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

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. 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. CMS has directed Medicare Advantage plans to follow the fee-for-service Medicare UR rules, and CAHs must be prepared to ensure plans understand the CAH environment and are compliant with inpatient admissions and observation stays. Don’t become a target or leave money on the table—have confidence in the UR determinations you and your facility are making.

The Live Virtual Medicare Boot Camp—Utilization Review for Critical Access Hospitals also answers all your questions about navigating the CMS website and finding Medicare resources.

You will leave this program knowing:

• How to apply the 2-midnight benchmark
• How the inpatient-only provisions apply to CAH services
• CMS guidance on case-by-case admissions
• The observation coverage rules and how they interact with the 2-midnight benchmark
• Rules for inpatient admission determinations by Medicare Advantage plans
• The differences between post-discharge and concurrent patient status reviews
• When self-denial is appropriate to take advantage of Part B payment for an inpatient case
• How national coverage determinations (NCD) and local coverage determinations (LCD) affect coverage of cases that meet the 2-midnight benchmark
• When the Advance Beneficiary Notice (ABN) and Hospital-Issued Notice of Non-Coverage (HINN) should be used for stays that don’t meet medical necessity requirements
• Requirements for swing bed coverage

This Boot Camp will help you to:

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

Who should attend?
With a more clinical focus than HCPro’s other Boot Camps, this class is designed for the physicians and nurses involved in the Medicare UR process, as well as the revenue cycle Product/ Lead Instructor professionals who support them. The course is also helpful for staff dealing with inpatient and outpatient denials and appeals.

• UR coordinators
• UR managers and directors
• UR committee members
• UR physician advisors
• Case managers
• Care coordinators
• Revenue cycle staff
• Nurse managers
• Compliance officers and auditors
• Medicare Administrative Contractor (MAC) personnel
• Healthcare lawyers and consultants

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 be more efficient applying Medicare guidelines.
• 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 Monday – Thursday for 4 days from 12:00 p.m. – 4:15 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 December 8 – December 11. Registration cut-off date: 12/1/2025

For more information about our 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®—Utilization Review for Critical Access Hospitals

Course Outline

Module 1: Medicare Program, Contractors, and Resources

• Overview of Medicare Part A, B, C, and D
• Medicare contractors, including Medicare Administrative Contractors (MAC), Recovery Audit Contractors (RAC), and Quality Improvement Organizations (QIO)
• Web-based resources and key sources of Medicare authority

Module 2: Medical Necessity Rules, Policies, and Notices

• Medicare coverage, including guidelines for evaluating medical necessity
• Medicare Coverage Center, including local coverage determinations (LCD), national coverage determinations (NCD), and Coverage with Evidence Development (CED)
• Medicare Advantage plan coverage determinations, including prior authorizations

Module 3: Coverage of Observation

• Coverage of observation services
• Coding and billing of observation
• Payment for observation, including at critical access hospitals (CAH)

Module 4: Medicare Outpatient Notices

• The Medicare Outpatient Observation Notice (MOON)
• Advance Beneficiary Notice (ABN) for non-covered observation

Module 5: Inpatient Orders and Certification

• Inpatient order requirements
• Inpatient certification requirements, including 96-hour CAH certification

Module 6: Inpatient Admission Guidelines

• Inpatient-only procedures
• The 2-midnight benchmark
• Admission on a case-by-case basis
• Livanta guidance, including clinical examples

>Module 7: Inpatient Utilization Review (UR) and Billing Requirements

• UR requirements and self-denials
• Concurrent review and billing with condition code 44
• Inpatient Part B payment and billing with condition code W2

Module 8: Medicare Inpatient Notices

• Important Message from Medicare (IM)
• Detailed Notice of Discharge (DN)
• Hospital-Issued Notice of Non-Coverage (HINN) for non-covered inpatient services

Module 9: Coverage, Notices, and Billing for Swing Bed Admissions in a CAH

• Coverage for swing beds
• Level of care and documentation requirements
• Skilled nursing facility (SNF) ABN notice requirement
• Reimbursement methodology and patient coinsurance
• Consolidated billing rules for CAH swing beds

Course agenda/outline is subject to change.

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:

• Apply Medicare observation coverage rules
• Evaluate the appropriate application of ABNs for observation patients
• Comply with inpatient order and certification requirements
• Break down the 2-midnight benchmark
• Identify exceptions to the 2-midnight benchmark
• Assess the effect of the inpatient-only list on UR determinations
• Differentiate between condition codes 44 and W2
• Quantify inpatient and outpatient deductibles and copayments

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.

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

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®—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 two 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 class will be hosted on the GoTo Meeting 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 GoTo Meeting 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 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. 

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.

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 afterward, 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.

Can I host a Medicare Boot Camp for my staff?
sales@hcpro.com.

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

Who typically attends the Medicare Boot Camp—Utilization Review for Critical Access Hospitals?

• UR coordinators
• UR managers and directors
• UR committee members
• UR physician advisors
• Case managers
• Care coordinators
• Revenue cycle staff
• Nurse managers
• Compliance officers and auditors
• Medicare Administrative Contractor (MAC) personnel
• Healthcare lawyers and consultants

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.