Master complex Medicare regulations and prepare for government audits.

Transcription

1 2011 Summer/Fall Classes Master complex Medicare regulations and prepare for government audits. Seattle, WA August 1 5 Cincinnati,OH September Dallas,TX October San Diego, CA Oct. 31 Nov. 4 Nashville, TN December 5 9 Register Today Visit or CALL 800/

2 LEADER The leader in Medicare billing and compliance training Understand the rules to improve front-end processes before outside auditors take back your reimbursement. Attend the Medicare Boot Camp Hospital Version and learn how to successfully: Maintain compliance with the latest rules and regulations Prevent missed revenue and denials Prepare for RAC and other government audits It s not just about RACs anymore! Includes the latest Medicare regulatory updates to prepare you for all types of denials. Medicare Boot Camp Hospital Version focuses on target areas identified by RACs and other auditors to assist in risk assessment and future appeals. Leave this program with an understanding of: RAC appeal processes Recent changes to the three-day rule Physician supervision Observation services and inpatient status Learn to unlock the ANSWERS to ALL your Medicare questions Using a combination of lecture, class discussion, and hands-on exercises, this intensive four-and-a-half day course not only teaches you the rules and their application, but gives you the tools and skills to research your own Medicare questions long after the Boot Camp. Course participants receive a FREE copy of HCPro s RAC Benchmarking report know what your peers across the country are doing to get ready. Medicare Boot Camp Hospital Version see the HCPro difference for yourself. This isn t just any revenue cycle and compliance course; this is the most comprehensive course available today. Check out the benefits of the Medicare Boot Camp : Focus on the Actual Rules Learn how to find and apply CMS rules and guidelines to ensure that hospital services furnished to Medicare beneficiaries are billed accurately and appropriately. Hands-On Learning Attendees work a set of exercises/case studies after each module to ensure that 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.

3 Course Agenda 1 Medicare Basics: Understanding Medicare and Finding Resources on the Web Researching Medicare issues and finding Medicare resources on the Web How to understand statutes, regulations, manuals, transmittals and other Medicare rules and guidelines Medicare Part A and B The role of Medicare contractors, including MAC and RAC 2 UB-04, ICD-9-CM, NPI, and Other Must Know Billing Fundamentals Key UB-04 fields applicable to hospital services, including proper use of condition codes, revenue codes, HCPCS codes, diagnosis codes and present on admission indicators Review of ICD-9 coding for outpatient services 3 Medicare Claims Processing Fundamentals Repetitive, non-repetitive and recurring services, including claims frequency Inpatient billing issues Date of admission Pre-admission services and the three-day payment window Medicare claims flow and processing systems, including the outpatient code editor and Medicare (inpatient) code editor Medicare appeals process Limitations on recoupment and interest on recoupments Appeal levels and timeframes 4 Medical Necessity and Non-Coverage: What to know when Medicare is not paying the bill Overview of limitations of liability and when advanced notice is required The outpatient advanced beneficiary notice (ABN) forms and instructions How to bill for non-covered outpatient services Application of limitation on liability to inpatient services, including hospital issued notices of non-coverage (HINNs) How to bill conditions arising during or from a non-covered stay 5 NCCI, MUEs, Modifiers, and Other Must- Know Coding Fundamentals Composition and application of NCCI edits, including column 1/column 2, mutually exclusive and medically unlikely edits Proper use of modifiers with NCCI edits Special considerations and practical issues for hospitals related to NCCI edits 6 Tools for Understanding and Predicting Medicare Outpatient Revenue: Overview of the OPPS Overview of the OPPS system and ambulatory payment classifications (APCs) How to use Addendum A and B and status indicators to understand APCs Determining separately paid services and how they are paid Determine services that are packaged Understand composite APCs Low dose rate prostate brachytherapy Cardiac electrophysiology evaluation and ablation Extended assessment and management Radiology family composites How to calculate Medicare allowable and patient coinsurance Understand and calculate outpatient outlier payments 7 Hospital Provider-Based Departments: E/M services, critical care and other hot topics Coverage of hospital outpatient services under the hospital incident-to provisions Physician supervision of hospital therapeutic and diagnostic services Proper E/M coding, including clinic, emergency department, critical care and trauma activation Proper application of modifier The Essentials of Drugs, Biologicals and Devices: How are they covered and how are they paid? Coverage of drugs, including self administered drugs Billing of packaged drugs, biologicals, and devices Pass through and non-pass through payment for drugs, biologicals, and devices 9 Surgical and Radiology Services under OPPS: Discounts, modifiers, and more Modifiers for terminated/discontinued surgical and radiology procedures Surgical procedures implanting devices received at reduced or no cost Proper reporting of bilateral procedures

