reporting modifier -JW for drug wastage.  
• CMS updated hospital outpatient quality reporting measures for 2023, which providers must follow to receive the maximum possible reimbursement. 
• CMS is expanding coverage of dental services that it deems “medically necessary” to perform in conjunction with certain procedures, treatments, or services. 
• CMS updated its 2023 coverage and payment policies regarding remote mental health services when billed by outpatient hospitals. 

Who should attend?  

• Finance directors  
• Reimbursement managers  
• Chargemaster coordinators  
• Patient financial services management and staff  
• Managed care contracting management and staff  
• Revenue integrity management and staff  
• Payer relations staff  
• HIM directors and managers  
• Coding directors and managers  
• Compliance officers, directors, and managers 
• Claims auditors  

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 patients 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 questions long after the Boot Camp ends.  

Case studies: Case studies ensure attendees 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). 

For more detailed information about HCPro's Boot Camps, contact us at 800-650-6787 or email sales@hcpro.com.

Revenue Integrity and Chargemaster Boot Camp

Course Locations & Dates

Below is the current course schedule for upcoming classes of this boot camp. We update this schedule on a regular basis. 

Registrations are processed in the order received. Class size is limited and classes often sell out. We recommend against making travel arrangements until after we have confirmed your course registration. 

To register for a class, click the "Register" button. If you would like to register multiple attendees, please call Customer Service at (800) 650-6787 o email us at sales@hcpro.com.

Locations marked as "Tentative" are subject to change.

To view our cancellation policy, click here.

March 2024

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Revenue Integrity and Chargemaster Boot Camp

Outline/Agenda

Module 1: Revenue Integrity Overview and Resources  

• Revenue integrity functions and key principles, including how the chargemaster fits into revenue integrity functions  
• Medicare and other revenue integrity and chargemaster resources  
• Understanding authoritative sources such as statutes, regulations, manuals, transmittals, and other Medicare rules and guidelines 

Module 2: Insurance Eligibility Principles  

• Review major payors and insurance types 
• Principles of health insurance eligibility  
• Coordination of Benefits & Subrogation  
• Medicare Secondary Payer (MSP) concepts
  
  

Module 3: Benefits, Coverage, and Medical Necessity  

• Review how insurance benefits are structured for hospital and other services  
• The importance of coverage, medical necessity, and both implied and statutorily excluded benefits  
• Pre-service coverage analysis and associated waiver/notice requirements  
• Serious preventable events and relationship to risk management 
• Investigational/experimental services and implications for coverage  

Module 4: Providers, Suppliers, and Enrollment  

• Types of facilities, providers, physicians, practitioners, and suppliers  
• Provider-based department requirements, including on and off-campus modifier requirements  
• Licensure, the scope of practice, privileging, and relationship to coverage  
• Conditions of participation, survey & certification, and accreditation  
• Importance of medical staff bylaws & regulations and relationship to conditions of payment 

Module 5: Claims Submission Fundamentals 

• HIPAA transaction sets for claims 
• Key UB-04 claim fields and special instructions 
• Billing repetitive, recurring and non-repetitive services 
• Billing for Readmissions 
• Special rules for inpatient part B claims 
• Medicare Claims Flow   

Module 6: Medicare Edit Systems 

• Common Edit systems 
• Medicare Code Editor (MCE) and Integrated Outpatient Code Editor (IOCE) 
• National Correct Coding Initiative (NCCI) 
• Procedure-to-procedure (PTP) edits and modifiers  
• Medically Unlikely Edits (MUE) 
• Add-on code edits (AOC) 

Module 7: Inpatient Payment Systems and Methodologies 

• Inpatient payment methodologies 
• Payment concepts, including stop loss, outlier, and carve-outs 
• Inpatient Prospective Payment System (IPPS) and Medicare-Severity Diagnosis Related Groups (MS-DRGs) 
• Three Day Pre-admission Payment Window 
• Bundled and Episode of Care payments 
• Value Based Purchasing 

Module 8: Outpatient Payment Systems and Methodologies 

• Outpatient payment methodologies, including prospective vs. fee schedule payment, and bundled vs. packaged services 
• Outpatient Prospective Payment System (OPPS) 
• Medicare Physician Fee Schedule (MPFS) key concepts 
• Ambulatory Surgery Center (ASC) payment system 
• Clinical Laboratory Fee Schedule 

Module 9: Audits, Appeals, and Denial Management 

• Principles of denial management  
• Types of auditors, audits, and audit contractors 
• Adjustment claims and automated provider reopening  
• Initial and revised determinations and appeal rights  
• Levels of appeal and timelines for filing  

