Boot Camps

Medicare Boot Camp®—Utilization Review Version Online

Course Overview

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

Utilization review processes play an important role in the revenue cycle and maintaining compliance. CMS has directed Medicare Advantage plans to follow the fee-for-service 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.

Medicare Boot Camp—Utilization Review Version Online 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, including cases with observation
• 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 Plans
• 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 NCDs, LCDs, 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 ABNs and HINNs should be used for stays that don’t meet medical necessity requirements
• Delivery requires for the Important Message from Medicare and Detailed Notice of Discharge

This Boot Camp will help you to:

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

Who should attend?

• 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
• Fiscal intermediary personnel
• Healthcare lawyers and consultants

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®—Utilization Review Version Online

Dates

Below is the current course schedule for upcoming Medicare Boot Camp®—Utilization Review Version Online classes.

To view our cancellation policy, click here.

Medicare Boot Camp®—Utilization Review Version Online

Outline/Agenda

Module 1:  Medicare Program, Contractors, and Resources

• Overview of Medicare Part A, B, C, and D
• Medicare contractors, including the MAC, RAC and QIO
• Web-based Resources and Key Sources of Medicare Authority

Module 2: Medical Necessity Rules, Policies and Notices

• Medicare Coverage Center, including LCDs, NCDs, and CEDs
• 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 PPS and CAH hospitals

Module 4: Medicare Outpatient Notices

• The Medicare Outpatient Observation Notice (MOON)
• Advanced 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 Two-Midnight Benchmark
• Admission on a case-by-case basis
• Livanta Guidance, including clinical examples

Module 7: Inpatient Utilization Review and Billing Requirements

• Utilization review 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 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)

Module 10: Outpatient Payment Systems and Patient Liability

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

Course Agenda/Outline is subject to change.

Medicare Boot Camp®—Utilization Review Version Online

Questions/Answers

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

How does it work?
You’ll receive the same content and instruction that you would experience at our classroom-based, nationally recognized Boot Camps. Here’s how it works:

• 60-day access to video instruction after purchase date: View video sessions and complete all assignments, including review of all answer keys.
• 24-hour access: Video instruction is available at any time of day—you choose the time that works for you. You can also email questions to our instructors. We try to answer all questions either via email or phone within two business days.
• Ask the Expert: Email questions to our instructors. We try to answer all questions via email or phone within three business days.

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 with coding, billing, and reimbursement. 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. 

How long will I have access to the content? 
The online portal location for your class sessions and materials will be available for 60 days from the class start date.

Does this course prepare participants for coding certification?
The Medicare Boot Camp®—Utilization Review Version Online contains a review of pertinent coding issues as they relate to Medicare coverage, billing, and payment; however, the course is not 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 assist participants in preparation for national coding certification. For more details, please review the information for these courses using the links above or contact customer service at email customer@simplifycompliance.com or 800-650-6787.

Does HCPro offer "on-site" Medicare Boot Camps?
In addition to our open registration courses, we also offer Medicare Boot Camps 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?
Cancellation Policy
Please click here to view our cancellation policy.

Who typically attends the Medicare Boot Camp?

• Finance and reimbursement personnel
• Case Managers
• Chargemaster personnel
• Billers and coders
• Medical records/health information personnel
• Clinical department personnel
• Provider-based clinic personnel
• Revenue managers
• Compliance officers and auditors
• Registration personnel
• Medicare Advantage and MAC personnel
• Healthcare lawyers, consultants, and CPAs
• Legal department personnel

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 our sales team at 800-650-6787 or email sales@hcpro.com.

Medicare Boot Camp®—Utilization Review Version Online

Continuing Education

AAPC
This program has the prior approval of AAPC for 10 continuing education hours. Granting of prior approval in no way constitutes endorsement by AAPC of the program content or the program sponsor.

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 10.25 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 10.25 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 10 continuing education units for use in fulfilling the continuing education requirements of the American Health Information Management Association (AHIMA).

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 11.25 nursing contact hours.

NAHRI
This program has been approved for 10.25 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).