Live Virtual Medicare Boot Camp®—Denials and Appeals Version

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Live Virtual Medicare Boot Camp®—Denials and Appeals Version

Product Code: MBDV

The Live Virtual Medicare Boot Camp®—Denials and Appeals Version teaches you about the latest claim audit and appeal issues based on official guidance. You’ll leave the class armed with a thorough understanding of the audit and appeal process and ready to put your new knowledge into action.

Live Virtual Medicare Boot Camp®—Denials and Appeals Version

Course Overview

Get expert guidance on preventing denials and focusing appeals efforts for success. The evolution of reimbursement models and uncertainty regarding healthcare laws mean that to keep the doors open, organizations can’t afford write off appealable denials. Organizations need sound, practical information on overturning denials. Live Virtual Medicare Boot Camp®—Denials and Appeals Version is your key to proven strategies for success and will answer all of your questions on denials management and appeals processes.

This Boot Camp teaches you about the latest claim audit and appeal issues based on official guidance. You’ll leave the class armed with a thorough understanding of the audit and appeal process and ready to put your new knowledge into action.

You will leave this program knowing how to:

  • Prepare for CMS audits
  • Navigate the appeals process up to the Administrative Law Judge level
  • Research denials and upcoming audit focus areas
  • Implement policies to support efficient appeals and identify appropriate denials to appeal


Who should attend?

  • Revenue cycle directors and managers
  • Revenue integrity directors, managers, and staff
  • HIM directors, managers, and staff
  • CDI directors, managers, and specialists
  • Compliance directors, officers, and auditors
  • Business office managers
  • Case management directors and managers
  • Case managers
  • Utilizations review staff
  • Utilization management staff
  • Physician advisors
  • Audit directors and coordinators
  • Auditors
  • Appeals coordinators
  • Patient financial services directors

Live Virtual Medicare Boot Camp®—Denials and Appeals Version

Outline/Agenda

Module 1: Medicare Overview and Resources

  • The Four Parts of Medicare
  • Medicare Contractors
  • Independent Government Agencies-Medicare Involvement


Module 2: Medicare Research and Resources

  • Web-Based Resources
  • Key Sources of Authority
  • Medicare Coverage Center, including LCDs NCDs, CED and Lab Coverage Manual
  • Ways to Stay Current 


Module 3: Medicare Program Safeguards and Medicare Notices

  • Medicare Policy Development, Financing, the Trust Funds, the need for Program Safeguards
  • Improper Payments
  • Program Safeguards
  • Limitation on Liability provisions of the Social Security Act  
  • Notices of Non-Coverage


Module 4: Prepayment Claim Reviews/Audits

  • Prepayment Reviews Overview
  • Automated Prepayment Reviews
  • Prepayment Non-Medical Record Reviews
  • Prepayment Medical Record Reviews 


Module 5: Postpayment Claim Reviews/Audits

  • Establishment of Postpayment Claim Review/Audits Process
  • Postpayment Claim Reviews/Audits Overview
  • Postpayment Non-Medical Record Reviews
  • Statistical Sampling and Extrapolations
  • Postpayment Medical Record Reviews 


Module 6: Medicare FFS Claim Appeals Process (Part 1)

  • Initial Determinations
  • Reopenings and Overlap with Appeals Process
  • Level 1 Appeal Process: Redetermination
  • Level 2 Appeal Process: Reconsideration


Module 7: Medicare Appeals Process Overview (Part 2)

  • Level 3 Appeal Process: Administrative Law Judge (ALJ) Hearing
  • Level 4 Appeal Process: Medicare Appeals Council
  • Level 5 Appeal Process: Judicial Review in U.S. District Court 


Module 8: Current Medicare Claim Audits and Appeals Issues Overview

  • Two Midnight Expectation and QIO Review
  • Expedited Judicial Review
  • Medicare Overpayments
  • Appeals Backlog
  • Ways to Stay Current: Audit Topics
  • Ways to Stay Current: ALJ Decisions, Appeals Council Decisions and Federal Court Decisions


Course Agenda/Outline is subject to change.

Live Virtual Medicare Boot Camp®—Denials and Appeals Version

Learning Objectives

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

  • Research the appeals process and related regulations
  • Identify key steps in the appeals process up to the Administrative Law Judge level
  • Explain common causes of Medicare denials
  • Develop policies and practices to support compliance, reduce denials, and expedite appeals
  • Analyze denied claims to select appropriate appeals

Live Virtual Medicare Boot Camp®—Denials and Appeals Version

Continuing Education Credit

AAPC
This program has been approved by the AAPC for 16 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 16 CE credits for use in fulfilling the continuing education requirements of the American Health Information Management Association (AHIMA).

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 16 nursing contact hours is provided by HCPro.

Association of Clinical Documentation Integrity Specialists (ACDIS)
This program has been approved for 16 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).

California Board of Registered Nursing
HCPro is approved by the California Board of Registered Nursing to provide 19.2 nursing contact hours. California BRN Provider #CEP 14494.

Commission for Case Manager Certification (CCMC)
This program has been pre-approved by The Commission for Case Manager Certification to provide 16 hours of continuing education credit to CCM board certified case managers.

Compliance Certification Board (CCB)
The Compliance Certification Board (CCB) has approved this event for up to 19.2 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 16 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 19 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.

Live Virtual Medicare Boot Camp®—Denials and Appeals Version

Questions/Answers

What is the focus of the Live Virtual Medicare Boot Camp®—Denials and Appeals Version?
Live Virtual Medicare Boot Camp®—Denials and Appeals Version version is an intensive, two-day course on Medicare appeals and denials management, covering the Medicare claims review processes, types of audits and how providers should respond to them, and the different levels of the appeals process. The goal of the course is to provide participants with a sound understanding of the audit, denial, and appeal process, including the payer perspective, that is based directly on current regulations.

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 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, click here.

Who typically attends the Medicare Boot Camp®—Denials and Appeals Version?

  • Revenue cycle directors and managers
  • Revenue integrity directors, managers, and staff
  • HIM directors, managers, and staff
  • CDI directors, managers, and specialists
  • Compliance directors, officers, and auditors
  • Business office managers
  • Case management directors and managers
  • Case managers
  • Utilizations review staff
  • Utilization management staff
  • Physician advisors
  • Audit directors and coordinators
  • Auditors
  • Appeals coordinators
  • Patient financial services directors


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


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.