Medicare Boot Camp®—Critical Access Hospital and Rural Health Clinic Version

Medicare Boot Camp®—Critical Access Hospital and Rural Health Clinic Version

Course Overview

Master Medicare rules for critical access hospitals and rural health clinics

Medicare Boot Camp®—Critical Access Hospital and Rural Health Clinic Version is a four-day intensive course on Medicare coverage, coding, billing, and payment, with three days dedicated to critical access hospitals (CAH) and one day dedicated to rural health clinics (RHC). This course prepares you to better manage your revenue cycle in these unique settings by focusing on actual guidance from CMS. You’ll leave class ready to make improvements that will strengthen reimbursement and compliance for your CAH and RHC.

This one-of-a-kind, custom class will show you which rules apply so you can successfully process claims and get paid without disruption to your revenue stream. It will also teach you how to research Medicare regulations to resolve billing issues and respond to denials. You’ll have the research tools and skills at your fingertips to answer your own Medicare questions long after the Boot Camp is over.

Medicare Boot Camp®—Critical Access Hospital and Rural Health Clinic Version will give you the knowledge and confidence to:

• Find the answers to your specific Medicare questions relating to CAHs and RHCs
• Understand outpatient observation, inpatient status rules, and utilization review (UR) requirements at CAHs
• Submit accurate claims to Medicare, including CAH Part B inpatient billing
• Ensure appropriate reimbursement from Medicare for outpatient, inpatient, and swing bed services, including the application of the patient’s financial responsibility
• Research and resolve claim edits that cause denials and delay revenue in your CAH and RHC
• Understand RHC reporting of revenue codes, Healthcare Common Procedure Coding System (HCPCS) codes, and related charges for all services provided
• Explain the all-inclusive rate (AIR) payment in independent and provider-based RHCs, including the application of Medicare Part B deductible and coinsurance
• Implement best practices to receive the revenue you deserve for your CAH and RHC while staying in compliance with the regulations

Leave this course with an understanding of:

• RHC reporting of revenue codes, HCPCS codes, and related charges for all services provided
• Outpatient observation, inpatient status rules, and UR requirements at CAHs
• How to process claims, get paid, and manage your revenue cycle through CMS guidance

Who should attend?
This course is best for healthcare staff looking to strengthen their knowledge of Medicare coding, billing, and reimbursement in both the CAH and RHC settings.

• Auditors and analysts
• Billing specialists
• CAH revenue cycle, compliance, case management, and clinical personnel
• Chargemaster coordinators and managers
• Chief financial officers
• Clinic managers and department heads
• Clinical documentation integrity specialists
• Coding specialists
• Compliance officers
• Finance and reimbursement managers
• Health plan financial analysis, claims processing, and provider relations professionals
• Healthcare consultants, CPAs, and lawyers
• HIM directors and managers
• Medicare Administrative Contractors
• Patient access/admitting staff
• Physician advisors
• Provider-based clinical personnel
• Recovery audit coordinators
• RHC revenue cycle, compliance, case management, and clinical personnel

Want to attend only the Critical Access Hospital modules, or only the Rural Health Clinic modules? You can! Make your selection of class preference at the top of this page – take the individual class that is most relevant to you, or take the combined class! For more information, visit these individual pages:

Medicare Boot Camp®—Critical Access Hospital Version
Medicare Boot Camp®—Rural Health Clinic Version

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.
• Hands-on learning: Attendees work a set of case studies within  each module to ensure they 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).

For more detailed information about the Medicare Boot Camp—Critical Access Hospital and Rural Health Care Version, contact customer service 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!

Medicare Boot Camp®—Critical Access Hospital and Rural Health Clinic Version

Course Locations & Dates

Below is the current course schedule for upcoming classes of this Medicare Boot Camp. We update this schedule on a regular basis. 

Registrations are processed in the order received. Class size is limited, and classes often sell out. We recommend against making travel arrangements until after we have confirmed your course registration.

To register for a class, click the "Register" button. If you would like to register multiple attendees, fill in the "Additional Attendees" box or call our sales team at 800-650-6787 or email us at sales@hcpro.com.

Locations marked as "Tentative" are subject to change.

To view our cancellation policy, click here.

