Boot Camps

Live Virtual Revenue Integrity and Chargemaster Boot Camp

Course Overview

Chargemaster and Revenue Integrity is critical for cash flow. Let our expert instructors help you understand what you need to know with chargemaster and revenue integrity performance.

The Live Virtual Revenue Integrity and Chargemaster Boot Camp provides education on chargemaster and revenue integrity concepts. The Boot Camp relates the chargemaster function to revenue cycle and revenue integrity functions, including cost reporting and key operational issues, such as eligibility, coverage, clinical documentation, charge capture, and coding.

It also provides context for chargemaster set-up and maintenance following HIPAA transaction set requirements with an objective to help avoid pre- and post-billing edits and payer denials.

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
• Explain the legal authorities for HIPAA transaction sets that govern key fields in the chargemaster and revenue cycle functions
• 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, charge capture, and documentation issues 
• Review chargemaster issues for commercial/managed care versus CMS requirements

Leave this Boot Camp with an understanding of revenue optimization and identify areas with potential revenue opportunities that are commonly overlooked.

Who should attend?

• CFOs
• Finance directors
• Reimbursement managers
• Chargemaster coordinators
• Patient financial services management and staff
• Managed care contracting management and staff
• Revenue integrity management and staff
• Payer relations staff
• HIM directors and managers
• Coding directors and managers
• Compliance officers, directors, and managers

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 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).

How does the Live Virtual Revenue Integrity and Chargemaster Boot Camp work?

Class is held Mondays – Thursday for 2 weeks from 12:00 p.m. – 4:00 p.m. Eastern Time (10 classes).

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

Monday – Thursday from April 10 – April 20. Registration cut-off date: 4/3/2023

Monday – Thursday from July 17 – July 27. Registration cut-off date: 7/10/2023

Monday – Thursday from December 4 – December 14. Registration cut-off date: 11/27/2023

NAHRI members save $150 off the registration fee. Call 800-650-6787 to receive your special discount rate or sign up to become a NAHRI member today!

For more information about our Boot Camps, contact us at 615-724-7200 or email PD-IS@SimplifyCompliance.com.

Live Virtual Revenue Integrity and Chargemaster Boot Camp

Outline/Agenda

Module 1: Revenue Integrity Overview and Resources

• Revenue integrity functions and key principles including how the chargemaster fits into over 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 major and different types of medical insurances
• Principles of health insurance eligibility and verification of insurance
• Coordination of Benefits & Subrogation
• Medicare Secondary Payer (MSP) 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

• 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

Exercises: Concepts of Revenue Integrity

Module 5: Charge Description Master Structure and Charge Capture Principles

• Definition, purpose and key fields of a chargemaster
• Concepts for code set up in CDMs and relationship to HIM coding
• Principles of bundled services per CPT definition vs reporting packaged services and implications for separate charging of packaged services
• Strategies to address payer differences in the chargemaster
• The relationship of chargemaster to 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: Claims 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 7: Special Medicare Billing Issues

• Billing requirements for outpatient repetitive versus non-repetitive recurring and non-recurring services
• The three-day payment window and outpatient services billed on inpatient claims
• Billing of non-covered inpatient and outpatient services
• Patient status and billing inpatient non-medically necessary services

Exercises: CDM Structure, Claims and Billing Issues

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 peri-operative 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

Exercises: Routine and Ancillary Services by Revenue Code

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 (MPFS), DMEPOS, Clinical Lab Fee Schedule
• Review emerging payment methodologies such as Bundled/Episode Payments (CJR) and Value-Based Purchasing

Module 12: Outpatient Prospective Payment System (OPPS)

• Understanding OPPS payable services and structure of APCs
• Learn how to determine whether services are paid separately or packaged
• Understand C-APCs and complexity adjustments
• Understand impact of inpatient deductible cap on co-payments for beneficiaries

Module 13: Medicare Physician Fee Schedule (MPFS)

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

Exercises: Payment Systems

Module 14: Charge Description Master Management and Maintenance Strategies

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

Module 15: Denial Management

• Principles of denial 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 for carve out options
• Importance of tracking administrative cost by payer and developing and trending payer scorecards
• Contract negotiations and annual price increase limits/caps applicable to chargemaster

Exercises: Strategies for CDM Management, Denials and Payer Contracting

Course Outline/Agenda subject to change.

