Medicare Boot Camp - Utilization Review

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Medicare Boot Camp - Utilization Review (RIS Pre-conference)

Product Code: URBC10142018

1st Attendee $1,099.00*
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Save 20% when you register for BOTH the 2018 Revenue Integrity Symposium and this Pre-Conference! Your discount will automatically calculate in your cart. Questions? Call Customer Service at 615-724-7200 to learn more.

Medicare Boot Camp - Utilization Review (RIS Pre-conference)

Course Overview

Master Medicare rules for utilization review.

Medicare Boot Camp®—Utilization Review Version is an intensive two-day course focusing on the Medicare regulatory requirements for patient status and the role of the utilization review (UR) committee. 

Managing patient status plays a critical role in proper compliance, correct reimbursement, and stabilizing inpatient payments for the hospital. In 2018, CMS made significant changes to the inpatient-only list and continues to change its strategies for auditing patient status. Don’t become a target or leave money on the table—ensure the UR committee is ready to implement and leverage the regulatory requirements. 

Medicare Boot Camp—Utilization Review Version also answers all your questions about navigating the CMS website and finding Medicare requirements. You will be able to find answers to your questions long after the Boot Camp is over. 

You will leave this program knowing: 

  • How to apply the 2-midnight benchmark and 2-midnight presumptions 
  • Implement changes to the inpatient-only list for 2018 
  • The differences between post-discharge versus concurrent patient status reviews 
  • When self-denial is appropriate to take advantage of Part B payment for an inpatient case 
  • How NCDs, LCDs, and coverage with evidence development (CED) affect coverage of cases that meet the 2-midnight benchmark 
  • The observation coverage rules and how they interact with the 2-midnight benchmark 
  • When ABNs and HINNs should be used for stays that don’t meet medical necessity requirements 

Medicare Boot Camp - Utilization Review

Course Location & Dates

The Revenue Integrity Symposium and Pre-Conference Boot Camp will be held October 14-15 at: 

WHERE: The Wigwam Hotel 
300 East Wigwam Blvd. 
Litchfield Park, AZ 85340 

  • Room rate $203/night ($189/night + $7/night resort fee + $7/night resort gratuity) 
  • Hotel cut-off date is Friday, September 21, 2018 
  • Reservation Center: 1-800-327-0396 and referencing the Revenue Integrity Symposium 
  • Hotel website:

To view our cancellation policy, click here.


Medicare Boot Camp - Utilization Review

Course Outline/Agenda

  • Module 1: Medicare Overview and Contractors
    • Overview of Medicare Part A, B, C, and D
    • Medicare contractors, including the MAC, RAC and QIO
  • 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 
    • Medicare Coverage Center, including LCDs, NCDs, CED and Lab Coverage Manual
    • Limitations of Liability and notice requirements for non-covered services
    • Links to Medicare resources and resources for staying current
  • Module 3: Outpatient Observation
    • Coverage of observation services
    • The Medicare Outpatient Observation Notice (MOON)
    • Advanced Beneficiary Notice (ABN) for non-covered observation
    • Coding and billing of observation
    • Payment for observation under the Observation Comprehensive APC (C-APC)
  • Module 4: Coverage of Inpatient Admissions
    • Inpatient order and certification requirements
    • Inpatient criteria and the 2-Midnight Benchmark
    • Inpatient-only procedures
    • Admission on a case-by-case basis
    • Documentation and use of screening tools
    • QIO short stay audits
  • Module 5: Inpatient Utilization Review and Notices
    • Utilization review requirements and self-denials
    • Concurrent review and billing with condition code 44 
    • Inpatient Part B payment and billing with condition code W2
    • Important Message from Medicare (IM)
    • Detailed Notice of Discharge (DN)
    • Hospital Issued Notice of Non-Coverage (HINN) for non-covered inpatient services
  • Module 6: Medicare Payment Fundamentals and Patient Responsibility
    • Basics of the Outpatient Prospective Payment System (OPPS)
    • Patient coinsurance under Part B
    • Basics of the Inpatient Prospective Payment System (IPPS)
    • Three-day payment window and pre-admission services
    • Medicare-severity diagnosis related groups (MS-DRGs)
    • Payment for transfers and post-acute care transfers
    • Inpatient deductible, coinsurance, and lifetime reserve days (LRDs)

Course Outline/Agenda subject to change.

Medicare Boot Camp - Utilization Review

Continuing Education

CE Credit information coming soon!

Medicare Boot Camp - Utilization Review

Learning Objectives

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

  • Define observation coverage, billing, coding, and payment rules 
  • Discuss the appropriate application of ABNs for observation patients 
  • State the new/revised inpatient order and certification requirements 
  • Explain CMS’ 2-midnight rule benchmark 
  • Describe the effect of hospital practice patterns on the 2-midnight presumption 
  • Recognize exceptions to the 2-midnight benchmark 
  • Describe the impact of LCD/NCD/CED criteria on inpatient coverage 
  • State the rules for "inpatient-only" procedure billing and reimbursement 
  • Describe the differences between condition codes 44 and W2 
  • Use appropriate billing codes for full Part B payment for inpatient cases, including for "self-denials" 
  • Differentiate inpatient and outpatient deductibles and co-payments 

Need to train a group?

Bring our industry-leading instructors to your facility! Hosting a Boot Camp is a cost-effective and convenient solution for training your staff on the latest regulations. For more information, call 877-233-8734 or contact one of our account managers.