Medicare Boot Camp®—Physician Services Version

Course Overview

Effectively bill and collect for professional services while avoiding compliance risks and repayments

Optimize reimbursement and protect your organization from costly denials and potential fines with in-depth training on Medicare’s coverage, billing, and coding rules for professional services.

The Medicare Boot Camp®—Physician Services Version walks you through the regulations and billing procedures that impact your reimbursement, including provider enrollment, split/shared billing, appropriate modifier usage, National Correct Coding Initiative (NCCI) edits, notification requirements for the Advance Beneficiary Notice (ABN), supervision and incident-to billing, teaching physician issues, billing for locum tenens, telehealth services, and more. In-depth discussions on how to operationalize CMS requirements effectively will help you mitigate compliance risk, avoid denials, and hold on to your revenue.

Updated with the latest regulatory information, the Medicare Boot Camp—Physician Services Version helps your physician practice or health system billing physician claims tackle the most challenging billing and compliance issues that hit your bottom line and leave you vulnerable during an audit. Take a look:

• E/M billing and documentation requirements—apply E/M guidelines for inpatient, observation, emergency department, and nursing homes to ensure accurate payment
• Split/shared billing—know when it’s applicable and which provider to report the service under to prevent penalties
• "Incident to" billing—protect against repayments by ensuring you’re meeting the requirements for nonphysician practitioner services, provider-based departments, and delineating between physician “incident to” and hospital “incident to”
• Teaching physician requirements—avoid corporate integrity agreements with an understanding of resident supervision rules, documentation requirements when residents are involved in patient care, and appropriate modifier use
• How and when to bill for Medicare’s expanded coverage of preventive services, care management, and overlapping care management
• Reporting for single dose drug use and appropriate use of the -JZ modifier
• Billing for the new social determinants of health assessment

Identify compliance red flags and costly inefficiencies in your billing processes
A solid understanding of CMS rules for physician services will keep your organization audit-ready. This class untangles the nuances of documentation and billing topics, including:

• How to research Medicare regulations and guidance
• Participation in Medicare
• Understanding the mechanics of the Medicare Physician Fee Schedule
• Completing the CMS-1500 claim form
• ABNs
• NCCI edits
• Global surgery rules
• Diagnostic testing rules
• Medicare coverage of preventive and screening services
• Teaching physician rules
• Appeals process

You will leave this program knowing how to:

• Analyze appropriate billing for professional services for different clinical scenarios and sites of service
• Illustrate an understanding of medical necessity, limitation of liability, and effective delivery of ABNs
• Examine Medicare coverage guidelines, including the general types of physician services covered
• Interpret payment principles for physician services, allowing for an anticipated projected income stream
• Examine requirements for efficient processes that streamline the revenue cycle and enhance staff productivity

Who should attend?
The Medicare Boot Camp—Physician Services Version is great for those who want to learn more about the basics of navigating Medicare regulations and guidelines applicable to professional services.

• Medical practice managers
• Billers and coders
• Medical records managers and staff
• Health information managers and staff
• Clinical managers and department heads
• Finance and reimbursement managers and staff
• Physicians
• Nurse practitioners
• Physician assistants
• Compliance officers and auditors
• Medicare carrier personnel
• Healthcare consultants, CPAs, and lawyers
• Legal department personnel

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

Medicare Boot Camp®—Physician Services Version

Course Outline

Module 1: Medicare Overview and Resources

• Overview of Medicare Part A, B, C, and D
• Medicare contractors, including Medicare Administrative Contractors (MAC), Recovery Audit Contractors, and Quality Improvement Organizations
• Finding Medicare source laws, including statutes, regulations, and final rules
• Finding Medicare sub regulatory guidance, including manuals and transmittals
• Medicare Coverage Center, including local coverage determinations, national coverage determinations (NCD), Coverage with Evidence Development, and the lab coverage manual
• Links to Medicare resources and resources for staying current

Module 2: Medicare Participation

• Medicare physician/supplier enrollment process
• Medicare enrollment forms—which form is appropriate to use?
• Reporting National Provider Identifiers (NPI) on Medicare claims
• Participation and nonparticipation in the Medicare program
• “Opting out” of the Medicare program
• Assigned versus nonassigned claims
• “Limiting charge” rules and the implications for assigned and nonassigned claims