Module 10: Payer Contracting Strategies 

• Contracting strategies and organization priorities 
• Payer Scorecards and Key Performance Indicators for payers 
• Contract provisions for effective contracting 
• Defined terms, negotiated remedies and pricing provisions 
• Annual price increase limits/caps applicable to chargemaster 
• Carve out provisions and stop-loss/outlier options 

Module 11: Charge Description Master Structure and Relationship to Cost Reporting 

• Definition, purpose, and key fields of a chargemaster 
• Concepts for code setup in CDMs and relationship to HIM coding 
• Strategies to address payer differences in the chargemaster 
• Relationship of the chargemaster to the overall accounts receivable system 
• Concepts for pricing services  
• Chargemaster, general ledger and relationship to cost reporting 

Module 12: Charge Capture Principles 

• Requirements for charges 
• Charges for routine and ancillary Services 
• Concepts of bundling and packaging, and appropriate charging 
• Principles of charge capture 

Module 13: Charge Description Master Management and Maintenance Strategies 

• Issues for annual chargemaster updates, including pricing, HCPCS codes, and no volume items 
• Strategies to work collaboratively with departments 
• Importance of patient accounts and charge reconciliation 
• Tracking CDM changes for compliance 
• Charge integrity monitoring and reducing unexplained variation in claims 

Module 14: Strategies and Key Issues by Revenue Code: Routine Services and Observation 

• Key concepts for accommodation codes and routine services, including outpatients in beds, specialty care units, and observation services  
• Coding and edit issues for revenue codes associated with routine services and observation  
• Major factors of coverage for these services  
• Applicable inpatient and outpatient payment concepts  
• General ledger and finance considerations, including pricing and charge capture   

Module 15: Strategies and Key Issues by Revenue Code: Ancillary Services 

• Key concepts for major ancillary service departments, including peri-operative services, emergency, cardiology, diagnostic imaging, pharmacy, and supplies  
• Coding and edit issues for revenue codes associated with ancillary services  
• Major factors of coverage for these services  
• Applicable inpatient and outpatient payment concepts  
• General ledger and finance considerations, including pricing and charge capture 

Module 16: Strategies and Key Issues by Revenue Code:  Other Departments 

• Key concepts for other common ancillary service departments, including respiratory therapy, clinics, behavioral health, and preventive services  
• Coding and edit issues for revenue codes associated with other departments  
• Major factors of coverage for these services  
• Applicable inpatient and outpatient payment concepts  
• General ledger and finance considerations, including pricing and charge capture 

*Course Outline/Agenda subject to change

Revenue Integrity and Chargemaster Boot Camp

Questions/Answers

What is the focus of the Revenue Integrity and Chargemaster Boot Camp?  
The Boot Camp focuses on finding and applying the HIPAA Transaction Sets rules and guidelines that apply to chargemaster and revenue integrity professionals to help ensure accurate and appropriate billing.  

Where is the course offered? 
Open registration sessions of the Revenue Integrity and Chargemaster Boot Camp 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, please click here. 

Who typically attends the Revenue Integrity and Chargemaster Boot Camp?

• Finance directors  
• Reimbursement managers  
• Chargemaster coordinators  
• Patient financial services management and staff  
• Managed care contracting management and staff  
• Revenue integrity management and staff  
• Payer relations staff  
• HIM directors and managers  
• Coding directors and managers  
• Compliance officers, directors, and managers  
• Claims auditors 

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?  
Yes, 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 lectures, class discussions, and hands-on exercises/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 800-650-6787 or email sales@hcpro.com.

Revenue Integrity and Chargemaster Boot Camp

Things to Know Before Attending Class

Directions and Hotel Information

The hotel address, phone number, URL, room rate and room rate cut-off date are posted on the Locations/Dates tab. The hotel websites give detailed directions to the hotel as well as information about the location. Please call the hotel directly to make a room reservation. Be sure to identify yourself as an HCPro Boot Camp participant. Please be sure to make your reservation before the cut-off date. After the cut-off date, contact the hotel to determine room availability and rates. 

Course Materials

When you arrive at class, you will receive extensive workbooks containing the class materials utilized throughout the boot camp. The workbooks will be yours to keep, so plan accordingly in allowing enough room in your luggage on the return trip home. Workbooks may also be shipped from the hotel at your own expense.

Classroom Time

It is an understatement to say that this course is intense. Other than breaks, we will be in class from 8:00am to 5:00pm Monday–Thursday. There will be about a one-hour lunch break each day. If the class gets behind, class may run later than 5:00pm.

