Medicare Boot Camp®—Critical Access Hospital Version

Course Overview

Master Medicare rules for critical access hospitals and understand the granular rules

The Medicare Boot Camp®—Critical Access Hospital Version is a three-day intensive course on Medicare coverage, billing, coding, and payment for critical access hospitals. It gives you the knowledge and tools to find the answers to your most pressing Medicare coding, billing, and reimbursement questions pertaining to this unique setting.

Find the answers to all of your coding, billing, and reimbursement questions pertaining to your unique position in the healthcare industry—the CAH.

This one-of-a-kind, custom class will show you which rules apply to you so you can successfully process claims and get paid. It will also teach you how to prepare and respond to recovery audits by mastering the key concepts behind what the Recovery Auditors have audited so far.

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

• Find the answers to your specific Medicare questions relating to CAHs
• Understand outpatient observation and inpatient status rules and UR requirements
• Submit accurate claims to Medicare, including Part A to B rebilling
• Ensure appropriate reimbursement
• Avoid compliance pitfalls
• Identify risks for government audits and other payers

Leave this Boot Camp with an understanding of:

• Where to look for Medicare guidance and how to interpret rules relevant to your business to submit claims and get paid
• The ways you can prepare your organization for MAC and government audits
• Navigating the nuance regulations specific to CAHs

Who should attend?

• Auditors and analysts
• Billing specialists
• Chargemaster coordinators and managers
• Clinical documentation improvement specialists
• Clinical managers and department heads
• Compliance officers
• Finance and reimbursement managers
• Healthcare consultants, CPAs, and lawyers
• Health plan financial analysts, claims processing, and provider relations professionals
• HIM directors and managers
• Medicare administrative contractors
• Patient access/admitting staff
• Provider-based clinical personnel
• Physician advisors
• Recovery audit coordinators
• Chief financial officer

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 are provided a set of exercises after 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 Version, contact us at 615-724-7200 or email PD-IS@SimplifyCompliance.com.

Medicare Boot Camp®—Critical Access Hospital Version

Course Outline/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 the MAC, RAC, and 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 and Limitation on Liability Notices

• Medicare Coverage Center, including LCDs, NCDs, CED, and Lab Coverage Manual
• Prior authorization for specified outpatient procedures and services
• Limitations of liability statute and notice requirements
• Advance Beneficiary Notice (ABN) form and instructions

Module 4:  Medicare Claims 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
• Billing of non-covered outpatient services
• Treatment of conditions arising during or from a non-covered inpatient stay

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:  Outpatient Visits and Provider Based Departments

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

Module 7:  Observation Services

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

Module 8:  Outpatient Surgery and Radiology Services

• Coverage requirements for outpatient diagnostic services
• Multiple procedure discounting for surgical and radiology services for Method II billing
• Exclusion from reporting certain imaging modifiers
• Global surgery concepts for Method II billing
• Reporting modifiers for terminated/discontinued and bilateral procedures
• Special consideration for inpatient-only procedures

Module 9:  Special Billing and Payment Issues for Drugs, Laboratory Services, and Outpatient Therapy

• Billing and payment for drugs, including self-administered drugs
• Discarded drugs
• Laboratory coding, billing, and payment, including reference lab
• Blood and blood products
• Payment for therapy, including therapy thresholds
• “Sometimes” and “always” therapy

Module 10:  Overview of the Cost-Based Reimbursement System

• Components of the cost-based system
• Method I and Method II billing
• CRNA pass-through exemption
• Patient responsibility, including outpatient and inpatient deductible and coinsurance

Module 11:  Coverage and Billing for Inpatient Services

• Inpatient order and certification requirements
• Inpatient criteria and the 2-Midnight Benchmark
• Important Message from Medicare (IMM) and Detailed Notice of Discharge
• Hospital Issued Notices of Non-Coverage (HINN)
• Utilization review determinations for non-covered inpatient cases
• Inpatient Part B billing and payment

Module 12:  Coverage and Billing for Swing Bed Admissions in a CAH

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

Course Outline-Agenda subject to change.

