Live Virtual Medicare Boot Camp®—Utilization Review for Medicare Advantage Version

Course Overview

Master Medicare fee-for-service coverage rules for application by Medicare Advantage plans

The Live Virtual Medicare Boot Camp®—Utilization Review for Medicare Advantage Version is an intensive course focusing on the Medicare regulatory requirements for coverage determinations, including patient status. This course is designed to provide Medicare Advantage (MA) plan staff with proficiency in fee-for-service (FFS) coverage rules for application to plan patients.

New rules require MA plans to apply FFS coverage criteria, including patient status regulations, in coverage determinations for their patients. Additionally, there are new requirements for reviews that result in a denial, as well as prior authorization guidelines. This course prepares staff to find and compliantly apply FFS coverage guidelines, giving them confidence in the prior authorizations they make for Medicare beneficiaries. The course also covers requirements for development of plan policies when FFS coverage policies have not fully established coverage, as well as the new requirement for a utilization management committee and the committee’s role in policy review and development.

Medicare Boot Camp—Utilization Review for Medicare Advantage Version also answers all your questions about navigating the CMS website and finding FFS Medicare resources.

You will leave this program knowing:

• How to find and apply FFS Medicare coverage policies in MA plan decisions
• How to find and apply local coverage determinations (LCD), national coverage determinations (NCD), and coverage with evidence development (CED) policies
• The requirements for developing policies when FFS has not fully established coverage guidelines
• The composition and role of an MA plan’s utilization management committee
• How to apply the 2-midnight benchmark, including cases with observation
• How to find and apply the Medicare inpatient-only list
• CMS guidance on case-by-case admissions

This Boot Camp will help you to:

• Find FFS Medicare coverage policies
• Implement compliant coverage determinations for MA plan patients
• Determine the correct inpatient or outpatient status of a patient under FFS Medicare guidelines for application by an MA plan
• Understand the difference between FFS Medicare coverage guidelines and other commercial coverage criteria

Who should attend?
This class is designed for MA plan staff involved in coverage determinations, prior authorization and coverage policies for Medicare plan patients. It is appropriate for staff involved in making these determinations or in developing coverage policies for the plan. Staff responsible for monitoring their plan’s compliance with CMS regulations will also benefit from attending this class.

See the HCPro difference for yourself!

Focus on the actual rules: We provide references for all information provided and tools directly from Medicare, 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 help you more efficiently apply Medicare guidelines.

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).

Looking to train your whole team? We can bring our expert instructors to you! Learn more here!

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

Live Virtual Medicare Boot Camp®—Utilization Review for Medicare Advantage Version

Outline/Agenda

Module 1: Medicare Program Fundamentals

• Relationship of parts A and B (fee-for-service (FFS) Medicare) and Part C (Medicare Advantage (MA))
• How MA coverage decisions are affected by FFS coverage and payment rules
• Composition, requirements, and role of the MA plan’s utilization management committee

Module 2: Medicare Program Resources

• Finding web-based Medicare resources, including regulations, final rules, and manuals
• Using the Medicare Coverage Center, including local coverage determinations (LCD), national coverage determinations (NCD), and coverage with evidence development (CED) policies
• FFS prior authorization programs

Module 3: MA Plan Prior Authorization and Utilization Management Regulations

• Development of MA plan coverage policies when FFS guidance does not fully establish coverage criteria
• Requirements for MA prior authorizations, including coordinated care plans
• Review requirements for adverse determinations

Module 4: FFS Medicare Inpatient Coverage Regulations and Guidance

• Coverage of observation services
• Inpatient-only procedures
• The 2-midnight benchmark
• Admissions on a case-by-case basis
• Clinical examples from CMS review contractor

Course Agenda/Outline is subject to change.

Live Virtual Medicare Boot Camp®—Utilization Review for Medicare Advantage Version

Questions/Answers

What is the focus of the Live Virtual Medicare Boot Camp®—Utilization Review for Medicare Advantage Version?
The Live Virtual Medicare Boot Camp—Utilization Review for Medicare Advantage Version is an intensive two-day course focusing on the Medicare regulatory requirements for coverage determinations, including patient status. This course is designed to provide Medicare Advantage plan staff with proficiency in fee-for-service coverage rules for application to plan patients.

What computer setup do I need to attend this class?
This class 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 sessions of the Live Virtual Medicare Boot Camp—Utilization Review for Medicare Advantage Version?
In addition to our open registration courses, we also offer the Medicare Boot Camp—Utilization Review for Medicare Advantage Version as an on-site program (with a substantial discount) for organizations with a number of employees who need training. For more information on hosting an on-site Medicare Boot Camp—Utilization Review for Medicare Advantage Version, click on Train Groups On-Site.

What if I need to cancel or transfer my registration?
To view our cancellation policy, please click here.

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.

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, a notebook for taking notes, and sticky notes/flags.

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.

Live Virtual Medicare Boot Camp®—Utilization Review for Medicare Advantage 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 where these materials should be shipped. 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 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. You will be given the page location in the welcome email. 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 20-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 800-650-6787 or email sales@hcpro.com.

We Look Forward to Having You In Class!

Live Virtual Medicare Boot Camp®—Utilization Review for Medicare Advantage Version

Learning Objectives

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

• Apply Medicare observation coverage rules
• Break down how LCDs, NCDs, and CEDs affect coverage of services for MA patients
• Develop compliant medical review policies if coverage is not already fully established
• Assess the utilization management committee’s compliance with Medicare regulations
• Break down the 2-midnight benchmark
• Identify exceptions to the 2-midnight benchmark
• Assess the effect of the inpatient-only list on authorizations for inpatient care

Continuing Education

AHIMA
This program has been approved for 2 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.

Ability to claim credits for this webinar expires on: 8/28/2024

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.