June 2025

Medicare Boot Camp®—Critical Access Hospital Version

Course Locations & Dates

June 2025

Medicare Boot Camp®—Rural Health Clinic Version

Course Locations & Dates

June 2025

Medicare Boot Camp®—Critical Access Hospital and Rural Health Clinic Version

Course Outline

Critical Access Agenda

Module 1: Overview of Critical Access Hospital (CAH) Designation

• General requirements for CAH designation
• Limitations on acute care beds and length of stay
• Identification of and use of beds excluded from licensure limitations

Module 2: Medicare Overview, Contractors, Research, and Resources

• Overview of Medicare Parts A, B, C, and D
• Medicare contractors, including Medicare Administrative Contractors (MAC), Recovery Auditors (RAC), and Quality Improvement Organizations (QIO)
• Medicare source laws, including statutes, regulations, and final rules
• Medicare sub-regulatory guidance, including manuals and transmittals
• Links to Medicare information and resources for staying current

Module 3: Medical Necessity, Limitation on Liability Notices, and Medicare Advantage Plans

• Medicare Coverage Center, including local and national coverage determinations (LCD/NCD), coverage with evidence development (CED), and Lab Coverage Manual
• Prior authorization for specified outpatient procedures and services
• Limitation on liability statute and notice requirements
• Medicare Advantage plans

Module 4: Medicare Claim Submission Fundamentals and Billing Issues

• UB-04 claim form and key fields applicable to a CAH
• Outpatient repetitive, non-repetitive, and recurring services
• Outpatient services billed separately from inpatient claims
• Advance Beneficiary Notice (ABN) form and instructions
• Billing of non-covered outpatient services

Module 5: Medicare Edit Systems

• Medicare Code Editor (MCE) and Outpatient Code Editor (OCE)
• National Correct Coding Initiative (NCCI), including Procedure to Procedure (PTP) edits, Medically Unlikely Edits (MUE), and add-on code edits
• Modifiers used with NCCI edits

Module 6: Overview of the Cost-Based Reimbursement System

• Components of the cost-based system
• Method I and Method II billing
• Quality Payment Program under Method II billing
• Pass-through exemption for certified registered nurse anesthetists (CRNA)
• Price transparency
• Patient responsibility, including outpatient and inpatient deductible and coinsurance

Module 7: Outpatient Visits and Provider-Based Departments

• Incident-to coverage of outpatient therapeutic services
• Defining on- and off-campus departments
• Mental health telehealth services
• Coding for clinics, emergency departments, critical care, and trauma activation
• Proper use of modifier -25

Module 8: Observation Services

• Coverage of observation services
• Delivery of the Medicare Outpatient Observation Notice (MOON)
• Billing and payment of observation services

Module 9: Special Billing and Payment Topics for Outpatient Surgery and Therapy Services

• Multiple-procedure discounting for surgical services for Method II billing
• Global surgery concepts for Method II billing
• Reporting modifiers for terminated/discontinued and bilateral procedures
• Special consideration for inpatient-only procedures
• Payment for therapy, including therapy thresholds
• "Sometimes" and "always" therapy

Module 10: Special Billing and Payment Topics for Outpatient Diagnostic Services and Drugs

• Coverage requirements for outpatient diagnostic services
• Appropriate Use Criteria (AUC) for advanced imaging services
• Multiple-procedure discounting for radiology services for Method II billing
• Exclusion from reporting certain imaging modifiers
• Laboratory coding, billing, and payment, including reference labs
• Blood and blood products
• Coverage, billing, and payment for drugs, including self-administered drugs and discarded drugs

Module 11: Coverage, Notices, and Billing for Inpatient Services

• Inpatient order and certification requirements
• Inpatient criteria and the 2-midnight benchmark
• Treatment of conditions arising during or from a non-covered inpatient stay

Module 12: Inpatient Utilization Review, Billing, and Notices

• Utilization review determinations for non-covered inpatient cases
• Inpatient Part B billing and payment
• Important Message from Medicare (IMM) and Detailed Notice of Discharge
• Hospital Issued Notice of Non-Coverage (HINN)

Module 13: Coverage, Notices, and Billing for Swing Bed Admissions in a CAH

• Coverage for swing beds
• Level of care and documentation requirements
• SNF ABN notice requirements
• Reimbursement methodology and patient coinsurance
• Exclusion from SNF PPS consolidated billing rules

Rural Health Class Agenda

Module 1: Designation as a Rural Health Clinic (RHC), Including Required Practitioners and Services

• Definition and purpose of an RHC
• Certification criteria, including location, staffing, and required services
• Basic requirements for services furnished by RHC practitioners or incident to an RHC practitioner, including requirements for direct supervision
• Services that are excluded from the RHC benefit
• Distinguishing between an independent and a provider-based RHC

Module 2: Medicare Claim Fundamentals

• Claims processing requirements, including type of bill, revenue codes, HCPCS codes, modifiers, and charge reporting
• RHC practitioners and Appropriate Use Criteria (AUC)
• Three-day window applicability