Module 3: Medical Necessity and Noncoverage

• Social Security Act “limitation on liability” provisions and when they apply
• Situations in which an Advance Beneficiary Notice (ABN) is necessary to hold the patient responsible for non-covered services
• Circumstances under which an ABN would be ineffective/invalid
• When it is inappropriate to present an ABN to a patient
• Circumstances where a routine ABN is permitted
• Appropriate reporting of ABN modifiers

Module 4: CMS-1500, ICD-10-CM, NPI, and Other Must-Know Billing Fundamentals

• Role and functions of the MAC
• MAC jurisdiction for services furnished to a Medicare beneficiary
• CMS-1500 data set instructions and proper reporting of services provided
• Proper reporting of site of service and the effect on payment
• Overview of skilled nursing facility (SNF) consolidated billing and how it affects billing for professional services furnished to SNF residents
• Reassignment relationships and when they are permissible under the Medicare reassignment regulations/guidelines

Module 5: Overview of the Resource-Based Relative Value Scale

• Medicare payment and the Physician Fee Schedule
• Using the relative value file/Physician Fee Schedule database to make operational decisions
• Medicare’s annual deductible and coinsurance and the effect on beneficiary liability and payment to practitioners
• Proper use of modifiers -22 and -52 and their effect on reimbursement

Module 6: National Correct Coding Initiative (NCCI), Medically Unlikely Edits, Modifiers, and Other Must-Know Billing Fundamentals

• NCCI edits, composition, and application
• Differentiating between Column 1/Column 2 and Mutually Exclusive code edits
• Determining special considerations and practical issues for practitioners related to NCCI edits
• Determining when an NCCI edit will apply to a claim
• Determining the correct way to bill for a code pair that is subject to an NCCI edit, including appropriate use of modifiers

Module 7: Evaluation and Management (E/M) Services: The Most Commonly Billed Physician Service

• Appropriate billing for E/M services furnished to a hospital inpatient
• Appropriate billing for E/M services furnished to a hospital observation patient
• Appropriate reporting of E/M services furnished in an emergency department
• Appropriate reporting of E/M services furnished to a nursing facility patient
• Medicare’s approach to consultations
• Appropriate billing for critical care, concurrent care, care management, behavioral integration, and care plan oversight services

Module 8: Surgical Services for Physicians: Modifiers and More

• Global surgical package—inclusion and exclusion of services
• Determining the applicable postoperative period of a procedure
• Appropriate billing for services furnished during the postoperative period that are not included in the surgical package, including the use of appropriate modifiers
• Multiple procedure reduction and its application to a particular Medicare claim
• Appropriate billing for bilateral surgeries, assistant surgeons, co-surgeons, and team surgeons
• Medicare coverage of dental and oral health services
• Services and procedures requiring prior authorization

Module 9: Clinical Lab, Radiology, and Other Diagnostic Services

• Determining when the professional and technical component services for a diagnostic test are separately billable
• Determining when and how to use modifiers to appropriately bill for professional and technical component services
• Physician supervision required for a particular diagnostic test
• Billing appropriately for diagnostic radiology services in a professional practice setting
• Application of multiple procedure payment reduction and calculation of its effect on reimbursement
• Clinical Laboratory Improvement Amendments (CLIA) requirements applicable to laboratory services furnished in a professional practice setting
• Locating and effectively using the clinical diagnostic laboratory services fee schedule and the NCDs applicable to clinical laboratory services

Module 10: Nonphysician Practitioners (NPP) and Therapist Services

• Medicare’s recognition of NPPs
• “Incident to” and “split/shared” coverage of NPP services
• NPP services that qualify for incident-to coverage
• Circumstances when NPP services may be appropriately billed under split/shared coverage rules
• Medicare coverage and billing of therapy services

Module 11: Physicians at Teaching Hospitals

• Overview of Medicare coverage of services provided by interns and residents
• Situations in which a teaching/attending physician’s presence is required when residents are involved in patient care
• Appropriate billing for resident involvement of patient care (including the appropriate use of modifiers)
• Documentation requirements applicable to teaching/attending physician services when residents are involved in patient care
• Appropriate billing for services furnished by an intern or resident functioning as an assistant surgeon
• Determining whether Medicare payment is available for services furnished by a particular moonlighting resident

