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Live Virtual Medicare Boot Camp®—Utilization Review Version
$899.00
Product Code:
URCV
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.
* Next registration cut-off date: 10/27/2025
To register multiple attendees, please call our sales team at 615-724-7200.
This live virtual Boot Camp is perfect for those looking to expand their Medicare knowledge with instructor-led education that can be accessed from the comfort of your own home. Classes are led by our expert instructors, typically take place over the course of a week or two, and allow instructor/student interaction and engagement. |
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.
Managing patient status plays a critical role in proper compliance, correct reimbursement, and stabilizing inpatient payments for the hospital. Medicare Advantage Plans must also follow the Two-Midnight rule and inpatient only list. Understanding the intricacies of these rules and the CMS guidance will be critical to ensure plans are compliant with their obligations to patients and providers. Short stay auditor Livanta has also concluded their first year of audit with over half of denials for admission related to the circulatory and digestive systems.
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 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
- CMS’ current strategy related to the inpatient only list
- CMS guidance on case-by-case admissions
- 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 stays that don’t meet medical necessity requirements
This Boot Camp will help you to:
- Determine the correct inpatient or outpatient status of a patient under Medicare FFS guidelines
- Conduct compliant utilization review of Medicare patients
- 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 compliance 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 utilization review process, as well as the revenue cycle people who support them. The course is also helpful for staff dealing with inpatient and outpatient denials and appeals.
- Utilization review coordinators
- Utilization review 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
See the HCPro difference for yourself!
Focus on the actual rules: Learn how to find and apply CMS rules and guidelines to ensure Medicare beneficiaries are placed in the correct status and billed correctly for the services they receive.
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).
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 3 – November 6. Registration cut-off date: 10/27/2025
For more information about our Boot Camps, contact us at 800-650-6787 or email sales@hcpro.com.
Live Virtual Medicare Boot Camp®—Utilization Review Version
Outline/Agenda
Week 1: Medicare Overview and Resources
- Overview of Medicare Part A, B, C, and D
- Medicare contractors, including the MAC, RAC and QIO
- Links to Medicare resources and resources for staying current
- Medicare Coverage Center, including LCDs, NCDs and CED
- Prior authorization for specified outpatient procedures and services
Week 1: Medicare Observation:
- Coverage of observation services
- The Medicare Outpatient Observation Notice (MOON)
- Advanced Beneficiary Notice (ABN) for non-covered observation
- Coding and billing of observation
- Payment for observation under the Observation Comprehensive APC (C-APC)
- Payment for observation at a Critical Access Hospital (CAH)
Week 2: Coverage of Inpatient Admissions
- Inpatient order requirements
- Inpatient certification requirements, including 96-hour CAH certification
- Inpatient criteria and the 2-Midnight Benchmark
- Inpatient-only procedures
- Admission on a case-by-case basis
- Documentation and use of screening tools
Week 3: Inpatient Utilization Review and Notices
- Utilization review requirements and self-denials
- Concurrent review and billing with condition code 44
- Inpatient Part B payment and billing with condition code W2
- Important Message from Medicare (IM)
- Detailed Notice of Discharge (DN)
- Hospital Issued Notice of Non-Coverage (HINN) for non-covered inpatient services
Week 4: Medicare Payment Fundamentals and Patient Responsibility
- Basics of the Outpatient Prospective Payment System (OPPS)
- Patient coinsurance under Part B
- 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)
Course Agenda/Outline is subject to change.
Live Virtual Medicare Boot Camp®—Utilization Review Version
Schedule
November — Class Schedule (Eastern time)
November 3 | 12:00 p.m. – 4:15 p.m. |
November 4 | 12:00 p.m. – 4:15 p.m. |
November 5 | 12:00 p.m. – 4:15 p.m. |
November 6 | 12:00 p.m. – 4:15 p.m. |
Live Virtual Medicare Boot Camp®—Utilization Review Version
Questions/Answers
What is the focus of Live Virtual Medicare Boot Camp®—Utilization Review Version?
The 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 set-up do I need to attend this class?
This will be hosted on the GoToMeeting 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 GoToMeeting 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-sites.
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?
- 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
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, notebook for taking notes, and sticky notes/flags.
What if I have a question that didn’t get addressed in class?
The course offers open office hours each week to address topics related to the course materials and class discussion. Questions should be related to the course and topics discussed throughout the course. Instructors are not able to address questions outside the scope of the course.
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
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
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.