Live Virtual Medicare Boot Camp®—Utilization Review for Critical Access Hospitals

Course Overview

The Live Virtual Medicare Boot Camp®—Utilization Review for Critical Access Hospitals is an intensive course focusing on the Medicare regulatory requirements for patient status and the role of the utilization review (UR) committee. Master Medicare rules for UR in just four 4-hour live online sessions. This is the only course of its kind catered exclusively to the needs of Critical Access Hospitals (CAH).

CAHs have a unique set of issues related to UR, including the complexities of swing bed admissions. Managing patient status plays a critical role in proper compliance, correct reimbursement, and stabilizing inpatient payments for the hospital. In recent years, CMS has made multiple changes to the inpatient only provisions and application of these changes to CAHs can be confusing The OIG also announced they will start patient status directed audits after a seven-year hiatus. Don’t become a target or leave money on the table—have confidence in the UR determinations you and your facility are making.

Medicare Boot Camp—Utilization Review for Critical Access Hospitals also answers all your questions about navigating the CMS website and finding Medicare requirements. You will be able to find answers to your questions long after the Boot Camp is over.

You will leave this program knowing:

• How coverage, notices, and billing for inpatient admissions work in a critical access hospital (CAH)
• How to apply the 2-midnight benchmark, including cases with observation
• How the inpatient only provisions apply to CAH services
• CMS guidance on case-by-case admissions
• The differences between post-discharge versus concurrent patient status reviews
• When self-denial is appropriate to take advantage of Part B payment for an inpatient case
• How NCDs, LCDs, and coverage with evidence development (CED) affect coverage of cases that meet the 2-midnight benchmark
• The observation coverage rules and how they interact with the 2-midnight benchmark
• When ABNs and HINNs should be used for stays that don’t meet medical necessity requirements
• Requirements for swing bed admission

This boot camp will help you to:

• Determine the correct inpatient or outpatient status of a patient under Medicare FFS guidelines
• Conduct compliant utilization review of Medicare patients
• Implement condition code 44 or self-denial processes correctly and compliantly
• Understand the role of a utilization review team in your organization and how they contribute to compliance and accurate reimbursement

Who should attend?

With a more clinical focus than other boot camp courses, this class is designed for the physicians and nurses involved in the Medicare utilization review process, as well as the revenue cycle people who support them. The course is also helpful for staff dealing with inpatient and outpatient denials and appeals.

• Utilization review coordinators
• Utilization review managers and directors
• Utilization review committee members
• UR physician advisors
• Case managers
• Care coordinators
• Revenue cycle staff
• Nurse managers
• Compliance officers and auditors
• Fiscal intermediary personnel
• Healthcare lawyers and consultants

See the HCPro difference for yourself!

Focus on the actual rules: Learn how to find and apply CMS rules and guidelines to ensure Medicare beneficiaries are placed in the correct status and billed correctly for the services they receive.

Tools and skills to navigate Medicare rules: Our instructors provide valuable tools and resources that will help you prioritize and research Medicare questions long after the Boot Camp ends.

Applied learning: Case studies throughout each module ensure participants understand the concepts and know how to apply them to real-world situations.

Small class size: A low participant-to-teacher ratio is guaranteed.

How does the Live Virtual Medicare Boot Camp®—Utilization Review for Critical Access Hospitals work?

Class is held Mondays – Thursday for 4 days from 12:30 p.m. – 4:30 p.m. Eastern Time (4 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 – Thursday from October 2 – October 5. Registration cut-off date: 9/25/2023

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 615-724-7200 or email PD-IS@SimplifyCompliance.com.

Live Virtual Medicare Boot Camp®—Utilization Review for Critical Access Hospitals

Outline/Agenda

Module 1: Medicare Overview, Contractors, and Resources

• Overview of Medicare Part A, B, C, and D
• Medicare contractors, including the MAC, RAC and QIO
• Medicare Coverage Center, including LCDs, NCDs and CED
• Review of prior authorization for specified outpatient procedures and services

Module 2: Outpatient Observation

• Coverage of observation services
• The Medicare Outpatient Observation Notice (MOON)
• Advanced Beneficiary Notice (ABN) for non-covered observation
• Coding and billing of observation
• Payment for observation at a Critical Access Hospital (CAH)
• Patient coinsurance under Part B

