Boot Camps

Live Virtual Medicare Boot Camp®—Denials and Appeals Version

Course Overview

Course Overview

Reduce claim denials and win appeals

Get expert guidance on preventing denials and focusing appeal efforts for success.  Reimbursement models continue to evolve, and uncertainty persists regarding healthcare laws and CMS policy. Both of these factors mean that organizations cannot afford to write off appealable denials that are winnable, lest they face insolvency or be forced to close their doors. 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 your questions on denials management and appeal processes.

This Boot Camp teaches you about the latest claim audit and appeal issues based on official guidance and regulations. 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 for tangible results.

You will leave this program knowing how to:

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

You will leave this Boot Camp with an understanding of:

• Navigating regulations and CMS policies in order to comply and increase CMS reimbursement from the get-go
• The different types of audits and how you can prepare your organization for them
• The audit, denial, and appeal process and what to look out for
• How you should respond to audits
• How to increase your organization’s favorable appeal decisions

Who should attend?
The course is fit for any member of your billing, revenue, or clinical team who wants to understand more about appeals and denials and how to prepare for and navigate them. 

• 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
• Utilization review staff
• Utilization management staff
• Physician advisors
• Audit directors and coordinators
• Auditors
• Appeal coordinators
• Patient financial services directors

See the HCPro Difference for Yourself!

• Focus on the actual rules: Learn how to prepare for CMS audits and navigate the appeals process up through and beyond the Administrative Law Judge and Medicare Appeals Council levels. Also learn about the Medicare Appeals Council rules and regulations.
• Tools and skills to navigate Medicare rules: Our instructors provide valuable tools and resources that will help you prioritize and research time-sensitive issues long after the Boot Camp ends. 
• 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.

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

Live Virtual Medicare Boot Camp®—Denials and Appeals Version

Outline/Agenda

Module 1: Denials and Appeals Overview

• Understanding the types of denials
• Steps involved when handling denials
• The main structure of appeals
• Timeline associated with appeals 

Module 2: Medicare Overview and Contractors

• The Four Parts of Medicare
• Medicare Contractors
• Independent government agencies—Medicare involvement

Module 3: Medicare, Medicaid, and Commercial Research and Resources

• Web-Based Resources
• Key Sources of Authority
• Medicare Coverage Center, including LCDs, NCDs, CED, and Lab Coverage Manual
• Medicaid Manual Research
• Commercial payer research
• Common Contractual Language in Commercial Contracts
• Ways to Stay Current

Module 4: Prepayment Claim Reviews/Audits

• Overview of prepayment reviews
• Automated Prepayment Reviews
• Prepayment Non-Medical Record Reviews
• Prepayment Medical Record Reviews 

Module 5: Postpayment Claim Reviews/Audits

• Establishment of postpayment claim review/audit process
• Postpayment claim review/audit overview
• Postpayment Non-Medical Record Reviews
• Statistical Sampling and Extrapolations
• Postpayment Medical Record Reviews

Module 6: Medicare FFS Claim Appeal Process

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

• Audit Overview
• Appeal process
• Strategies for Appeals
• Common appeal levels

Module 8: No Surprises Act Appeal Process

• Overview of the No Surprises Act
• Qualifying Payment Amount
• Good faith negotiation
• Arbitration

Module 9: Drafting and Constructing an Appeal Letter

• Overview of common elements of appeal letters
• Specific items to address in an appeal letter
• Structure of an effective appeal letter
• Identifying proper sources

Course agenda/outline is subject to change.

Live Virtual Medicare Boot Camp®—Denials and Appeals Version

Learning Objectives

At the completion of this Boot Camp, participants will be able to:  

• Articulate the appeals process and related regulations
• Define key steps in the appeals process up to the Administrative Law Judge level
• Describe common causes of Medicare denials
• Design policies and practices to support compliance, reduce denials, and expedite appeals
• Examine denied claims to select appropriate appeals
• Equip denials and appeal staff with effective and efficient strategies to effectively review and respond to denials and appeals
• Conduct research necessary to respond and effectively draft an appeal
• Articulate the common commercial contractual clauses that impact audits and appeals
• Construct a solid appeal letter and the necessary components to include in appeal letters

Continuing Education

If you are interested in offering this bootcamp to your employees and need to know what CE credits could be offered, please contact customer service at 800-650-6787 or email sales@hcpro.com.

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?
The Live Virtual Medicare Boot Camp—Denials and Appeals Version is an intensive course on Medicare denials and appeals management, covering the Medicare claims review process, types of audits and how providers should respond to them, and the different levels of the appeal 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 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 an on-site version of this Boot Camp?
In addition to our open registration and live virtual 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 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.

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.

What if I have a question that didn’t get addressed in class?
The course offers open office hours each week to address topics related to the course materials and class discussion. Questions should be related to the course and topics discussed throughout the course. Instructors are not able to address questions outside the scope of the 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
• Utilization review staff
• Utilization management staff
• Physician advisors
• Audit directors and coordinators
• Auditors
• Appeal coordinators
• Patient financial services directors

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

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 800-650-6787 or email sales@hcpro.com.

Live Virtual Medicare Boot Camp®—Denials and Appeals 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 of where these materials should be shipped to. 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 your 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 40-question quiz that is based on 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!