Revenue Integrity and Chargemaster for Critical Access Hospitals Boot Camp

Course Overview

This live Boot Camp is best for those looking for an interactive learning experience. Classes are led by our expert instructors, take place over the course of two days, and allow instructor/student interaction and engagement. 

Revenue Integrity and Chargemaster Boot Camp for Critical Access Hospitals 

Charge capture’s importance is at an all-time high. Let our expert instructors peel back the layers of chargemaster and revenue integrity in the critical access hospital setting. 

The Revenue Integrity and Chargemaster Boot Camp for Critical Access Hospitals provides education on chargemaster and revenue integrity concepts in a classroom format. The program will relate the chargemaster function to revenue cycle and revenue integrity functions, including cost reporting and key operational issues, such as coverage, clinical documentation, charge capture, and coding. It will also provide context for chargemaster setup and maintenance within revenue integrity to help avoid pre- and post-billing edits and payer denials. This Boot Camp reviews chargemaster coding requirements for critical access hospitals and excludes discussion of topics that are specific to coding for the Outpatient Prospective Payment System. 

You will leave this program knowing how to: 

• Provide formal, organized education and training for revenue integrity and chargemaster staff 
• Provide context for the intersection of the chargemaster with clinical/revenue departments, charge capture, coding, finance, and patient access and billing 
• Walk attendees through CMS regulatory requirements for pricing and charging patients, as well as key relationships between the chargemaster and provider cost reporting 
• Give detailed instructions for the majority of revenue codes for optimal chargemaster setup, maintenance, and charge capture 
• Understand documentation issues for critical access hospitals 
• Review chargemaster issues for commercial/managed care versus CMS requirements for critical access hospitals 

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. 
• 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). We currently conduct more than 30 Medicare Boot Camp courses each year.  

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 615-724-7200 or email PD-IS@SimplifyCompliance.com.

Revenue Integrity and Chargemaster for Critical Access Hospitals Boot Camp

Outline/Agenda

Module 1: Revenue Integrity Overview and Resources  

• Revenue integrity functions and key principles, including how the chargemaster fits into revenue integrity functions 
• Medicare and other revenue integrity and chargemaster resources 
• Understanding authoritative sources such as statutes, regulations, manuals, transmittals, and other Medicare rules and guidelines  

Module 2: Eligibility Principles  

• Review of major and different types of medical insurance 
• Principles of health insurance eligibility and verification of insurance 
• Coordination of benefits and subrogation 
• Medicare Secondary Payer concepts 

Module 3: Benefits, Coverage, and Medical Necessity 

• Review how insurance benefits are structured for hospital and other services 
• The importance of coverage, medical necessity, and both implied and specifically excluded benefits 
• Medicare’s prohibition against unbundling for inpatient and outpatient hospital services 
• Pre-service coverage analysis and associated waiver/notice requirements 
• Serious preventable events and relationship to risk management 
• Investigational/experimental services and implications for coverage 

Module 4: Provider Types, Licensure, Enrollment, Privileges, Credentialing, and Scope of Practice  

• Types of facilities, providers, physicians, practitioners, and suppliers 
• Provider-based department requirements, including implications of Section 603 of the Bipartisan Budget Act of 2015 
• Licensure, scope of practice, privileging, and relationship to coverage 
• Conditions of Participation, survey & certification, and accreditation 
• Importance of medical staff bylaws & regulations and relationship to conditions of payment 

Module 5: Chargemaster Structure and Relationship to Cost Reporting  

• Definition, purpose, and key fields of a chargemaster 
• Concepts for code setup in chargemasters and relationship to HIM coding 
• Principles of bundled services per CPT® definition versus reporting packaged services and implications for separate charging of packaged services 
• Strategies to address payer differences in the chargemaster 
• The relationship of the chargemaster to the overall AR system 
• Concepts for pricing services and why APCs are not a good gauge for pricing hospital services 
• Chargemaster, general ledger, and relationship to cost reporting 

Module 6: Principles of Charge Capture 

• Charge capture principles, logic, and reconciliation 
• HIPAA transaction sets 
• Routine and ancillary charges 
• Bundled versus packaged payments  

Module 7: Claim Submission Fundamentals and Code Edits  

• Key UB-04 fields applicable to hospital services 
• HIPAA transaction sets, including ICD-10 and HCPCS codes 
• Common claim edits, including NCCI and MUEs 
• Other transaction sets applicable to the revenue cycle, such as eligibility, payment, claim status, and denial transaction sets  

Module 8: Strategies and Key Issues by Revenue Code: Routine Services and Observation  

• Key concepts for accommodation codes and routine services, including outpatients in beds, specialty care units, and observation services 
• Coding and edit issues for revenue codes associated with routine services and observation 
• Major factors of coverage for these services 
• Applicable inpatient and outpatient payment concepts 
• General ledger and finance considerations, including pricing and charge capture  

Module 9: Strategies and Key Issues by Revenue Code: Ancillary Services  

• Key concepts for major ancillary service departments, including perioperative services, emergency, cardiology, diagnostic imaging, pharmacy, and supplies 
• Coding and edit issues for revenue codes associated with ancillary services 
• Major factors of coverage for these services 
• Applicable inpatient and outpatient payment concepts 
• General ledger and finance considerations, including pricing and charge capture 