Lunch

We will take about a one-hour break for lunch each day. Although we typically provide coffee in the morning and drinks and snacks in the afternoon, everyone is on their own for lunch. Note that many hotels do not have restaurants on-site. If you are flying to the course, we generally recommend renting a car.

What to Bring to Class

We recommend you bring the following to all classes:

• Highlighter and pen/pencil
• A notebook for making your own notes
• Sticky Notes/flags

Use of Laptop Computers or Electronic Devices

Our instructors demonstrate where to find many resources on the CMS website. If you have access to a laptop or tablet you may bring it to class to follow along, but you may wish to consider the power and wireless needs of your device. Many conference rooms do not have plugins situated conveniently to the tables so you may wish to ensure you have sufficient battery power. HCPro does not purchase group wireless access for the conference rooms, but many hotels provide free wireless access. You may wish to confirm your connectivity options prior to arriving at the hotel. Please be courteous in your use of electronic devices. Use of electronic devices should not disrupt the class or disturb other participants. HCPro is not responsible for lost, stolen, or damaged devices. Maintaining the security and safety of your device is your responsibility. Cell phone use during class is strictly prohibited.

Dress

Business attire is not necessary. Please dress comfortably. Also, we find that the classrooms are sometimes on the cool side, even during the warmer months. You may be more comfortable if you bring a sweater or sweatshirt in case you get cold.

Copyright Protection of Course Materials

You will receive a complete copy of our course materials at the beginning of class. 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 (i) 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. 

Cancellation and Transfer Policy

For our cancellation and transfer policy, visit our website: http://hcmarketplace.com/cancellations.

COVID Safety

Simplify Compliance and HCPro place the highest priority on the safety of our guests.  Simplify Compliance and HCPro will continue to monitor the COVID-19 environment and the recommended guidelines and will communicate adjustments to any onsite policies and procedures. 

Contact Information

For more information about our Boot Camps, contact us at 800-650-6787 or email sales@hcpro.com.

We Look Forward to Having You In Class!

Revenue Integrity and Chargemaster Boot Camp

Learning Outcomes

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

• Formulate effective and efficient strategies to obtain and maintain overall revenue integrity for both governmental and non-governmental payers 
• Analyze revenue integrity principles associated with eligibility, coverage, coding, billing, and payment using fee-for-service Medicare requirements as a framework 
• Articulate the scope and importance of adhering to HIPAA transaction sets and the authorities for the transaction sets 
• Identify standard charge description master (CDM) elements, design, and relationship to the general ledger and revenue cycle processes of coding and billing 
• Comply with claim requirements, CDM set-up, and maintenance guidelines by revenue code  
• Differentiate outpatient and inpatient hospital prospective payment systems reimbursement and rate-setting methodologies

Continuing Education

AAPC
This program has the prior approval of AAPC for 30 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 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 30 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.

CCB
The Compliance Certification Board (CCB) has approved this event for up to 36 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 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.

The National Association of Healthcare Revenue Integrity (NAHRI)

Become a NAHRI Member Today

NAHRI’s mission is to enhance the revenue integrity profession through standards, advocacy, networking, and the promotion of shared knowledge and resources. This mission statement was developed by our NAHRI Advisory Board, an amazing group of revenue integrity professionals who bring a wide range of expertise and experience to this organization’s leadership.

PEER-BASED RESOURES AND TOOLS

As a NAHRI member, you’ll get unlimited access to our vast members-only resources, tools, and content such as white papers, best practices, and research reports written by the most respected names in the industry.

Resources include:

• Member-Only Content, explore the hundreds of the latest articles and research by topic, including white papers and best practices, plus an extensive archive on the NAHRI website
• A library of sample webinars and other content on the latest revenue cycle topics
• NAHRI quarterly journal, featuring in-depth, members-only content on the latest developments in revenue cycle

LOCAL CHAPTERS

Be on the ground floor in establishing your local chapter! It’s a great way to: 

• Quickly integrate and network with other revenue cycle professionals 
• Expand your management, leadership, and public speaking skills by volunteering for the chapter executive board

CONFERENCES AND TRAINING

Members receive significant discounts on all national and local NAHRI events. Learn from the best and brightest, interact and network with industry leaders, or roll your sleeves up and participate in an intensive, in-person, training events.

CAREER RESOURCES AND CREDENTIAL PROGRAM

NAHRI members receive $150 off the Live In-Person and Live Virtual Revenue Integrity and Chargemaster Boot Camp credential program. To receive your special discount rate or sign up to become a NAHRI member today please call 800-650-6787.

NAHRI members receive $100 off the Certification in Healthcare Revenue Integrity (CHRI) credential program. This program will provide professionals like you a tangible way to enhance and promote your revenue cycle skills.