Live Virtual Revenue Integrity and Chargemaster Boot Camp

Schedule

April — Class Schedule (Eastern time)

July — Class Schedule (Eastern time)

December — Class Schedule (Eastern time)

Live Virtual Revenue Integrity and Chargemaster Boot Camp

Questions/Answers

What is the focus of the Live Virtual Revenue Integrity and Chargemaster Boot Camp?
The Boot Camp focuses on finding and applying the HIPAA Transaction Sets rules and guidelines that apply to chargemaster and revenue integrity professionals to help ensure accurate and appropriate billing.

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.

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?
To view our cancellation policy, please click here.

Who typically attends the Live Virtual Revenue Integrity and Chargemaster Boot Camp?

• CFOs
• Finance directors
• Reimbursement managers
• Chargemaster coordinators
• Patient financial services management and staff
• Managed care contracting management and staff
• Revenue integrity management and staff
• Payer relations staff
• HIM directors and managers
• Coding directors and managers
• Compliance officers, directors, and managers

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. 

How is the course taught?
The course is taught using a combination of lecture, class discussion, and 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, 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 615-724-7200 or email PD-IS@SimplifyCompliance.com.

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 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 4 business days prior to the class start and again 1 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 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 615-724-7200 or email PD-IS@SimplifyCompliance.com.

We Look Forward to Having You In Class!

Live Virtual Revenue Integrity and Chargemaster Boot Camp

Learning Objectives

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

• Equip hospital, payer and other healthcare specialists with effective and efficient strategies to obtain and maintain overall revenue integrity for both governmental and non-governmental payers
• Gain a working understanding of revenue integrity principles associated with eligibility, coverage, coding, billing and payment using fee-for-service Medicare requirements as a framework
• Explain standard charge description master (CDM) elements, design and relationship to the general ledger and revenue cycle processes of coding and billing
• Review claim requirements and specific issues of CDM set-up and maintenance by revenue code with associated cost reporting principles
• Exemplify outpatient and inpatient hospital prospective payment systems reimbursement and rate setting methodologies as well as appeal strategies to protect revenue

Continuing Education

AAPC
This program has the prior approval of AAPC for 30 continuing education hours. Granting of prior approval in no way constitutes endorsement by AAPC of the program content or the program sponsor.

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 Integrity Specialists (ACDIS).

AHIMA
This program has been approved for 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.

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 22.5 nursing contact hours.

CCB
The Compliance Certification Board (CCB) has approved this event for up to 36 CCB CEUs. Continuing Education Units are awarded based on individual attendance records. Granting of prior approval in no way constitutes endorsement by CCB of this program content or of the program sponsor.

CCMC
This program has been submitted to The Commission for Case Manager Certification for approval to provide board certified case managers with 30 clock hours.

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.

The National Association of Healthcare Revenue Integrity (NAHRI)

NAHRI’s mission is to enhance the revenue integrity profession through standards, advocacy, networking, and the promotion of shared knowledge and resources. This mission statement was developed by our NAHRI Advisory Board, an amazing group of revenue integrity professionals who bring a wide range of expertise and experience to this organization’s leadership.

PEER-BASED RESOURES AND TOOLS

As a NAHRI member, you’ll get unlimited access to our vast members-only resources, tools, and content such as white papers, best practices, and research reports written by the most respected names in the industry.

Resources include:

• Member-Only Content, explore the hundreds of the latest articles and research by topic, including white papers and best practices, plus an extensive archive on the NAHRI website
• A library of sample webinars and other content on the latest revenue cycle topics
• NAHRI quarterly journal, featuring in-depth, members-only content on the latest developments in revenue cycle

LOCAL CHAPTERS

Be on the ground floor in establishing your local chapter! It’s a great way to: 

• Quickly integrate and network with other revenue cycle professionals 
• Expand your management, leadership, and public speaking skills by volunteering for the chapter executive board

CONFERENCES AND TRAINING

Members receive significant discounts on all national and local NAHRI events. Learn from the best and brightest, interact and network with industry leaders, or roll your sleeves up and participate in an intensive, in-person, training events.

CAREER RESOURCES AND CREDENTIAL PROGRAM

NAHRI members receive $150 off the Live In-Person and Live Virtual Revenue Integrity and Chargemaster Boot Camp credential program. To receive your special discount rate or sign up to become a NAHRI member today please call 800-650-6787.

NAHRI members receive $100 off the Certification in Healthcare Revenue Integrity (CHRI) credential program. This program will provide professionals like you a tangible way to enhance and promote your revenue cycle skills.