Boot Camps

Live Virtual Medicare Boot Camp®—Utilization Review Version

Course Overview

Master Medicare rules for utilization review

Live Virtual 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.

UR processes play an important role in the revenue cycle and maintaining compliance. CMS has directed Medicare Advantage plans to follow the fee-for-service Medicare UR rules, and hospitals must be prepared to ensure plans are compliant in authorizing inpatient stays and observation. CMS contractor Livanta also continues to audit short stays. Don't become a target or leave money on the table—have confidence in the UR determinations you and your facility are making.

Live Virtual Medicare Boot Camp—Utilization Review Version also answers all your questions about navigating the CMS website and finding Medicare resources.

You will leave this program knowing:

• How to apply the 2-midnight benchmark 
• The observation coverage rules and how they interact with the 2-midnight benchmark 
• How to find and apply the Medicare inpatient -only list 
• CMS guidance on case-by-case admissions 
• Rules for inpatient admission determinations by Medicare Advantage Pplans 
• The differences between post-discharge and concurrent patient status reviews 
• When self-denial is appropriate to take advantage of Part B payment for an inpatient case 
• How national coverage determinations (NCD), local coverage determinations (LCD), and Coverage with Evidence Development (CED) affect coverage of cases that meet the 2-midnight benchmark 
• When and how Medicare Advantage plans must comply with coverage policies or can deviate from them 
• When the Advance Beneficiary Notice (ABN) and the Hospital-Issued Notice of Non-Coverage (HINN) should be used for stays that don't meet medical necessity requirements 
• Delivery requirements for the Important Message from Medicare (IM) and the Detailed Notice of Discharge (DN)

This Boot Camp will help you to:

• Determine the correct inpatient or outpatient status of a patient under Medicare guidelines
• Conduct compliant reviews of a Medicare patient's status
• Implement condition code 44 or self-denial processes correctly and compliantly
• Understand the role of a UR team in your organization and how they contribute to compliant and accurate reimbursement

Who should attend?
With a more clinical focus than other Boot Camp courses, this class is designed for the physicians and nurses involved in the Medicare UR process, as well as the revenue cycle staff who support them. The course is also helpful for staff dealing with inpatient and outpatient denials and appeals. 

• UR coordinators
• UR managers and directors
• UR committee members
• UR physician advisors
• Case managers
• Care coordinators
• Revenue cycle staff
• Nurse managers
• Compliance officers and auditors
• Medicare Administrative Contractor (MAC) personnel
• Healthcare lawyers and consultants

See the HCPro difference for yourself!

• Focus on the actual rules: We provide references for all information provided and tools directly from Medicare, 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 help you be more efficient applying Medicare guidelines.
• Case studies: Case studies ensure attendees 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).

How does the Live Virtual Medicare Boot Camp®—Utilization Review Version work?

Class is held Monday – Thursday for 1 week from 12:00 p.m. – 4:15 p.m. Eastern Time (4 classes).

Please Note: Four days before class starts, you will receive a welcome email that includes the dial-in information for the class.

Class is held Monday – Thursday from November 11 – November 14. Registration cut-off date: 11/4/2024

For more detailed information about HCPro's Boot Camps, us at 800-650-6787 or email sales@hcpro.com.

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

Live Virtual Medicare Boot Camp®—Utilization Review Version

Course Outline

Module 1: Medicare Program, Contractors, and Resources

• Overview of Medicare Part A, B, C, and D
• Medicare contractors, including Medicare Administrative Contractors (MAC), Recovery Audit Contractors (RAC), and Quality Improvement Organizations (QIO)
• Web-based resources and key sources of Medicare authority

Module 2: Medical Necessity Rules, Policies, and Notices

• Medicare Coverage Center, including local coverage determinations (LCD), national coverage determinations (NCD), and Coverage with Evidence Development (CED)
• Coverage of services related to clinical trials, registries, and studies
• Medicare Advantage plan coverage determinations, including prior authorizations
• Prior authorizations for specified outpatient procedures and services

Module 3: Coverage of Observation

• Coverage of observation services
• Coding and billing of observation
• Payment for observation, including at Prospective Payment System (PPS) hospitals and critical access hospitals (CAH)

Module 4: Medicare Outpatient Notices

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

Module 5: Inpatient Orders and Certification

• Inpatient order requirements
• Inpatient certification requirements, including 96-hour CAH certification

