Revenue Integrity and Chargemaster for Critical Access Hospitals Boot Camp

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Revenue Integrity and Chargemaster for Critical Access Hospitals Boot Camp

Product Code: RIBC


1st Attendee $1,499.00*
Additional Attendee(s)
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Revenue Integrity and Chargemaster Boot Camp

Course Overview

The Revenue Integrity and Chargemaster Boot Camp – Critical Access Hospital version - provides education on chargemaster and revenue integrity concepts in a classroom format. The program will relate the chargemaster function to revenue cycle and revenue integrity functions, including cost reporting and key operational issues, such as coverage, clinical documentation, charge capture, and coding.

It will also provide context for chargemaster set-up and maintenance within revenue integrity with an objective to help avoid pre- and post- billing edits and payer denials.  This Boot Camp reviews chargemaster coding requirements for Critical Access Hospitals and excludes discussion of topics that are specific to coding for the outpatient prospective payment system.

You will leave this program knowing how to:

  • Provide formal, organized education and training for revenue integrity and chargemaster staff
  • Provide context for the intersection of the chargemaster with clinical/revenue departments, charge capture, coding, finance, and patient access and billing
  • Walk attendees through CMS regulatory requirements for pricing and charging patients, as well as key relationships between the chargemaster and provider cost reporting
  • Give detailed instructions for the majority of revenue codes for optimal chargemaster setup, maintenance, charge capture, and documentation issues for critical access hospitals
  • Review chargemaster issues for commercial/managed care versus CMS requirements for critical access hospitals

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 PD-IS@SimplifyCompliance.com.

Locations marked as "Tentative" are subject to change.

To view our cancellation policy, click here

August 2020


Bloomington (Minneapolis), MN

 

August 3 - 6, 2020
8:00AM – 5:00PM each day

Courtyard Bloomington by Mall of America®
7800 Bloomington Ave. S.
Bloomington, MN 55425
952-876-0100
Hotel website


Room Rate: $139/night
Room Rate Cut-Off: July 10, 2020

 

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Revenue Integrity and Chargemaster Boot Camp

Outline/Agenda

Module 1: Revenue Integrity Overview and Resources

  • Review revenue integrity functions and key principles
  • Explain how the chargemaster fits into over revenue integrity functions
  • Identify where to find statutes, regulations, manuals, transmittals and other Medicare rules and guidelines
  • Describe how to find Medicare and chargemaster resources

Module 2: Eligibility Principles

  • Review major and different types of medical insurances
  • Discuss principles of eligibility and verification of insurance
  • Describe Coordination of Benefits & Subrogation
  • Explain Medicare Secondary Payer (MSP) concepts

Module 3: Benefits, Coverage and Medical Necessity

  • Review how insurance benefits are structured for hospital and other services
  • Describe the importance of coverage, medical necessity and both implied and specifically excluded benefits
  • Discuss importance of pre-service waiver/notice requirements
  • Review serious preventable events and relationship to risk management
  • Discuss investigational/experimental services and implications for coverage

Module 4: Provider Types, Licensure, Enrollment, Privileges, Credentialing and Scope of Practice

  • Review types of facilities, providers, physicians, practitioners and suppliers
  • Explain concepts of licensure, scope of practice, privileging and relationship to coverage
  • Discuss conditions of participation, survey & certification and accreditation
  • Review importance of medical staff bylaws & regulations and relationship to conditions of payment
  • Review requirements and issues associated with meeting requirements for provider-based status 

Module 5: Charge Description Master Structure and Charge Capture Principles

  • Explain the definition, purpose and key fields of a chargemaster
  • Discuss concepts of code set up in CDMs and relationship to HIM coding
  • Review principles of bundled services per CPT definition vs reporting packaged services
  • Learn strategies to address payer differences in the chargemaster
  • Explain the relationship of chargemaster to overall AR System
  • Review concepts for pricing services
  • Discuss chargemaster and relationship to cost reporting

Module 6: Claims Submission Fundamentals and Code Edits

  • Identify key UB-04 fields applicable to hospital services
  • Describe HIPAA transaction sets including ICD-10 and HCPCS codes
  • Review common billing edits including NCCI and MUEs
  • Discuss other transaction sets applicable to the revenue cycle such as eligibility, payment, claim status and denial transaction sets

Module 7: Strategies and Key Issues by Revenue Code: Routine Services and Observation

  • Learn key concepts for accommodation codes and routine services, including outpatients in beds, specialty care units and observation services
  • Discuss coding and edit issues for revenue codes associated with routine services and observation
  • Review major factors of coverage for these services
  • Review finance considerations including charge capture

Module 8: Strategies and Key Issues by Revenue Code: Ancillary Services

  • Learn key concepts for major ancillary service departments, including peri-operative services, emergency, cardiology, diagnostic imaging, pharmacy and supplies
  • Discuss coding and edit issues for revenue codes associated with ancillary services
  • Review major factors of coverage for these services
  • Review finance considerations including charge capture