Module 12: Medicare Coverage of Preventive Health Services

• Initial preventive physical exam
• Annual wellness visits
• Medicare coverage of screening services
• Medicare Diabetes Prevention Program

Module 13: Medicare Telehealth Benefit and Virtual Services

• Telehealth vs. telemedicine
• Originating-site and distant-site practitioners
• Geographic location requirements
• Appropriate use of modifiers and place of service codes
• Mental health services
• Status of COVID-19 expanded telehealth benefits

Module 14: When the Medicare Payment Is Not What You Expect: Audits and Appeals

• Overview of the Medicare program integrity function applicable to services furnished in a professional practice setting
• Comprehensive Error Rate Testing program
• Proper response for audits and record requests
• Overview of the Medicare Part B appeals process

Course Outline/Agenda subject to change.

Medicare Boot Camp®—Physician Services Version

Learning Outcomes

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

• Employ CMS guidelines to ensure proper reporting
• Analyze appropriate billing for professional services for different clinical scenarios and sites of service
• Apply Medicare’s evaluation and management guidelines to ensure proper billing
• Illustrate an understanding of medical necessity, limitation of liability, and effective delivery of Advance Beneficiary Notices
• Evaluate compliance pitfalls and prepare for potential audits
• Examine Medicare coverage guidelines, including the general types of physician services covered
• Comply with the specific Medicare coverage requirements for certain services
• Interpret payment principles for physician services, allowing for an anticipated projected income stream
• Explain Medicare’s telehealth benefits
• Examine requirements for efficient processes that lead to increased productivity

Continuing Education

AAPC
This program has been approved by the AAPC for 21 continuing education hours. Granting of prior approval in no way constitutes endorsement by AAPC of the program content or the program sponsor.

AHIMA
This program has been approved for 20.8 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.

NAHRI
This program has been approved for 21 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®—Physician Services 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 an extensive workbook containing the class materials utilized throughout the boot camp. This workbook 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 daily. 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 suggest that you have the following available during the class:

• Highlighter
• Notepaper
• Sticky notes/flags
• Pen/pencil

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

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®—Physician Services Version

Questions/Answers

What is the focus of the Medicare Boot Camp®—Physician Services Version? 
The Medicare Boot Camp—Physician Services Version is technically oriented and focuses on the Medicare regulations and guidelines applicable to professional services. The course's objective is to provide course participants with a detailed understanding of the Medicare rules, with a particular emphasis on those rules' real-world application.

Where is the course offered?
Open registration Medicare Boot Camps are offered at various locations around the country, typically at midpriced 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.

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

Who typically attends the Medicare Boot Camp—Physician Services Version?

• Medical practice managers
• Billers and coders
• Medical records managers and staff
• Health information managers and staff
• Clinical managers and department heads
• Finance and reimbursement managers and staff
• Physicians
• Nurse practitioners
• Physician assistants
• Compliance officers and auditors
• Medicare carrier personnel
• Healthcare consultants, accountants, and attorneys
• Legal department personnel

Does the course require any previous experience or training?
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 professional practice setting. Familiarity with the CPT® coding system will be particularly helpful.

How is the course taught?
The course is taught using a combination of lecture, class discussion, and hands-on exercises.

What do I need to bring to class?
When you arrive at class, you will receive an extensive binder of course materials. However, in order to get the most out of the course, we recommend you bring a current CPT manual to class. Any current version of the CPT manual will be fine so long as it is published by the American Medical Association (AMA). Our instructors use and recommend the AMA's CPT Professional Edition.

HCPro offers the lastest version of this manual on HCMarketplace.

Optum publishes a manual called CPT Expert. We recommend against using it for this course because CPT Expert does not contain all the official CPT guidelines.

Please bring the following to all classes: 

• Your CPT manual 
• A handheld calculator 
• Note paper 

How do I get more information?
Contact customer service at 800-650-6787 or email sales@hcpro.com.