Live Virtual Medicare Boot Camp®—Physician Services Version

Course Overview

Effectively bill and collect for professional services while avoiding compliance risks and repayments

Optimize reimbursement and protect your organization from costly denials and potential fines with in-depth training on Medicare’s coverage, billing, and coding rules for professional services.

The Live Virtual Medicare Boot Camp®—Physician Services Version walks you through the regulations and billing procedures that impact your reimbursement, including provider enrollment, split/shared billing, appropriate modifier usage, National Correct Coding Initiative (NCCI) edits, notification requirements for the Advance Beneficiary Notice (ABN), supervision and incident-to billing, teaching physician issues, billing for locum tenens, telehealth services, and more. In-depth discussions on how to operationalize CMS requirements effectively will help you mitigate compliance risk, avoid denials, and hold on to your revenue.

Updated with the latest regulatory information, the Live Virtual Medicare Boot Camp—Physician Services Version helps your physician practice or health system billing physician claims tackle the most challenging billing and compliance issues that hit your bottom line and leave you vulnerable during an audit. Take a look:

• E/M billing and documentation requirements—apply E/M guidelines for inpatient, observation, emergency department, and nursing homes to ensure accurate payment
• Split/shared billing—know when it’s applicable and which provider to report the service under to prevent penalties
• "Incident to" billing—protect against repayments by ensuring you’re meeting the requirements for nonphysician practitioner services, provider-based departments, and delineating between physician “incident to” and hospital “incident to”
• Teaching physician requirements—avoid corporate integrity agreements with an understanding of resident supervision rules, documentation requirements when residents are involved in patient care, and appropriate modifier use
• How and when to bill for Medicare’s expanded coverage of preventive services, care management, and overlapping care management
• Reporting for single dose drug use and appropriate use of the -JZ modifier
• Billing for the new social determinants of health assessment

Identify compliance red flags and costly inefficiencies in your billing processes
A solid understanding of CMS rules for physician services will keep your organization audit-ready. This class untangles the nuances of documentation and billing topics, including:

• How to research Medicare regulations and guidance
• Participation in Medicare
• Understanding the mechanics of the Medicare Physician Fee Schedule
• Completing the CMS-1500 claim form
• ABNs
• NCCI edits
• Global surgery rules
• Diagnostic testing rules
• Medicare coverage of preventive and screening services
• Teaching physician rules
• Appeals process

You will leave this program knowing how to:

• Analyze appropriate billing for professional services for different clinical scenarios and sites of service
• Illustrate an understanding of medical necessity, limitation of liability, and effective delivery of ABNs
• Examine Medicare coverage guidelines, including the general types of physician services covered
• Interpret payment principles for physician services, allowing for an anticipated projected income stream
• Examine requirements for efficient processes that streamline the revenue cycle and enhance staff productivity

Who should attend?
The Live Virtual Medicare Boot Camp—Physician Services Version is great for those who want to learn more about the basics of navigating Medicare regulations and guidelines applicable to professional services.

• Medical practice managers
• Billers and coders
• Medical records managers and staff
• Health information managers and staff
• Clinical managers and department heads
• Finance and reimbursement managers and staff
• Physicians
• Nurse practitioners
• Physician assistants
• Compliance officers and auditors
• Medicare carrier personnel
• Healthcare consultants, CPAs, and lawyers
• Legal department personnel

How does the Live Virtual Medicare Boot Camp®—Physician Services Version work?

Class is held Monday – Friday for 1 week from 12:00 p.m. – 4:30 p.m. Eastern Time (5 classes).

Please Note: Four days before class starts, you will receive a welcome email that includes the dial-in information for the class.

Class is held Monday – Friday from May 13 – May 17. Registration cut-off date: 5/6/2024

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

Live Virtual Medicare Boot Camp®—Physician Services Version

Course Outline

Module 1: Medicare Overview and Resources

• Overview of Medicare Part A, B, C, and D
• Medicare contractors, including Medicare Administrative Contractors (MAC), Recovery Audit Contractors, and Quality Improvement Organizations
• Finding Medicare source laws, including statutes, regulations, and final rules
• Finding Medicare sub regulatory guidance, including manuals and transmittals
• Medicare Coverage Center, including local coverage determinations, national coverage determinations (NCD), Coverage with Evidence Development, and the lab coverage manual
• Links to Medicare resources and resources for staying current