Module 3: The Qualifying Visit and Related Services

• Qualifying visit definition
• Coding and charging for the qualifying visit, including proper use of modifier -CG
• Mental health qualifying visits by telecommunication technology
• Preventive services provided with or as a qualifying visit, including vaccines
• Incident-to services, including drugs and drug administration services
• Global surgery concepts for RHCs

Module 4: Special RHC Billing Issues

• Transitional care management (TCM)
• General care management (GCM), including chronic care management (CCM), principal care management (PCM), general behavioral health integration (BHI) services, principal illness navigation (PIN), community health integration (CHI), remote physiological monitoring (RPM), and remote therapeutic monitoring (RTM) 
• Psychiatric Collaborative Care Model (CoCM)
• Telehealth, including originating and distant-site services
• Virtual communication services
• Mental health services
• Services for hospice patients
• Visiting nurse services
• Laboratory services and technical components of diagnostic services

Module 5: Reimbursement for RHC Services

• Identification of a qualifying visit for payment purposes
• Basic all-inclusive rate (AIR) reimbursement methodology for provider-based and independent RHCs
• Application of upper payment limit
• Application of Part B deductible and coinsurance

Module 6: Supplemental Review of Medicare Contractors, Research, and Resources

• Overview of Medicare Parts A, B, C, and D
• Role of Medicare contractors
• Medicare source laws, including statutes and regulations
• Medicare sub-regulatory guidance, including manuals and transmittals
• Links to Medicare information and resources for staying current

Module 7: Supplemental Review of Medicare Coverage Guidance and the Advance Beneficiary Notice (ABN)

• Medicare Coverage Center, including local coverage determinations (LCD), national coverage determinations (NCD), and Laboratory Manual
• Coverage of drugs, including self-administered drugs
• Limitations of liability statute and notice requirements 
• Advance Beneficiary Notice (ABN) and its instructions

Resources

Module 8: Appendices of Source Authority

• Regulations for Conditions for Certification (CfC) for RHCs
• Regulations with requirements for provider-based departments
• Regulations defining RHC services and payment
• Medicare Benefit Policy Manual, Chapter 13 for RHCs
• Medicare Claims Processing Manual, Chapter 9 for RHCs
• Medicare State Operations Manual, Appendix G, RHC CfC survey standards
• RHC MLN booklet
• Integrated Outpatient Code Editor, RHC excerpts

*Agenda subject to change.

Medicare Boot Camp®—Critical Access Hospital and Rural Health Clinic Version

Learning Outcomes

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

• Navigate the CMS and FedSys website to locate key sources of Medicare authority
• Interpret Medicare guidance and apply it to the services provided
• Identify how Medicare covers outpatient, inpatient, and swing bed services at CAHs
• Analyze limitations on coverage under the Medicare program and how they affect the services provided
• Quantify beneficiary liability under Medicare Part A and B for CAH services
• Analyze how Medicare pays for outpatient, inpatient, and swing bed services
• Comply with observation and inpatient status rules and regulations
• Break down the definition of an RHC and the criteria for certification 
• Differentiate covered RHC services provided by physicians, physician assistants, nurse practitioners, clinical nurse midwives, clinical psychologists, and social workers, as well as services provided “incident to” 
• Develop policies for billing requirements related to medical visits, preventive services, laboratory services, and other special services offered by RHCs 
• Identify what constitutes an “encounter” for payment purposes 
• Calculate the AIR payment in independent and provider-based RHCs, including the application of Medicare Part B deductible and coinsurance

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.

ACDIS
This program has been approved for 30 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 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.

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 30 nursing contact 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.

Medicare Boot Camp®—Critical Access Hospital Version

Continuing Education

More information found here: Medicare Boot Camp®—Critical Access Hospital Version

AAPC
This program has prior approval of the AAPC for 22.5 Continuing Education Units. Granting of this approval in no way constitutes endorsement by the AAPC of the program, content or the program sponsor.

ACDIS
This program has been approved for 22.5 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 Improvement Specialists (ACDIS).

AHIMA
This program has been approved for 22.5 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.

NAHRI
This program has been approved for 22.5 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®—Rural Health Clinic Version

Continuing Education

More information here: Medicare Boot Camp®—Rural Health Clinic Version

AAPC
This program has prior approval of the AAPC for 7.5 Continuing Education Units. Granting of this approval in no way constitutes endorsement by the AAPC of the program, content or the program sponsor.

ACDIS
This program has been approved for 7.5 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 Improvement Specialists (ACDIS).

AHIMA
This program has been approved for 7.5 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 7.5 nursing contact hours.

