Boot Camps

Live Virtual Revenue Integrity and Chargemaster Boot Camp for Critical Access Hospitals

Course Overview

Charge capture’s importance is at an all-time high. Let our expert instructors peel back the layers of chargemaster and revenue integrity in the critical access hospital setting. 

The Live Virtual Revenue Integrity and Chargemaster Boot Camp for Critical Access Hospitals provides education on chargemaster and revenue integrity concepts in a classroom format. The program will relate the chargemaster function to revenue cycle and revenue integrity functions, including cost reporting and key operational issues, such as coverage, clinical documentation, charge capture, and coding. It will also provide context for chargemaster setup and maintenance within revenue integrity to help avoid pre- and post-billing edits and payer denials. This Boot Camp reviews chargemaster coding requirements for critical access hospitals and excludes discussion of topics that are specific to coding for the Outpatient Prospective Payment System. 

You will leave this program knowing how to: 

• Provide formal, organized education and training for revenue integrity and chargemaster staff 
• Provide context for the intersection of the chargemaster with clinical/revenue departments, charge capture, coding, finance, and patient access and billing 
• Walk attendees through CMS regulatory requirements for pricing and charging patients, as well as key relationships between the chargemaster and provider cost reporting 
• Give detailed instructions for the majority of revenue codes for optimal chargemaster setup, maintenance, and charge capture 
• Understand documentation issues for critical access hospitals 
• Review chargemaster issues for commercial/managed care versus CMS requirements for critical access hospitals 

See the HCPro difference for yourself! 

• Focus on the actual rules: Learn how to find and apply CMS rules and guidelines to ensure hospital services furnished to Medicare beneficiaries are billed accurately and appropriately. 
• 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. 
• Case studies: Case studies ensure attendees understand the concepts and know how to apply them to real-world situations. 
• Small class size: A low participant-to-teacher ratio is guaranteed. 
• Highly rated, well-established program: Participants consistently give the course an overall rating of 4.75 or higher (on a 5.0 scale). We currently conduct more than 30 Medicare Boot Camp courses each year.  

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

Looking to train your whole team? Our experts can provide virtual training for your organization!  Learn more here!

Live Virtual Revenue Integrity and Chargemaster Boot Camp for Critical Access Hospitals

Course Outline

Module 1: Revenue Integrity Overview and Resources  

• Revenue integrity functions and key principles, including how the chargemaster fits into revenue integrity functions 
• Medicare and other revenue integrity and chargemaster resources 
• Understanding authoritative sources such as statutes, regulations, manuals, transmittals, and other Medicare rules and guidelines 

Module 2: Eligibility Principles  

• Review of major and different types of medical insurance 
• Principles of health insurance eligibility and verification of insurance 
• Coordination of benefits and subrogation 
• Medicare Secondary Payer concepts  

Module 3: Benefits, Coverage, and Medical Necessity 

• Review how insurance benefits are structured for hospital and other services 
• The importance of coverage, medical necessity, and both implied and specifically excluded benefits 
• Medicare’s prohibition against unbundling for inpatient and outpatient hospital services 
• Pre-service coverage analysis and associated waiver/notice requirements 
• Serious preventable events and relationship to risk management 
• Investigational/experimental services and implications for coverage 

Module 4: Provider Types, Licensure, Enrollment, Privileges, Credentialing, and Scope of Practice  

• Types of facilities, providers, physicians, practitioners, and suppliers 
• Provider-based department requirements, including implications of Section 603 of the Bipartisan Budget Act of 2015 
• Licensure, scope of practice, privileging, and relationship to coverage 
• Conditions of Participation, survey & certification, and accreditation 
• Importance of medical staff bylaws & regulations and relationship to conditions of payment 

Module 5: Chargemaster Structure and Relationship to Cost Reporting  

• Definition, purpose, and key fields of a chargemaster 
• Concepts for code setup in chargemasters and relationship to HIM coding 
• Principles of bundled services per CPT® definition versus reporting packaged services and implications for separate charging of packaged services 
• Strategies to address payer differences in the chargemaster 
• The relationship of the chargemaster to the overall AR system 
• Concepts for pricing services and why APCs are not a good gauge for pricing hospital services 
• Chargemaster, general ledger, and relationship to cost reporting 

Module 6: Principles of Charge Capture 

• Charge capture principles, logic, and reconciliation 
• HIPAA transaction sets 
• Routine and ancillary charges 
• Bundled versus packaged payments 

Module 7: Claim Submission Fundamentals and Code Edits  

• Key UB-04 fields applicable to hospital services 
• HIPAA transaction sets, including ICD-10 and HCPCS codes 
• Common claim edits, including NCCI and MUEs 
• Other transaction sets applicable to the revenue cycle, such as eligibility, payment, claim status, and denial transaction sets 

Module 8: Strategies and Key Issues by Revenue Code: Routine Services and Observation  

• Key concepts for accommodation codes and routine services, including outpatients in beds, specialty care units, and observation services 
• Coding and edit issues for revenue codes associated with routine services and observation 
• Major factors of coverage for these services 
• Applicable inpatient and outpatient payment concepts 
• General ledger and finance considerations, including pricing and charge capture 