4 Course Agenda 10 Let s not forget about the Lab: Coverage, blood products and more National coverage determinations for laboratory services Reference laboratory billing Blood, blood products, and blood processing and storage 11 Sorting out patient status: Observation services and inpatient admissions Coverage and proper billing of observation services Identification and billing of inpatient only procedures Inpatient coverage rules Requirements for utilization review Changing patient status from inpatient to outpatient, including proper use of condition code 44 Payment under Part B for services furnished to inpatients 12 Tools for Understanding and Predicting Medicare Inpatient Revenue: Overview of the IPPS Overview of IPPS Medicare severity diagnosis related groups (MS DRGs), including MS-DRG grouping and the effect of hospital acquired conditions IPPS payment calculation The standardized amounts How to find and use the Medicare wage index and geographic adjustment factor Patient responsibility, including deductible, coinsurance, and life time reserve days 13 When the DRG Payment is Not What you Expect: Special IPPS Payments and Adjustments Medicare dependent hospitals and sole community hospitals Payment for transfers and the post acute care transfer payment policy Payment adjustment for devices received without cost or with substantial credit The disproportionate share hospital (DSH) adjustment Indirect medical education (IME) adjustment New technology add-on payment Inpatient outlier basics Register Today Visit or CALL 800/ COMMON Questions Are continuing education credits provided? Visit us at for complete information about continuing education credits. The Medicare Boot Camp Hospital Version offers continuing education credits from the following organizations: American Academy of Professional Coders (AAPC), Healthcare Compliance Certification Board (HCCB), American Nurses Credentialing Center (ANCC), National Association of State Boards of Accountancy (NASBA), Accreditation Council for Continuing Medical Education (ACCME) Are there any prerequisites? Familiarity with the ICD-9-CM and CPT coding systems is helpful but not required. This course is taught on a basic to intermediate level. Due to the fast-paced nature of the course, it is recommended but not required that course participants have at least one year of experience working in a hospital. However, the course starts with Medicare fundamentals and does not assume that participants have any particular background or experience. Who should attend? Auditors Billers Case managers CDI professionals Chargemaster coordinators and managers Clinical department managers Coders and coding managers Compliance officers Finance and reimbursement personnel Fiscal intermediary personnel Healthcare lawyers, consultants, and CPAs HIM directors and managers Legal department personnel RAC coordinators Registration managers and staff Revenue cycle managers Course agenda subject to change Course participants receive the RAC benchmarking report for free!

5 ADDITIONAL SERVICES AVAILABLE Need to train a group? Bring the Medicare Boot Camp to your organization. If you have a group to train, holding a Boot Camp at your organization is easy and cost-effective. Eliminate travel costs and enjoy a group discount while ensuring your staff is up to date on the latest regulations and guidelines. Courses can be customized to meet the specific needs of your facility. For more information on hosting a Boot Camp, call 800/ Additional Boot Camps offered by HCPro:» Certified Coder Boot Camp Live and Online» Certified Coder Boot Camp Inpatient Version» NEW! HCPro ICD-10 Basics Boot Camp TM Live and Online» Clinical Documentation Improvement TM Live and Online» Evaluation & Management Boot Camp Professional Version» Medicare Boot Camp Long-Term Care Version» Medicare Boot Camp Critical Access Hospital Version For a complete course listing and more information, including a current class schedule, visit or contact us at 800/ HCPro s Revenue Cycle Institute specializes in education and training, regulatory monitoring and surveillance, and electronic research tools customized to your organization s unique needs. Areas covered include: RAC education and training Coding training for inpatient, outpatient, and physician services Patient status and observation services training Regulatory surveillance services, including on-call research and analysis Electronic regulatory research databases and tools Medicare Membership program Visit us at or call 877/ for more information. Register 30 days in advance and SAVE $200! Call 800/ to receive your discount!

