Medicare Boot Camp®—Hospital Version

Course Overview

Medicare explained: Understand Medicare rules and their application

Join our Medicare experts for a course exploring Medicare coverage, billing, and coding. This comprehensive course includes in-depth discussions of Medicare’s coverage rules, claims and billing guidelines, hospital-based department reimbursement, drug and device billing and modifiers, and more. The Medicare Boot Camp—Hospital Version unlocks the answers to all your Medicare questions.

This course provides insights into the CMS initiatives affecting your revenue. We delve into the details of Medicare regulations and how to apply them. We provide you with an extensive manual, research tools, and skills to navigate Medicare’s resources and find the information you need. You’ll leave this course ready to make improvements that will strengthen reimbursement and compliance for your hospital or health system.

The Medicare Boot Camp—Hospital Version includes comprehensive sections explaining the complexities of:

• Medicare coverage, including national coverage determinations, local coverage determinations, and prior authorization
• Medicare edit systems, including the National Correct Coding Initiative and Medically Unlikely Edits
• Billing and coding for hospital-based clinics and departments
• Billing of drugs and devices, including modifiers
• Observation and the 2-midnight rule
• Utilization review, condition code 44, and self-denial (inpatient Part B) billing
• Payment and patient coinsurance under the Outpatient Prospective Payment System and Inpatient Prospective Payment System
• Medicare websites and resources

New sections for 2024 cover developments in:

• Coverage and prior authorization rules for Medicare Advantage plans
• Medicare coverage and billing of clinical trials, registries, and studies
• Behavioral health services, including remote services and intensive outpatient programs

You will leave this program knowing how to:

• Research and resolve claim edits that delay revenue
• Resolve claim denials and prevent them in the future
• Avoid Medicare compliance issues
• Implement best practices to get the revenue you deserve while staying in compliance

Who should attend?
Whether you are looking to get up to speed with the newest CMS initiatives or put all the pieces together for a better understanding of Medicare, this course is the right fit for you. Our students range from people new to their job just making their way through the tangle of Medicare requirements to people with years of experience looking to keep up to date and improve their understanding of the most complex Medicare issues. Individuals that may benefit from attending this Boot Camp include:

• Compliance officers and staff
• Business office managers and staff
• Revenue integrity managers and staff
• Chargemaster personnel
• Billers and coders
• Claims auditors
• Denials management and appeals staff
• Medicare Advantage and Medicare Administrative Contractor personnel
• Healthcare lawyers, consultants, and CPAs

See the HCPro difference for yourself!

• Focus on the actual rules: We provide references for all the information provided, giving you confidence you are getting accurate, timely information.
• Tools and skills to navigate Medicare rules: Our instructors provide valuable understanding, tools, and resources to make you more efficient finding the answers to your Medicare questions long after the course ends.
• Applied learning: Case studies throughout each module ensure participants 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).

Looking to train your whole team? We can bring our expert instructors to you! Learn more here! 

For more information about our Boot Camps, contact us at 800-650-6787 or email sales@hcpro.com.

Medicare Boot Camp®—Hospital Version

Course Outline

Module 1: Medicare Overview and Contractors

• Overview of Medicare Part A, B, C, and D
• Medicare contractors, including Medicare Administrative Contractors, Recovery Audit Contractors, and Quality Improvement Organizations

Module 2: Medicare Research and Resources

• Finding Medicare source laws, including statutes, regulations, and final rules
• Finding Medicare sub-regulatory guidance, including manuals and transmittals
• Links to Medicare resources and resources for staying current

Module 3: Medical Necessity and Limitation on Liability Notices

• Medicare Coverage Center, including local coverage determinations, national coverage determinations, Coverage with Evidence Development, and the Lab Coverage Manual
• Coverage of services related to clinical trials, registries, and studies
• Medicare Advantage plan coverage determinations, including prior authorization
• Prior authorization for specified outpatient procedures and services

Module 4: Medicare Claim Submission Fundamentals

• Claim fields with special Medicare instructions
• Medicare Secondary Payer principles, including liability claims
• Adjustment claims and automated reopenings
• Medicare claims flow

Module 5: Medicare Edit Systems

• Outpatient Code Editor and Medicare Code Editor
• National Correct Coding Initiative
• Procedure-to-procedure edits and modifiers
• Medically Unlikely Edits
• Add-on code edits

Module 6: Medicare Billing Issues

• Outpatient repetitive, nonrepetitive, and recurring services
• Three-day payment window: outpatient services billed on inpatient claims
• Limitations of liability statute and notice requirements
• The Advance Beneficiary Notice form and instructions
• Billing of non-covered outpatient services
• Treatment of conditions arising during or from a non-covered inpatient stay

Module 7: Medicare Outpatient Payment Systems

• Outpatient Prospective Payment System (OPPS)
• Addendum B and D to determine the payment status of a HCPCS code
• Addendum A and Ambulatory Payment Classifications (APC)
• Comprehensive APC (C-APC) basic rules
• Surgical C-APCs, including complexity adjustment
• Payment under the OPPS, including outliers
• Part B deductible and coinsurance

Module 8: Outpatient Surgical Services, Including Implantable Devices

• Inpatient-only procedures
• Multiple procedure discount for minor surgical services
• Modifiers for terminated, discontinued, and bilateral procedures
• Device-intensive procedures and procedure-to-device edits
• Pass-through devices
• Free and reduced-cost device reporting