Medicare Boot Camp®—Critical Access Hospital Version

Questions/Answers

What is the focus of the Medicare Boot Camp®—Critical Access Hospital Version?
The Medicare Boot Camp—Critical Access Hospital Version is a three-day intensive course on Medicare coverage, billing, coding, and payment for CAHs. It gives you the knowledge and tools to find the answers to your most pressing Medicare coding, billing, and reimbursement questions pertaining to this unique setting. This one-of-a-kind class will show you which rules apply to your setting so you can successfully submit claims and get paid appropriately. It will also teach you how to prepare for and respond to MAC and other government audits.

Where is the course offered?
Open registration Medicare Boot Camps are offered at various locations around the country, typically at mid-priced business hotels such as Hyatt Place or Hilton Garden Inn. For a current schedule of upcoming open registration Medicare Boot Camps, click on "Locations/Dates" above.

Does this course prepare participants for coding certification?
The Medicare Boot Camp—Critical Access Hospital 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 Version 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 email customer@simplifycompliance.com or 800-650-6787.

Does HCPro offer on-site Medicare Boot Camps?
In addition to our open registration courses, we also offer the Medicare 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 Medicare Boot Camp—Critical Access Hospital Version, call 800-780-0584 or click on "Train Groups On-Site". We offer a Rural Health Clinic add-on that covers general billing requirements and reimbursement for this unique setting.

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

Who typically attends the Medicare Boot Camp?

• Finance and reimbursement personnel
• Billers and coders
• Medical records/health information personnel
• Clinical department personnel
• Case managers
• CDI professionals
• Provider-based clinic personnel
• Compliance officers and auditors
• Revenue cycle managers
• 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 hands-on 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 our sales team at 615-724-7200 or email PD-IS@SimplifyCompliance.com.

Medicare Boot Camp®—Critical Access Hospital 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 the Locations/Dates tab. 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

It is an understatement to say that this course is intense. Other than breaks, we will be in class from 8:00am to 5:00pm. Monday-Thursday, and from 8:00am to 1:00pm on Friday. There will be about a one hour lunch break each day. If the class gets behind, class may run later than 5:00pm.    

Lunch

We will take about a one hour break for lunch each day. Although we 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 in connection with this course 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: http://hcmarketplace.com/cancellations

COVID Safety

Simplify Compliance and HCPro place the highest priority on the safety of our guests. In preparation for attendance at our events, we want to share the following measures to promote health and well-being:

• If the region where our event is located is deemed by the CDC to be within the substantial or high-risk category, we will require all attendees, regardless of vaccination status, to wear masks when indoors except while actively eating or drinking. 
• Meeting rooms will be set to support social distancing when necessary.
• Food service will follow the safety guidelines implemented by the hotel.

 To view all the safety measures that a specific hotel has implemented, please see the information listed on their website. 

Simplify Compliance and HCPro will continue to monitor the COVID-19 environment and the recommended guidelines, and will communicate adjustments to the onsite policies and procedures as necessary.

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!

Medicare Boot Camp®—Critical Access Hospital Version

Learning Objectives

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

• Locate key sources of Medicare authority on the Internet
• Interpret Medicare guidance and apply it to the services provided
• Describe how Medicare covers inpatient and outpatient services at CAHs
• Describe limitations on coverage under the Medicare program
• Explain when the beneficiary is financially responsible for services provided
• Discuss how documentation of patient care affects billing of the services the provider renders
• Explain how Medicare pays for inpatient and outpatient services

Continuing Education

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 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.

CCMC
This program is approved by the Commission for Case Manager Certification for 22.5 Continuing Education Units.

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®—Critical Access Hospital Version

COVID Safety

Simplify Compliance and HCPro place the highest priority on the safety of our guests. Simplify Compliance and HCPro will continue to monitor the COVID-19 environment and the recommended guidelines and will communicate adjustments to any onsite policies and procedures outlined in the Getting Ready for Class document that will be emailed to attendees one week and one business day prior to the class.