Revenue Integrity and Chargemaster for Critical Access Hospitals Boot Camp

Course Overview

The Revenue Integrity and Chargemaster Boot Camp – Critical Access Hospital version - 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 set-up and maintenance within revenue integrity with an objective 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, charge capture, and documentation issues for critical access hospitals
• Review chargemaster issues for commercial/managed care versus CMS requirements for critical access hospitals

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Revenue Integrity and Chargemaster for Critical Access Hospitals Boot Camp

Outline/Agenda

Module 1:  Revenue Integrity Overview and Resources

Module 2:  Eligibility Principles

Module 3:  Benefits, Coverage and Medical Necessity

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

Module 5: Charge Description Master Structure and Relationship to Cost Reporting

Module 6: Principles of Charge Capture

Module 7: Claims Submission Fundamentals and Code Edits

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

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

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

Module 11:  Introduction to Payment Systems

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

Module 13:  Medicare Physician Fee Schedule (MPFS)

Module 14: Charge Description Master Management and Maintenance Strategies

Module 15:  Denial Management

Module 16:  Payer Contracting Strategies

Course Outline/Agenda subject to change.

Revenue Integrity and Chargemaster for Critical Access Hospitals Boot Camp

Learning Objectives

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

• Equip hospital, payer and other healthcare specialists with effective and efficient strategies to obtain and maintain overall revenue integrity for both governmental and non-governmental payers
• Gain a working understanding of revenue integrity principles associated with eligibility, coverage, coding, billing and payment using fee-for-service Medicare requirements as a framework
• Explain how the chargemaster fits into revenue integrity functions
• Review requirements and issues associated with provider-based status
• Explain standard charge description master (CDM) elements, design and relationship to the general ledger and revenue cycle processes of coding and billing
• Review claim requirements and specific issues of CDM set-up and maintenance by revenue code with associated cost reporting principles
• Review concepts of pricing different services
• Exemplify Critical Access Hospital cost-based reimbursement, including Method I and II, and as well as appeal strategies to protect revenue

Revenue Integrity and Chargemaster for Critical Access Hospitals Boot Camp

Continuing Education

Continuing Education credits for this course are pending approval.