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      Medicare Boot Camp®—Utilization Review Version in Broomfield

      • Medicare Boot Camp®—Utilization Review Version Photo #1
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      October 4, 2020

      Sunday   8:00 AM - 5:00 PM (daily for 2 times)

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      Medicare Boot Camp®—Utilization Review Version

      Medicare Boot Camp®—Utilization Review Version
      About this Event


      Course Overview

      Master Medicare rules for utilization review

      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. In 2020, CMS made significant changes to the inpatient-only list and continues to change its strategies for auditing patient status. Don’t become a target or leave money on the table—ensure the UR committee is ready to implement and leverage the regulatory requirements.

      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 and 2-midnight presumptions
      Implement changes to the inpatient-only list for 2020
      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
      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
      CFOs, CNOs, and VPs
      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 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.

      Hands-on learning: Attendees work a set of exercises/case studies after each module to ensure they 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.

      Learning Objectives

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

      Define observation coverage, billing, coding, and payment rules
      Discuss the appropriate application of ABNs for observation patients
      State the new/revised inpatient order and certification requirements
      Explain CMS’ 2-midnight rule benchmark
      Describe the effect of hospital practice patterns on the 2-midnight presumption
      Recognize exceptions to the 2-midnight benchmark
      Describe the impact of LCD/NCD/CED criteria on inpatient coverage
      State the rules for "inpatient-only" procedure billing and reimbursement
      Describe the differences between condition codes 44 and W2
      Use appropriate billing codes for full Part B payment for inpatient cases, including for "self-denials"
      Differentiate inpatient and outpatient deductibles and co-payments

      Course Outline/Agenda

      Module 1: Medicare Overview and Contractors

      Overview of Medicare Part A, B, C, and D

      Medicare contractors, including the MAC, RAC and QIO

      Module 2: Medicare Research and Resources

      Finding Medicare source laws, including statutes, regulations and final rules

      Finding Medicare sub-regulatory guidance, including manuals and transmittals

      Medicare Coverage Center, including LCDs, NCDs, CED and Lab Coverage Manual

      Limitations of Liability and notice requirements for non-covered services

      Links to Medicare resources and resources for staying current

      Module 3: Outpatient 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)

      Module 4: Coverage of Inpatient Admissions

      Inpatient order and certification requirements

      Inpatient criteria and the 2-Midnight Benchmark

      Inpatient-only procedures

      Admission on a case-by-case basis

      Documentation and use of screening tools

      QIO short stay audits

      Module 5: 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

      Module 6: 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 Outline/Agenda subject to change.


      Coming Soon!

      Cost: $1,089

      Categories: Conferences & Tradeshows

      This event repeats daily for 2 times: Oct 4, Oct 5

      Event details may change at any time, always check with the event organizer when planning to attend this event or purchase tickets.

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