Module 2: Medicare Participation

• Medicare physician/supplier enrollment process
• Medicare enrollment forms—which form is appropriate to use?
• Reporting National Provider Identifiers (NPI) on Medicare claims
• Participation and nonparticipation in the Medicare program
• “Opting out” of the Medicare program
• Assigned versus nonassigned claims
• “Limiting charge” rules and the implications for assigned and nonassigned claims

Module 3: Medical Necessity and Noncoverage

• Social Security Act “limitation on liability” provisions and when they apply
• Situations in which an Advance Beneficiary Notice (ABN) is necessary to hold the patient responsible for non-covered services
• Circumstances under which an ABN would be ineffective/invalid
• When it is inappropriate to present an ABN to a patient
• Circumstances where a routine ABN is permitted
• Appropriate reporting of ABN modifiers

Module 4: CMS-1500, ICD-10-CM, NPI, and Other Must-Know Billing Fundamentals

• Role and functions of the MAC
• MAC jurisdiction for services furnished to a Medicare beneficiary
• CMS-1500 data set instructions and proper reporting of services provided
• Proper reporting of site of service and the effect on payment
• Overview of skilled nursing facility (SNF) consolidated billing and how it affects billing for professional services furnished to SNF residents
• Reassignment relationships and when they are permissible under the Medicare reassignment regulations/guidelines

Module 5: Overview of the Resource-Based Relative Value Scale

• Medicare payment and the Physician Fee Schedule
• Using the relative value file/Physician Fee Schedule database to make operational decisions
• Medicare’s annual deductible and coinsurance and the effect on beneficiary liability and payment to practitioners
• Proper use of modifiers -22 and -52 and their effect on reimbursement

Module 6: National Correct Coding Initiative (NCCI), Medically Unlikely Edits, Modifiers, and Other Must-Know Billing Fundamentals

• NCCI edits, composition, and application
• Differentiating between Column 1/Column 2 and Mutually Exclusive code edits
• Determining special considerations and practical issues for practitioners related to NCCI edits
• Determining when an NCCI edit will apply to a claim
• Determining the correct way to bill for a code pair that is subject to an NCCI edit, including appropriate use of modifiers

Module 7: Evaluation and Management (E/M) Services: The Most Commonly Billed Physician Service

• Appropriate billing for E/M services furnished to a hospital inpatient
• Appropriate billing for E/M services furnished to a hospital observation patient
• Appropriate reporting of E/M services furnished in an emergency department
• Appropriate reporting of E/M services furnished to a nursing facility patient
• Medicare’s approach to consultations
• Appropriate billing for critical care, concurrent care, care management, behavioral integration, and care plan oversight services

Module 8: Surgical Services for Physicians: Modifiers and More

• Global surgical package—inclusion and exclusion of services
• Determining the applicable postoperative period of a procedure
• Appropriate billing for services furnished during the postoperative period that are not included in the surgical package, including the use of appropriate modifiers
• Multiple procedure reduction and its application to a particular Medicare claim
• Appropriate billing for bilateral surgeries, assistant surgeons, co-surgeons, and team surgeons
• Medicare coverage of dental and oral health services
• Services and procedures requiring prior authorization

Module 9: Clinical Lab, Radiology, and Other Diagnostic Services

• Determining when the professional and technical component services for a diagnostic test are separately billable
• Determining when and how to use modifiers to appropriately bill for professional and technical component services
• Physician supervision required for a particular diagnostic test
• Billing appropriately for diagnostic radiology services in a professional practice setting
• Application of multiple procedure payment reduction and calculation of its effect on reimbursement
• Clinical Laboratory Improvement Amendments (CLIA) requirements applicable to laboratory services furnished in a professional practice setting
• Locating and effectively using the clinical diagnostic laboratory services fee schedule and the NCDs applicable to clinical laboratory services

Module 10: Nonphysician Practitioners (NPP) and Therapist Services

• Medicare’s recognition of NPPs
• “Incident to” and “split/shared” coverage of NPP services
• NPP services that qualify for incident-to coverage
• Circumstances when NPP services may be appropriately billed under split/shared coverage rules
• Medicare coverage and billing of therapy services