Module 9: Hospital Outpatient Departments, Including Clinics

• Incident-to coverage of outpatient therapeutic services
• On- and off-campus departments, proper use of modifiers -PO and -PN
• Coding for clinics, emergency departments, critical care, and trauma activation
• Proper use of modifier -25
• Payment for off-campus department services
• Therapy coding, including "sometimes" and "always" therapy codes
• Payment for therapy under the Physician Fee Schedule, including therapy caps

Module 10: Behavioral Health Services

• Remote mental health services in the patient’s home
• Daily mental health composite
• Intensive outpatient programs
• Partial hospitalization programs

Module 11: Outpatient Drugs

• Coverage of drugs, including self-administered drugs
• Packaged, pass-through, and non-pass-through drugs and biologicals
• Modifiers applicable to drugs: -JG, -TB, -JW, and -JZ
• Biological skin substitutes

Module 12: Outpatient Diagnostic Services

• Coverage requirements for outpatient diagnostic services
• Imaging family C-APCs
• Special radiology modifiers
• Radiation therapy
• Laboratory billing and coding issues, including date of service 
• Payment for labs under the Laboratory Fee Schedule, including reference labs
• Blood and blood products

Module 13: Observation Services

• Coverage of observation services
• Delivery of the Medicare Outpatient Observation Notice
• Billing of observation services
• Observation C-APC payment

Module 14: Coverage of Hospital Inpatient Services

• Inpatient order and certification requirements
• Inpatient criteria and the 2-midnight benchmark
• Admission on a case-by-case basis
• Documentation and use of screening tools

Module 15: Inpatient Utilization Review and Notices

• Utilization review determinations
• Condition code 44 and self-denials with inpatient Part B coverage
• Inpatient Part B billing and payment
• Important Message from Medicare and Detailed Notice of Discharge
• Hospital-Issued Notice of Non-Coverage

Module 16: Inpatient Payment and Patient Responsibility

• Inpatient Part A payment and the Inpatient Prospective Payment System (IPPS)
• Medicare severity diagnosis-related groups
• Complications and comorbidities and the effect of a hospital-acquired condition (HAC)
• Inpatient deductible, coinsurance, and lifetime reserve days

Module 17: IPPS Adjustment Factors

• Standardized amount adjustments: Hospital Quality Reporting Program and electronic health record meaningful use
• Quality adjustments: Value-Based Purchasing Program, Hospital Readmissions Reduction Program, and HAC Reduction Program
• Payment add-on for new technology
• Medicare inpatient pricer
• Payment for transfers and post-acute care transfers

*Course Agenda/Outline is subject to change.

Medicare Boot Camp®—Hospital Version

Learning Objectives

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
• Apply Medicare guidance to the services provided
• Articulate how Medicare covers inpatient and outpatient services at hospitals
• Analyze limitations on coverage under the Medicare program and how they affect the services provided
• Assess the effect of coding rules on reporting hospital services and hospital reimbursement
• Convey how Medicare pays for inpatient and outpatient services
• Quantify Medicare deductibles and copayments for hospital inpatient and outpatient services
• Comply with rules and regulations for inpatient and observation status

Continuing Education

AAPC
This program has been approved by the AAPC for 34.5 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 34.75 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 34.75 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 34.75 nursing contact hours.

CCB
The Compliance Certification Board (CCB) has approved this event for up to 41.4 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 34.75 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®—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 8:00 a.m. to 5:00 p.m. Monday-Thursday, and from 8:00 a.m. to 1:00 p.m. on Friday. There will be about a one-hour lunch break each day. If the class gets behind, class may run later than 5:00 p.m.

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:

• Notepaper
• Sticky Notes/flags
• Pen/Pencil
• Highlighter

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 printed and electronic 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: https://hcmarketplace.com/cancellations

Contact Information

For more information about our Boot Camps, contact us at 800-650-6787 or email sales@hcpro.com

We Look Forward to Having You In Class!

Medicare Boot Camp®—Hospital Version

Questions/Answers

What is the focus of the Medicare Boot Camp®—Hospital Version?
The Medicare Boot Camp®—Hospital Version is an intensive four-and-a-half-day course on Medicare coverage, billing, coding, and payment for hospital outpatient and inpatient services. The course is technically oriented and focuses on the Medicare regulations and guidelines applicable to hospital services. 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.

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®—Hospital Version contains a review of pertinent coding issues as they relate to Medicare coverage, billing, and payment; however, it is not primarily designed as a coding course. HCPro does offer two courses focused on coding fundamentals: T 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, while 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 information, please review the information for these courses using the links above or please contact us at 800-650-6787 or email sales@hcpro.com.

Does HCPro offer "on-site" Medicare Boot Camps?
In addition to our open registration courses, we also offer the Medicare Boot Camp®—Hospital Version 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?
Please click here to view our cancellation policy.

Who typically attends the Medicare Boot Camp?

• Compliance officers and staff
• Business office managers and staff
• Revenue Integrity managers and staff
• Chargemaster personnel
• Billers and coders
• Claims auditors
• Denials management and appeals staff
• Medicare Advantage and MAC personnel
• Healthcare lawyers, consultants, and CPAs

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. Familiarity with the ICD-10-CM and CPT coding systems is helpful, but not required.

How is the course taught?
The course is taught using a combination of lecture, class discussion, and 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, you may want to bring the following to all classes:

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

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.