 Module 9: Strategies and Key Issues by Revenue Code:  Other Departments

  • Learn key concepts for other common ancillary service departments, including respiratory therapy, clinics, behavioral health, and preventive services
  • Discuss coding and edit issues for revenue codes associated with other departments
  • Review major factors of coverage for these services
  • Review finance considerations including charge capture

Module 10: Special Medicare Billing Issues

  • Review billing requirements for outpatient repetitive, non-repetitive and recurring services
  • Discuss billing of non-covered outpatient services
  • Gain an understanding of patient status and billing inpatient non-medically necessary services

Module 11:  Introduction to Payment Systems

  • Review inpatient payment systems including DRGs, Case Rates and Per Diems
  • Discuss hospital outpatient hospital payment systems including OPPS & APCs, fee schedules and percent of charges
  • Review ASC payment method
  • Review other ambulatory payment systems such as the physician fee schedule (MPFS), DMEPOS, Clinical Lab Fee Schedule
  • Discuss other proprietary systems
  • Review emerging payment methodologies such as Bundled/Episode Payments (CJR) and Value-Based Purchasing

Module 12: Critical Access Hospital Cost-based Reimbursement

  • Method I
  • Method II

Module 13: Medicare Physician Fee Schedule (MPFS)

  • Review the relative value units and structure that makes up the Medicare physician fee schedule
  • Discuss site of service adjustments for facility and non-facility services
  • Review global versus technical and professional components, payment policy indicators

Module 14: Charge Description Master Management and Maintenance Strategies

  • Review topics and issues surrounding the annual chargemaster updates including pricing, HCPCS codes, charge items with no volume
  • Discuss strategies to work collaboratively with departments
  • Discuss importance of charge reconciliation and tracking CDM changes for compliance as well as charge integrity monitoring

Module 15: Denial Management

  • Review adjustment claims, automated reopenings and initial and revised determinations
  • Learn levels of appeal and timelines
  • Discuss types of auditors including external auditors from commercial plans 

Module 16: Payer Contracting Strategies

  • Discuss the concept and criteria of carve out options for contracting and tips to watch out for with commercial percent of charge contracting
  • Review importance of tracking administrative cost by payer and developing and trending payer scorecards
  • Discuss legal requirements for both providers and payers to adhere to Administrative Simplification Act and transaction set requirements include complaint-based enforcement


Course Outline/Agenda subject to change.

Revenue Integrity and Chargemaster Boot Camp

Learning Objectives

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

  • Equip hospital, payer and other healthcare specialists with effective and efficient strategies to obtain and maintain overall revenue integrity for both governmental and non-governmental payers
  • Gain a working understanding of revenue integrity principles associated with eligibility, coverage, coding, billing and payment using fee-for-service Medicare requirements as a framework
  • Explain how the chargemaster fits into over revenue integrity functions
  • Review requirements and issues associated with provider-based status
  • Explain standard charge description master (CDM) elements, design and relationship to the general ledger and revenue cycle processes of coding and billing
  • Review claim requirements and specific issues of CDM set-up and maintenance by revenue code with associated cost reporting principles
  • Review concepts of pricing different services
  • Exemplify Critical Access Hospital cost-based reimbursement, including Method I and II, and as well as appeal strategies to protect revenue

Revenue Integrity and Chargemaster Boot Camp

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.

American Health Information Management Association (AHIMA)
This program has been approved for 30 continuing education units for use in fulfilling the continuing education requirements of the American Health Information Management Association (AHIMA).

Association of Clinical Documentation Improvement Specialists (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 Improvement Specialists (ACDIS).

American Nurses Credentialing Center (ANCC) 
HCPro is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.

This educational activity for 30 nursing contact hours is provided by HCPro.

California Board of Registered Nursing 
HCPro is approved by the California Board of Registered Nursing to provide 36 nursing contact hours. California BRN Provider #CEP 14494.

Commission for Case Manager Certification (CCMC) 
This program has been submitted to The Commission for Case Manager Certification for approval to provide board certified case managers with 30 clock hours.

Compliance Certification Board (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.

National Association of Healthcare Revenue Integrity (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).

National Association of State Boards of Accountancy (NASBA)
Earn up to 36 CPE Credits!
Program Level: Basic
Delivery Method: Group-Live
Field of Study: Specialized Knowledge

HCPro is registered with the National Association of State Boards of Accountancy (NASBA) as a sponsor of continuing professional education on the National Registry of CPE Sponsors. State boards of accountancy have final authority on the acceptance of individual courses for CPE credit. Complaints regarding registered sponsors may be submitted to the National Registry of CPE Sponsors through its website: www.learningmarket.org.

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. 

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? 
Cancellation Policy
Please click here to view our cancellation policy.

Who typically attends the Revenue Integrity and Chargemaster Boot Camp? 

  • CFOs 
  • 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 


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. 

How is the course taught? 
The course is taught using a combination of lecture, class discussion, and hands-on exercise/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 
  • A handheld calculator 


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.