Module 11: Physicians at Teaching Hospitals

• Overview of Medicare coverage of services provided by interns and residents
• Situations in which a teaching/attending physician’s presence is required when residents are involved in patient care
• Appropriate billing for resident involvement of patient care (including the appropriate use of modifiers)
• Documentation requirements applicable to teaching/attending physician services when residents are involved in patient care
• Appropriate billing for services furnished by an intern or resident functioning as an assistant surgeon
• Determining whether Medicare payment is available for services furnished by a particular moonlighting resident

Module 12: Medicare Coverage of Preventive Health Services

• Initial preventive physical exam
• Annual wellness visits
• Medicare coverage of screening services
• Medicare Diabetes Prevention Program

Module 13: Medicare Telehealth Benefit and Virtual Services

• Telehealth vs. telemedicine
• Originating-site and distant-site practitioners
• Geographic location requirements
• Appropriate use of modifiers and place of service codes
• Mental health services
• Status of COVID-19 expanded telehealth benefits

Module 14: When the Medicare Payment Is Not What You Expect: Audits and Appeals

• Overview of the Medicare program integrity function applicable to services furnished in a professional practice setting
• Comprehensive Error Rate Testing program
• Proper response for audits and record requests
• Overview of the Medicare Part B appeals process

Course Outline/Agenda subject to change.

Live Virtual Medicare Boot Camp®—Physician Services Version

Learning Outcomes

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

• Employ CMS guidelines to ensure proper reporting
• Analyze appropriate billing for professional services for different clinical scenarios and sites of service
• Apply Medicare’s evaluation and management guidelines to ensure proper billing
• Illustrate an understanding of medical necessity, limitation of liability, and effective delivery of Advance Beneficiary Notices
• Evaluate compliance pitfalls and prepare for potential audits
• Examine Medicare coverage guidelines, including the general types of physician services covered
• Comply with the specific Medicare coverage requirements for certain services
• Interpret payment principles for physician services, allowing for an anticipated projected income stream
• Explain Medicare’s telehealth benefits
• Examine requirements for efficient processes that lead to increased productivity

Continuing Education

AAPC
This program has been approved by the AAPC for 21 continuing education hours. Granting of prior approval in no way constitutes endorsement by AAPC of the program content or the program sponsor.

AHIMA
This program has been approved for 20.8 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.

NAHRI
This program has been approved for 21 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.

Live Virtual Medicare Boot Camp®—Physician Services 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 to. If you order over the phone or are unsure of what address we have on file, please ask the person you are speaking with to verify your address information 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, visit https://support.goto.com/meeting/system-check. We will send out access information for the class four business days prior to the class start date 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 two business days following the first session. 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 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!

Live Virtual Medicare Boot Camp®—Physician Services Version

Questions/Answers

What is the focus of the Live Virtual Medicare Boot Camp®—Physician Services Version?
The Live Virtual Medicare Boot Camp—Physician Services Version is technically oriented and focuses on the Medicare regulations and guidelines applicable to professional services. The course's objective is to provide course participants with a detailed understanding of the Medicare "rules," with a particular emphasis on those rules' real-world application.

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.

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

Who typically attends the Live Virtual Medicare Boot Camp—Physician Services Version?

• Medical practice managers
• Billers and coders
• Medical records managers and staff
• Health information managers and staff
• Clinical managers and department heads
• Finance and reimbursement managers and staff
• Physicians
• Nurse practitioners
• Physician assistants
• Compliance officers and auditors
• Medicare carrier personnel
• Healthcare consultants, accountants, and attorneys
• Legal department personnel

Does the course require any previous experience or training?
The course starts with Medicare fundamentals and does not assume that participants have any 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 professional practice setting. Familiarity with the CPT® coding system will be particularly helpful.

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

Four days before class starts, you will receive a welcome email that includes the dial-in information for the class.

What should I have available for each session?
For each class, participants should have their packet of materials and may wish to have available a highlighter, a notebook for taking notes, and sticky notes/flags.

To get the most out of the course, you should also have a current CPT manual available. Any current version of the CPT manual will be fine so long as it is published by the American Medical Association (AMA). Our instructors use and recommend the AMA's CPT Professional Edition. HCPro offers the latest version of this manual on HCMarketplace.

Optum publishes a manual called CPT Expert. We recommend against using it for this course because CPT Expert does not contain all the official CPT guidelines.

How do I get more information?
Contact us at 800-650-6787 or email sales@hcpro.com.