Module 10: Strategies and Key Issues by Revenue Code: Other Departments  

• Key concepts for other common ancillary service departments, including respiratory therapy, clinics, behavioral health, and preventive services 
• Coding and edit issues for revenue codes associated with other departments 
• Major factors of coverage for these services 
• Applicable inpatient and outpatient payment concepts 
• General ledger and finance considerations, including pricing and charge capture 

Module 11: Introduction to Payment Systems  

• Review inpatient payment systems, including DRGs, APR-DRGs, case rates, and per diems 
• Discuss hospital outpatient hospital payment systems, including OPPS & APCs, eAPGs, fee schedules, and percent of charges 
• Review outpatient surgery payment methodologies such as ASC and ambulatory fee schedules 
• Review other ambulatory service payment systems such as the physician fee schedule, DMEPOS, and the clinical lab fee schedule 
• Review emerging payment methodologies such as bundled/episode payments (CJR) and value-based purchasing  

Module 12: Critical Access Hospital Reimbursement: Methods I & II  

• Cost-based reimbursement, interim, and period interim payment rates 
• Method I and Method II outpatient billing 
• Medicare reimbursement and payment for Method II billing 
• CRNA pass-through exemption  
• Method II billing of outpatient anesthesia services 

Module 13: Medicare Physician Fee Schedule 

• The resource-based relative value system 
• Relative value unit structure 
• Site-of-service adjustments for facility and non-facility services 
• Global versus technical and professional components 
• Payment policy indicators 

Revenue Integrity and Chargemaster for Critical Access Hospitals Boot Camp

Learning Outcomes

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

• Construct effective and efficient strategies for hospitals, payers, and other healthcare specialists to obtain and maintain overall revenue integrity for governmental and non-governmental payers 
• Develop a working understanding of revenue integrity principles associated with eligibility, coverage, coding, billing, and payment using fee-for-service Medicare requirements as a framework 
• Identify how the chargemaster fits into revenue integrity functions 
• Anticipate requirements and issues associated with provider-based status 
• Analyze standard chargemaster elements, design, and relationship to the general ledger and revenue cycle processes of coding and billing 
• Examine claim requirements and specific issues of chargemaster setup and maintenance by revenue code with associated cost reporting principles 
• Break down concepts of pricing different services 
• Compare critical access hospital cost-based reimbursement, including Method I and Method II, as well as appeal strategies to protect revenue 

Continuing Education

AAPC
This program has prior approval of the AAPC for 30 Continuing Education Units. Granting of this approval in no way constitutes endorsement by the AAPC of the program, content or the program sponsor.

AHIMA
This program has been approved for 30 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 30 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.

Revenue Integrity and Chargemaster for Critical Access Hospitals Boot Camp

Questions/Answers

What is the focus of the Revenue Integrity and Chargemaster Boot Camp for Critical Access Hospitals?
The Revenue Integrity and Chargemaster Boot Camp for Critical Access Hospitals

educates those who work within the critical access hospital setting about chargemaster and revenue integrity concepts. Some of these concepts include revenue cycle and revenue integrity functions, as well as cost reporting and key operations issues like coverage, clinical documentation, charge capture, and coding. It also gives attendees context about chargemaster setup and maintenance within revenue integrity and provides education about pre- and post-billing edits and payer denials.

Where is the course offered?
Open registration sessions are offered at various locations around the country, typically at mid-priced business hotels such as HYATT Place or Hilton Garden Inn. For a current schedule of upcoming open registration courses, click on “Locations/Dates” above.

Does HCPro offer an “on-site” version of this Boot Camp?
In addition to our open registration courses, we also offer this Boot Camp 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?
To view our cancellation policy, click here.

Who typically attends the Revenue Integrity and Chargemaster Boot Camp for Critical Access Hospitals?

• Reimbursement managers
• Revenue integrity staff
• Chargemaster staff
• Chargemaster managers
• Finance and reimbursement staff
• Finance and reimbursement managers & directors
• Claims auditors
• Payer relations staff
• HIM directors and managers
• Compliance officers, directors, and managers
• Coding directors and managers
• RAC coordinators

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 hands-on exercise/case studies.

What do I need to bring to class?
When you arrive at class, you will receive an extensive notebook of course materials. In addition, please bring the following to all classes:

• A highlighter
• A notebook for taking notes
• Sticky notes/flags
• A pen/pencil

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 615-724-7200 or email PD-IS@SimplifyCompliance.com.

Revenue Integrity and Chargemaster for Critical Access Hospitals Boot Camp

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 our web site at https://hcmarketplace.com/product-type/boot-camps/medicare. The hotel website gives 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 extensive workbooks containing the class materials utilized throughout the Boot Camp. The workbooks 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 8:00 a.m. to 5:00 p.m. Monday–Thursday. There will be about a one-hour lunch break each day. If the class gets behind, it may run later than 5:00 p.m.

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 recommend you bring the following to all classes: 

• Highlighter and pen/pencil
• A notebook for making your own notes
• Sticky notes/flags

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 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 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

COVID-19 Safety

Simplify Compliance and HCPro place the highest priority on the safety of our guests.  Simplify Compliance and HCPro will continue to monitor the COVID-19 environment and the recommended guidelines and will communicate adjustments to any on-site policies and procedures.

Contact Information

If you have any questions about the Boot Camp program, please contact:  

Customer Service  
(800) 650-6787 phone  
(800) 785-9212 fax  

http://hcmarketplace.com/product-type/boot-camps  

We look forward to having you in class!