Module 9: Strategies and Key Issues by Revenue Code: Ancillary Services  

• Key concepts for major ancillary service departments, including perioperative services, emergency, cardiology, diagnostic imaging, pharmacy, and supplies 
• Coding and edit issues for revenue codes associated with ancillary services 
• Major factors of coverage for these services 
• Applicable inpatient and outpatient payment concepts 
• General ledger and finance considerations, including pricing and charge capture 

Module 10: Strategies and Key Issues by Revenue Code: Other Departments  

• Key concepts for other common ancillary service departments, including respiratory therapy, clinics, behavioral health, and preventive services 
• Coding and edit issues for revenue codes associated with other departments 
• Major factors of coverage for these services 
• Applicable inpatient and outpatient payment concepts 
• General ledger and finance considerations, including pricing and charge capture 

Module 11: Introduction to Payment Systems  

• Review inpatient payment systems, including DRGs, APR-DRGs, case rates, and per diems 
• Discuss hospital outpatient hospital payment systems, including OPPS & APCs, eAPGs, fee schedules, and percent of charges 
• Review outpatient surgery payment methodologies such as ASC and ambulatory fee schedules 
• Review other ambulatory service payment systems such as the physician fee schedule, DMEPOS, and the clinical lab fee schedule 
• Review emerging payment methodologies such as bundled/episode payments (CJR) and value-based purchasing 

Module 12: Critical Access Hospital Reimbursement: Methods I & II  

• Cost-based reimbursement, interim, and period interim payment rates 
• Method I and Method II outpatient billing 
• Medicare reimbursement and payment for Method II billing 
• CRNA pass-through exemption  
• Method II billing of outpatient anesthesia services 

Module 13: Medicare Physician Fee Schedule 

• The resource-based relative value system 
• Relative value unit structure 
• Site-of-service adjustments for facility and non-facility services 
• Global versus technical and professional components 
• Payment policy indicators 

Module 14: Chargemaster Management and Maintenance Strategies  

• Issues surrounding the annual chargemaster updates, including pricing, HCPCS codes, and charge items with no volume 
• Strategies to work collaboratively with departments 
• Importance of patient account and charge reconciliation 
• Tracking chargemaster changes for compliance 
• Charge integrity monitoring and reducing unexplained variation in claims 

Module 15: Denials Management  

• Principles of denials management 
• Adjustment claims and automated provider reopening 
• Initial and revised determinations and appeal rights 
• Levels of appeal and timelines for filing 
• Types of auditors, including external auditors from commercial plans 

Module 16: Payer Contracting Strategies  

• Concept and criteria carve-out options 
• Importance of tracking administrative costs by payer and developing and trending payer scorecards 
• Contract negotiations and annual price increase limits/caps applicable to the chargemaster 

Course Outline/Agenda subject to change.

Live Virtual Revenue Integrity and Chargemaster Boot Camp for Critical Access Hospitals

Learning Outcomes

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

• Construct effective and efficient strategies for hospitals, payers, and other healthcare specialists to obtain and maintain overall revenue integrity for governmental and non-governmental payers
• Develop a working understanding of revenue integrity principles associated with eligibility, coverage, coding, billing, and payment using fee-for-service Medicare requirements as a framework
• Identify how the chargemaster fits into revenue integrity functions
• Anticipate requirements and issues associated with provider-based status
• Analyze standard chargemaster elements, design, and relationship to the general ledger and revenue cycle processes of coding and billing
• Examine claim requirements and specific issues of chargemaster setup and maintenance by revenue code with associated cost reporting principles
• Break down concepts of pricing different services
• Compare critical access hospital cost-based reimbursement, including Method I and Method II, as well as appeal strategies to protect revenue

Continuing Education

AAPC
This program has prior approval of the AAPC for 30 Continuing Education Units. Granting of this approval in no way constitutes endorsement by the AAPC of the program, content or the program sponsor.

AHIMA
This program has been approved for 30 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 30 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 Revenue Integrity and Chargemaster Boot Camp 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. 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 the 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 off of 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 Revenue Integrity and Chargemaster Boot Camp for Critical Access Hospitals

Questions/Answers

What is the focus of the Live Virtual Revenue Integrity and Chargemaster Boot Camp for Critical Access Hospitals? 
The Live Virtual Revenue Integrity and Chargemaster Boot Camp for Critical Access Hospitals educates those who work within the critical access hospital setting about chargemaster and revenue integrity concepts. Some of these concepts include revenue cycle and revenue integrity functions, as well as cost reporting and key operations issues like coverage, clinical documentation, charge capture, and coding. It also gives attendees context about chargemaster setup and maintenance within revenue integrity and provides education about pre- and post-billing edits and payer denials. 

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 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? 
Please click here to view our cancellation policy. 

Who typically attends the Live Virtual Revenue Integrity and Chargemaster for Critical Access Hospitals Boot Camp? 

• Reimbursement managers 
• Revenue integrity staff 
• Chargemaster staff 
• Chargemaster managers 
• Finance and reimbursement staff 
• Finance and reimbursement managers & directors 
• Claims auditors 
• Payer relations staff 
• HIM directors and managers 
• Compliance officers, directors, and managers 
• Coding directors and managers 
• RAC coordinators 

What material does the course cover? 
To view the course outline, click on "Course Outline" above. 

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

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. 

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