Medicare Boot Camp®—Critical Access Hospital Version

Bookmark and Share

Medicare Boot Camp®—Critical Access Hospital Version

Product Code: MBCC

Medicare Boot Camp®—Critical Access Hospital Version. Don't lose focus of Medicare rules and regulations for critical access hospitals. Master the rules for critical access hospitals.

Interested in this class? Contact us to be put on a notification list when a new date is added at

This live Boot Camp is best for those looking for an interactive learning experience. Classes are led by our expert instructors, take place over the course of a week, and allow instructor/student interaction and engagement.

Medicare Boot Camp®—Critical Access Hospital Version

Course Overview

Master Medicare rules for critical access hospitals

Medicare Boot Camp®—Critical Access Hospital Version is a three-day intensive course on Medicare coverage, billing, coding, and payment for critical access hospitals (CAH). 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, 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.

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, inpatient status rules, and utilization review (UR) requirements
  • Submit accurate claims to Medicare, including Part A to B rebilling
  • Ensure appropriate reimbursement
  • Avoid compliance pitfalls
  • Identify risks for government and other payer audits

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 nuanced regulations specific to CAHs

Who should attend?

  • Auditors and analysts
  • Billing specialists
  • Chargemaster coordinators and managers
  • Chief financial officers
  • Clinical documentation integrity specialists
  • Clinical managers and department heads
  • 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

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 800-650-6787 or email

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 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, 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 Plan

Module 4: Medicare Claim Submission Fundamentals, Billing Issues, and Liability Forms

  • 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
  • Advanced 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
  • CRNA pass-through exemption
  • 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
  • Coding for clinics, emergency departments, critical care, and trauma activation
  • Proper use of modifier -25

Module 8: Mental Health Services

  • Partial Hospitalization Programs and Intensive Outpatient Programs
  • Certification and Covered Services
  • Billing of services
  • Telehealth Services

Module 9: Observation Services

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

Module 10: 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 11: 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 12: Coverage, Notices, and Billing for Inpatient Services

  • Inpatient order and certification requirements
  • Inpatient criteria and the 2-midnight benchmark
  • Inpatient Part B billing and payment

Module 13: 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 Notices of Non-Coverage (HINN)

Module 14: 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

Course Outline-Agenda subject to change.

Medicare Boot Camp®—Critical Access Hospital Version

Learning Outcomes

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

  • Navigate the CMS and FedSys websites 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

Continuing Education

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.

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).

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.

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.

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

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.    


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.


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:

Contact Information

For more information about our Boot Camps, contact us at 800-650-6787 or email

We Look Forward to Having You In Class!

Medicare Boot Camp®—Critical Access Hospital Version


What is the focus of Medicare Boot Camp®—Critical Access Hospital Version?
Medicare Boot Camp®—Critical Access Hospital 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 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 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 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