Module 6: Inpatient Admission Guidelines

• Inpatient-only procedures
• The 2-midnight benchmark
• Admission on a case-by-case basis
• Livanta guidance, including clinical examples 

Module 7: Inpatient Utilization Review (UR) and Billing Requirements

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

Module 8: Medicare Inpatient Notices

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

Module 9: Overview of Inpatient Payment Systems and Patient Liability

• Basics of the Inpatient Prospective Payment System (IPPS)
• Three-day payment window and preadmission services
• Medicare Severity Diagnosis-Related Groups (MS-DRG)
• Payment for transfers and post-acute care transfers
• Inpatient deductible, coinsurance, and lifetime reserve days (LRD)

Module 10: Outpatient Payment Systems and Patient Liability

• Basics of the Outpatient Prospective Payment System (OPPS)
• Encounter-based Comprehensive Ambulatory Payment Classifications (C-APC)
• Patient coinsurance under Part B

Course Outline/Agenda subject to change.

Live Virtual Medicare Boot Camp®—Utilization Review Version

Schedule

November — Class Schedule (Eastern time)

Live Virtual Medicare Boot Camp®—Utilization Review Version

Continuing Education

ACCME
HCPro is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

HCPro designates this educational activity for a maximum of 15 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

ACDIS
This program has been approved for 15 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 Integrity Specialists (ACDIS).

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 15 nursing contact hours.

CCMC
This program has been pre-approved by the Commission for Case Manager Certification to provide 15 continuing education credit to Certified Case Managers (CCMs).

NAHRI
This program has been approved for 15 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.

Live Virtual Medicare Boot Camp®—Utilization Review Version

Things to Know Before Attending Class

What is Included with Your Purchase

When you purchase a seat for our live virtual boot camps you get online access for one participant to the live sessions, a hard copy of our printed workbook materials, and access to the recordings of the sessions. HCPro reserves the right to revoke your access if we find that you are sharing your login or any of the class information.

Course Materials

You will receive a hard copy of the class materials. These will be shipped to you via UPS. If ordering on our website, please be sure to enter the physical address of where these materials should be shipped to. If you order over the phone or if you are unsure of what address we have on file, please ask the person you are speaking with to verify your address information and update accordingly or call our customer service department. Materials should arrive approximately two business days prior to the start of class.

Virtual Boot Camp Platform

We use GoToMeeting to present our virtual boot camps. To ensure your system supports GoToMeeting, use this link https://support.goto.com/meeting/system-check. We will send out access information for the class 4 business days prior to the class start and again 1 business day prior.

Session Recordings

You will have access to the recordings of each class session via a password protected page on our website. You will be given the page location two business days following the first session. Recordings will be added to the page within one business day following the live session. You will have access to this page for 60 days after the final live session. 

Continuing Education Credits

To receive continuing education credits, you will be required to successfully complete a 40-question quiz that is based off of the content covered throughout the course. Successful completion is achieved by getting at least 80% of the multiple-choice questions correct.

What to Bring to Class

We suggest that you have the following available during the class:

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

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!

Live Virtual Medicare Boot Camp®—Utilization Review Version

Questions/Answers

What is the focus of the Live Virtual Medicare Boot Camp®—Utilization Review Version?
Live Virtual Medicare Boot Camp—Utilization Review Version is an intensive course focusing on the Medicare regulatory requirements for patient status and the role of the utilization review (UR) committee.

What computer setup do I need to attend this class?
This class will be hosted on the GoTo Meeting platform. Attendees should have access to a computer that has a microphone and speakers to participate. There is also an option to dial in over a phone line if you need to connect on your phone. You can read the full system requirements for GoTo Meeting by visiting https://support.goto.com/meeting/help/system-requirements-for-attendees-g2m010003. You can also test your system by visiting https://support.logmeininc.com/gotomeeting/get-ready.

Does HCPro offer on-site sessions of Live Virtual 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-site.

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

Who typically attends Medicare Boot Camp—Utilization Review Version?

• UR coordinators
• UR managers and directors
• UR committee members
• UR physician advisors
• Case managers
• Care coordinators
• Revenue cycle staff
• Nurse managers
• Compliance officers and auditors
• Medicare Administrative Contractor (MAC) personnel
• Healthcare lawyers and consultants

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.

How is the course taught?
The course is taught using a combination of lecture, class discussion, and case studies.

What should I have available for each session?
For each class, participants should have their packet of materials and may wish to also have available a highlighter, a notebook for taking notes, and 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