6 Dates And LocationS Location Class Dates Renton (Seattle), WA August 1 5 Hilton Garden Inn Seattle/Renton 1801 East Valley Road, Renton, WA / Room Rate $149 Hotel Cut-off Date: July 11 Cincinnati,OH September Hyatt Place/Cincinnati Northeast 5070 Natorp Boulevard, Cincinnati, OH / Room Rate: $109 Hotel Cut-off Date: August 14 Dallas,TX October Hyatt Place Dallas North by the Galleria 5229 Spring Valley Road, Dallas, TX / Room Rate: $109 Hotel Cut-off Date: September 26 San Diego, CA October 31 November 4 Homewood Suites by Hilton San Diego Airport/Liberty Station 2576 Laning Road, San Diego, CA / Room Rate: $152 Hotel Cut-off Date: October 1 Brentwood (Nashville) TN December 5 9 Homewood Suites Nashville/Brentwood 5107 Peter Taylor Park, Brentwood, TN / Room Rate: $109 Hotel Cut-off Date: November 15 Class times are 8:00 a.m. 5:00 p.m. Monday Thursday; 8:00 a.m. 1:00 p.m. on Friday. For more dates and locations Visit Hotel Reservations We have negotiated a special rate for a limited number of rooms at each course location. Rooms are available on a first-come, first-served basis and may sell out before the cut-off date. Make your hotel reservations immediately to guarantee rate and availability, and be sure to identify yourself as a participant of HCPro s Medicare Boot Camp Hospital Version Special Room Rates Available! Limited Availability Register Early! Course Fee The registration fee for the five-day redesigned Medicare Boot Camp Hospital Version is $1,699, which includes all five-days of comprehensive training and course workbook. For information regarding administrative policies, such as cancellations, transfers, refunds, or comments, call 800/ or visit Register Today Visit or CALL 800/

7 REGULATORY EXPERTS Kimberly Anderwood Hoy, JD, CPC, is the director of Medicare and compliance for HCPro, Inc. Hoy is a lead consultant for HCPro s Revenue Cycle Institute and is the lead instructor for HCPro s Medicare Boot Camp Hospital Version. She is a national expert in Medicare compliance and regulatory issues and has vast experience conducting billing compliance audits and internal investigations. She has served as a compliance officer and in-house legal counsel for hospitals and has developed and implemented corporate-wide compliance programs for two hospitals. Judith L. Kares, JD, is an instructor for HCPro s Medicare Boot Camp Hospital Version. She spent a number of years in private law practice, representing hospitals and other health care clients, and then as in-house legal counsel prior to beginning her current legal/consulting practice. Debbie Mackaman, RHIA, CHCO, is an instructor for HCPro s Medicare Boot Camp Hospital Version and the Medicare Boot Camp Critical Access Hospital Version. A former hospital compliance officer and HIM director, she has more than 18 years of experience in the healthcare industry, including both inpatient and outpatient Prospective Payment Systems (IPPS and OPPS) and Critical Access Hospital (CAH) coding and reimbursement issues. Hugh Aaron, CPC, CPC-H, is the original developer of the Medicare Boot Camp Hospital Version. He is a senior advisor for Healthcare for Virginia Capital Partners, LLC, a private equity fund based in Richmond, VA. He also owns The Aaron Group, LLC, a consulting firm that focuses on coding and reimbursement issues. He is an adjunct assistant professor at the University of Richmond where he teaches health care regulation. BOOTCAMP GRADUATES ARE SAYING... Best seminar ever! Learned so much. Professional, clear, interesting, knowledgeable instructor. I will recommend to others and will sign up again. The group dynamic was great, too. Clare Abadie, Director Claims, Desert Oasis Healthcare, Palm Springs, CA Judy knew the material inside and out. She made the conference worth every penny. She made this conference a success. She took dry material and made it interesting. Judy is wonderful, kind, knowledgeable, and very helpful. Susan Taggart, Revenue Cycle Analyst, Marin General, Greenbrae, CA Great job! Un-stumpable! Very knowledgeable. You can tell Ms. Hoy really is passionate about her career. Thank you for sending her our way! Teresa Berry, Service Line Senior Coder, Orlando Health, Orlando, FL Debbie is very knowledgeable. I have been a manager of UM for 11 years. It would have been a great benefit to have had HCPro s support in the years past, or the Medicare boot camp which would have made things much easier. Thank you so much. Juliana Montgomery, UM Manager, Baptist Health, Jacksonville, FL This is a very knowledgeable educational session which clarify a lot of Medicare regulations and rules. Course materials are very organized into different modules. Highly recommend. This instructor is very energetic, knowledgeable, and expressive person to demonstrate the important concepts of Medicare issues, rules, and regulations. Eileen Shiu, Patient Account Analyst, Century Financial Services, North Haven, CT