San Francisco Professional Events List

Medicare Boot Camp®—Utilization Review Version (BLR)

Dec 03, 2018 - 08:00 AM
NY Events List
3939, Ocean Bluff Ave

San Diego,
ZIP: 92130

Medicare Boot Camp®—Utilization Review Version (BLR)


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 2018, 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 2018 
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


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)

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

Continuing Education

This program has been approved by the AAPC for 15 continuing education hours. Granting of prior approval in no way constitutes endorsement by AAPC of the program content or the program sponsor.

American Health Information Management Association (AHIMA)
This program has been approved for 15 CE credits for use in fulfilling the continuing education requirements of the American Health Information Management Association (AHIMA).

Association of Clinical Documentation Improvement Specialists (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 Improvement Specialists (ACDIS).

American Nurses Credentialing Center (ANCC)
HCPro is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation.

This educational activity for 15 nursing contact hours is provided by HCPro.

California Board of Registered Nursing
HCPro is approved by the California Board of Registered Nursing to provide 18 nursing contact hours. California BRN Provider #CEP 14494.

Commission for Case Manager Certification (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).

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.

National Association of State Boards of Accountancy (NASBA)
Earn up to 18 CPE Credits!
Program Level: Basic
Delivery Method: Group-Live
Field of Study: Specialized Knowledge and Applications

HCPro is registered with the National Association of State Boards of Accountancy (NASBA) as a sponsor of continuing professional education on the National Registry of CPE Sponsors. State boards of accountancy have final authority on the acceptance of individual courses for CPE credit.

Please contact the event manager Marilyn (marilyn.b.turner(at) ) below for:
- Multiple participant discounts
- Price quotations or visa invitation letters
- Payment by alternate channels (PayPal, check, Western Union, wire transfers etc)
- Event sponsorships

Service fees included in this listing.
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