Medicare Boot Camp®—Utilization Review Version Administrative Webinar Series

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Medicare Boot Camp®—Utilization Review Version Administrative Webinar Series

Product Code: URBO2020

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Prefer Medicare Utilization Review for Clinical Staff? Check out our course: here

Medicare Boot Camp®—Utilization Review Version Administrative Webinar Series

Course Overview

Master Medicare Rules for Utilization Review

Medicare Boot Camp®—Utilization Review Version Webinar Series consists of 10 one-hour webinars 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 2020, 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
  • How to find the inpatient only list and exceptions to the inpatient only requirements
  • 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 observation stays that don’t meet medical necessity requirements

Who should attend?

  • Utilization review staff
  • Utilization review coordinators
  • Utilization management managers and directors
  • Utilization review committee members
  • UR physician advisors
  • Case managers
  • Care coordinators
  • Revenue cycle staff
  • Nurse managers
  • Compliance officers and auditors
  • CFOs, CNOs, and VPs
  • Fiscal intermediary personnel
  • Healthcare lawyers and consultants

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 review a set of case studies  to ensure they understand the concepts and know how to apply them to real-world situations.

Highly rated, well-established program: Participants consistently give the course an overall rating of 4.75 or higher (on a 5.0 scale). We currently conduct more than 30 Medicare Boot Camp courses each year.

For more detailed information about Medicare Boot Camps, contact customer service at 800-650-6787 or email

Medicare Boot Camp®—Utilization Review Version Administrative Webinar Series

Course Outline – Full Agenda

Session 1 – Medicare Overview

  • Overview of Medicare Part A, B, C, and D
  • Medicare contractors, including the MAC, RAC, and QIO

Session 2 – Medicare Medical Necessity, Coverage and Resources

  • General Medicare Coverage Requirements
  • Medicare Coverage Center, NCDs and LCDs
  • Links to Medicare resources and resources for staying current

Session 3 – Observation

  • Coverage of observation services
  • Coding and billing of observation
  • Payment for observation for OPPS and CAH facilities

Session 4 – Observation Notices

  • Advanced Beneficiary Notice (ABN) for non-covered observation
  • The Medicare Outpatient Observation Notice (MOON)

Session 5 – Inpatient Orders and Certifications

  • Inpatient order and certification requirements
  • Documentation and use of screening tools
  • QIO short stay audits

Session 6 – Inpatient Two-Midnight Rule

  • Inpatient 2-Midnight Benchmark

Session 7 – Inpatient Only and Case-by-Case Admission

  • Inpatient-only procedures
  • Admission on a case-by-case basis

Session 8 – UR Review

  • Utilization review requirements and self-denials
  • Concurrent review and billing with condition code 44
  • Inpatient Part B payment and billing with condition code W2

Session 9 – Inpatient Notices

  • Important Message from Medicare (IM)
  • Detailed Notice of Discharge (DN)
  • Hospital Issued Notice of Non-Coverage (HINN) for non-covered inpatient services

Session 10 – Patient liability and Payment Basics

  • Patient coinsurance under Part B
  • Inpatient deductible, coinsurance, and lifetime reserve days (LRDs)
  • Basics of CAH facility payment
  • Basics of the Outpatient Prospective Payment System (OPPS)
  • 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

Medicare Boot Camp®—Utilization Review Version Administrative Webinar Series

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

Medicare Boot Camp®—Utilization Review Version Administrative Webinar Series


What is the focus of Medicare Boot Camp®—Utilization Review Version – Webinar Series?
Medicare Boot Camp—Utilization Review Version – Webinar Series
 consists of 10 one-hour webinar sessions on Medicare coverage for hospital outpatient observation 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," with a particular emphasis on the operational application of those rules.

Does this course prepare participants for coding certification?
Medicare Boot Camp—Utilization Review Version
  is not primarily 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 help participants prepare 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 sessions of Medicare Boot Camp—Utilization Review Version?
In addition to our open registration courses, we also offer Medicare Boot Camp—Utilization Review Version as an on-site program (with a substantial discount) for organizations with a number of employees who need training. For more information on hosting an on-site Medicare Boot Camp—Utilization Review Version, click on Train Groups On-sites.

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.

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."