Medicare Boot Camp®—Denials and Appeals Online

Course Overview

Get expert guidance on preventing denials and focusing appeals efforts for success. The evolution of reimbursement models and uncertainty regarding healthcare laws and CMS policy means that to keep the doors open and prevent insolvency, organizations cannot afford to write off appealable denials that are winnable. Organizations need sound, practical information on overturning denials. This Boot Camp is your key to proven strategies for success and will answer your questions on denials management and appeals processes. You’ll leave the class armed with a thorough understanding of the audit and appeal process and ready to put your new knowledge into action for tangible results.

Who should attend:

• Revenue cycle directors and managers
• Revenue integrity directors, managers, and staff
• HIM directors, managers, and staff
• CDI directors, managers, and specialists
• Compliance directors, officers, and auditors
• Business office managers
• Case management directors and managers
• Case managers
• Utilizations review staff
• Utilization management staff
• Physician advisors
• Audit directors and coordinators
• Auditors
• Appeals coordinators
• Patient financial services directors

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

Medicare Boot Camp®—Denials and Appeals Online

Dates

Below is the current course schedule for upcoming Medicare Appeals and Denials Boot Camp—Online classes.

To view our cancellation policy, click here.

Medicare Boot Camp®—Denials and Appeals Online

Course Outline/Agenda

Module 1: Denials and Appeals Overview

• Understanding the types of denials
• Steps involved when handling denials
• The main structure of appeals
• Timeline associated with appeals

Module 2: Medicare Overview and Contractors

• The Four Parts of Medicare
• Medicare Contractors
• Independent Government Agencies-Medicare Involvement

Module 3: Medicare, Medicaid, and Commercial Research and Resources

• Web-Based Resources
• Key Sources of Authority
• Medicare Coverage Center, including LCDs NCDs, CED and Lab Coverage Manual
• Medicaid Manual Research
• Commercial Payor Research
• Common Contractual Language in Commercial Contracts
• Ways to Stay Current

Module 4: Prepayment Claim Reviews/Audits

• Prepayment Reviews Overview
• Automated Prepayment Reviews
• Prepayment Non-Medical Record Reviews
• Prepayment Medical Record Reviews

Module 5: Postpayment Claim Reviews/Audits

• Establishment of Postpayment Claim Review/Audits Process
• Postpayment Claim Reviews/Audits Overview
• Postpayment Non-Medical Record Reviews
• Statistical Sampling and Extrapolations
• Postpayment Medical Record Reviews

Module 6: Medicare FFS Claim Appeals Process

• Initial Determinations
• Reopenings and Overlap with Appeals Process
• Level 1 Appeal Process: Redetermination
• Level 2 Appeal Process: Reconsideration
• Level 3 Appeal Process: Administrative Law Judge (ALJ) Hearing
• Level 4 Appeal Process: Medicare Appeals Council
• Level 5 Appeal Process: Judicial Review in U.S. District Court

Module 7: Commercial Audit and Appeals Process

• Audit Overview
• Appeals Process
• Strategies for Appeals
• Common appeal levels

Module 8: No Surprises Act Appeal Process

• Overview of the No Surprises Act
• Qualifying Payment Amount
• Good faith negotiation
• Arbitration

Module 9: Drafting and Constructing an Appeal Letter

• Overview of common elements of appeal letter
• Specific items to address in an appeal letter
• Structure of an effective appeal letter
• Identifying proper sources

Course Agenda/Outline is subject to change.

Medicare Boot Camp®—Denials and Appeals Online

Learning Objectives

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

• Research the appeals process and related regulations
• Identify key steps in the appeals process up to the Administrative Law Judge level
• Explain common causes of Medicare denials
• Develop policies and practices to support compliance, reduce denials, and expedite appeals
• Analyze denied claims to select appropriate appeals

Continuing Education

AAPC
This program has been approved by the AAPC for 8.5 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 8.5 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.

CCB
The Compliance Certification Board (CCB) has approved this event for up to 10.5 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.

NAHRI
This program has been approved for 8.5 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.

Medicare Boot Camp®—Denials and Appeals Online

Questions/Answers

What is the focus of the Medicare Boot Camp®—Denials and Appeals Online?
Medicare Boot Camp®—Denials and Appeals Online is an intensive course focusing on the strategies for success and will answer your questions on denials management and appeals processes

How does it work?
You’ll receive the same content and instruction that you would experience at our classroom-based, nationally recognized Boot Camps. Here’s how it works:

• 60-day access to video instruction after purchase date: View video sessions and complete all assignments, including review of all answer keys.
• 24-hour access: Video instruction is available at any time of day—you choose the time that works for you. You can also email questions to our instructors. We try to answer all questions either via email or phone within two business days.

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.

How long will I have access to the content?
The online portal location for your class sessions and materials will be available for 60 days from the class start date.

Does HCPro offer "on-site" Medicare Boot Camps?
In addition to our in-person 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 should attend this Medicare Boot Camp?

• Revenue cycle directors and managers
• Revenue integrity directors, managers, and staff
• HIM directors, managers, and staff
• CDI directors, managers, and specialists
• Compliance directors, officers, and auditors
• Business office managers
• Case management directors and managers
• Case managers
• Utilizations review staff
• Utilization management staff
• Physician advisors
• Audit directors and coordinators
• Auditors
• Appeals coordinators
• Patient financial services directors

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.