NAHRI
This program has been approved for 7.5 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®—Critical Access Hospital and Rural Health Clinic Version

Things to Know Before Attending Class

Directions and Hotel Information

The hotel address, phone number, URL, room rate, and room rate cut-off date are posted on our website at Medicare Boot Camps. The hotel websites give detailed directions to the hotel as well as information about the location. Please call the hotel directly to make a room reservation. Be sure to identify yourself as an HCPro Boot Camp participant. Please be sure to make your reservation before the cut-off date. After the cut-off date, contact the hotel to determine room availability and rates.

Course Materials

When you arrive at class, you will receive extensive workbooks containing the class materials utilized throughout the Boot Camp. The workbooks will be yours to keep, so plan accordingly in allowing enough room in your luggage on the return trip home. Workbooks may also be shipped from the hotel at your own expense.

Classroom Time

Other than breaks, we will be in class from 8:00 a.m. to 5:00 p.m. If the class gets behind, class may run later than 5:00 p.m.

Lunch

Although our in-person Boot Camps typically provide coffee in the morning and drinks and snacks in the afternoon, everyone is on their own for lunch. Note that many hotels do not have restaurants on-site. If you are flying to the course, we generally recommend renting a car.

What to Bring to Class

We recommend you bring the following to all classes:

• Highlighter and pen/pencil
• A notebook for making your own notes
• Sticky Notes/flags

Use of Laptop Computers or Electronic Devices

Our instructors demonstrate where to find many resources on the CMS website. If you have access to a laptop or tablet, you may bring it to class to follow along, but you may wish to consider the power and wireless needs of your device. Many conference rooms do not have plugins situated conveniently to the tables, so you may wish to ensure you have sufficient battery power. HCPro does not purchase group wireless access for the conference rooms, but many hotels provide free wireless access. You may wish to confirm your connectivity options prior to arriving at the hotel. Please be courteous in your use of electronic devices. Use of electronic devices should not disrupt the class or disturb other participants. HCPro is not responsible for lost, stolen, or damaged devices. Maintaining the security and safety of your device is your responsibility. Cell phone use during class is strictly prohibited.

Dress

Business attire is not necessary. Please dress comfortably. Also, we find that the classrooms are sometimes on the cool side, even during the warmer months. You may be more comfortable if you bring a sweater or sweatshirt in case you get cold.

Copyright Protection of Course Materials

You will receive a complete copy of our course materials at the beginning of class. The materials used were custom designed by our company specifically for use in connection with this course. We have invested a tremendous amount of time, money, and effort in developing, refining, and maintaining these materials, and they are protected by copyright laws. Course materials may not be duplicated. You may use the materials (i) in direct connection with the course or (ii) as a personal reference in your day-to-day work. No claim is asserted to any U.S. Government, American Medical Association, or American Hospital Association works included in the course materials workbook.

Cancellation and Transfer Policy

For our cancellation and transfer policy, visit our website here.

Contact Information

If you have any question about the Boot Camp program, please contact:  

Customer Service 
(800) 650-6787 phone
(800) 785-9212 fax 
https://hcmarketplace.com/product-type/boot-camps

We Look Forward to Having You In Class!

Medicare Boot Camp®—Critical Access Hospital and Rural Health Clinic Version

Questions/Answers

What is the focus of Medicare Boot Camp®—Critical Access Hospital and Rural Health Clinic Version?
Medicare Boot Camp®—Critical Access Hospital and Rural Health Clinic Version is an intensive course on Medicare coverage, billing, coding, and payment for critical access hospital and/or rural health clinic services, depending on the specific version of the Boot Camp. The course is technically oriented and focuses on the Medicare regulations and guidelines applicable to these unique settings. The objective of the course is to provide participants with a detailed understanding of the Medicare rules, placing a particular emphasis on the operational application of those rules.

Does this course prepare participants for coding certification?
Medicare Boot Camp®—Critical Access Hospital and Rural Health Clinic Version 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 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 customerservice@hcpro.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 Medicare Boot Camp®—Critical Access Hospital and Rural Health Clinic Version, call 800-780-0584 or click on "Train Groups On-Site".

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

Who typically attends a Medicare Boot Camp?

• Finance and reimbursement personnel
• Billers and coders
• Medical records/health information personnel
• Clinical department personnel
• Case managers
• Clinical documentation integrity professionals
• Provider-based clinic personnel
• Recovery Auditor coordinators
• Compliance officers and auditors
• Revenue integrity managers and analysts
• Chargemaster personnel
• Fiscal intermediary personnel
• Registration personnel
• Legal department personnel

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 is the course taught?
The course is taught using a combination of lecture, class discussion, and classroom review of case studies. 

What do I need to bring to class?
When you arrive at class, you will receive an extensive notebook of course materials. In addition, please bring the following to all classes:

• A highlighter
• A notebook for taking notes
• Sticky notes/flags
• A pen/pencil

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 us at 800-650-6787 or email sales@hcpro.com.