Module 3: Coverage of Inpatient Admissions

• Inpatient order requirements
• Inpatient certification requirements, including 96-hour CAH certification
• Inpatient criteria and the 2-Midnight Benchmark
• Inpatient-only procedures
• Admission on a case-by-case basis
• Documentation and use of screening tools
• Inpatient deductible, coinsurance, and lifetime reserve days (LRDs)

Module 4: Inpatient Utilization Review and Notices

• Utilization review requirements and self-denials
• Concurrent review and billing with condition code 44
• Inpatient Part B payment and billing with condition code W2
• Important Message from Medicare (IM)
• Detailed Notice of Discharge (DN)
• Hospital Issued Notice of Non-Coverage (HINN) for non-covered inpatient services

Module 5: Coverage, Notices, and Billing for Swing Bed Admissions in a CAH

• Coverage for swing beds
• Level of care and documentation requirements
• SNFABN notice requirements

• Reimbursement methodology and patient coinsurance
• Exclusion from SNF PPS consolidated billing rules

Course Agenda/Outline is subject to change.

Live Virtual Medicare Boot Camp®—Utilization Review for Critical Access Hospitals

Schedule

October — Class Schedule (Eastern time)

Live Virtual Medicare Boot Camp®—Utilization Review for Critical Access Hospitals

Questions/Answers

What is the focus of the Medicare Boot Camp®—Utilization Review for Critical Access Hospitals?
Medicare Boot Camp®—Utilization Review for Critical Access Hospitals is an intensive course taught over several days focusing on the Medicare regulatory requirements for patient status and the role of the utilization review (UR) committee.

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.

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 with coding, billing, and reimbursement. 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, notebook for taking notes, and sticky notes/flags.

Are there recordings of the sessions?
In the event a participant is unable to attend a particular session, recordings will be made available for the duration of the course and a limited time after to allow the participant to complete the quiz required for CEUs. Class participation and sessions are an important part of the learning experience for the course. Students are expected to attend scheduled classes whenever possible.

Does this course prepare participants for coding certification?
The Medicare Boot Camp®—Utilization Review for Critical Access Hospitals contains a review of pertinent coding issues as they relate to Medicare coverage, billing, and payment; however, the course is not designed as a coding course. HCPro does offer two courses focused on coding fundamentals. The Certified Coder Boot Camp®—Original Version focuses on coding for physician and hospital outpatient services. The Certified Coder Boot Camp®—Inpatient Version focuses on hospital inpatient facility services. These courses may assist participants in preparation for national coding certification. For more details, please review the information for these courses using the links above or contact customer service at email customer@simplifycompliance.com or 800-650-6787.

Does HCPro offer "on-site" Medicare Boot Camps?
In addition to our open registration courses, we also offer Medicare Boot Camps 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 Medicare Boot Camp?

• Finance and reimbursement personnel
• Case Managers
• Chargemaster personnel
• Billers and coders
• Medical records/health information personnel
• Clinical department personnel
• Provider-based clinic personnel
• Revenue managers
• Compliance officers and auditors
• Registration personnel
• Medicare Advantage and MAC personnel
• Healthcare lawyers, consultants, and CPAs
• Legal department personnel

What do I need to know prior to attending?
Please read further with our Get Ready for Class outline.

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.

Live Virtual Medicare Boot Camp®—Utilization Review for Critical Access Hospitals

Learning Objectives

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

• Define observation coverage, billing, coding, and payment rules
• Discuss the appropriate application of ABNs for observation patients
• State the inpatient order and certification requirements
• Explain CMS’ 2-midnight rule benchmark 
• Recognize exceptions to the 2-midnight benchmark
• Describe the impact of LCD/NCD/CED criteria on inpatient coverage
• State the rules for "inpatient-only" procedure billing and reimbursement
• Describe the differences between condition codes 44 and W2
• Use appropriate billing codes for full Part B payment for inpatient cases, including for "self-denials"
• Differentiate inpatient and outpatient deductibles and co-payments

Continuing Education

ACCME
HCPro is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
HCPro designates this educational activity for a maximum of 15 AMA PRA Category 1 Credits.™ Physicians should only claim credit commensurate with the extent of their participation in the activity.

ACDIS
This program has been approved for 15 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).

ANCC
HCPro is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center’s Commission on Accreditation. 
This activity is available for 15 nursing contact hours

CCMC
This program has been pre-approved by the Commission for Case Manager Certification to provide 15 continuing education credit to Certified Case Managers (CCMs).

NAHRI
This program has been approved for 15 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.