  |
 Contact |
 |
Medical Billing and Coding: Medicare - Hospital Version |
|
Contact |
|
Medical Billing and Coding: Medicare - Hospital Version |
| Course Language: | English |
| Course Duration: | 4 Days |
| Cost | $1495.00 |
| Deployment Options: | Instructor-Led:On-Site Training |
Medical Billing and Coding: Medicare - Hospital Version: |
| With Client Site Training, courses can be scheduled on a date that is convenient for you, and
because they can be scheduled at your location, you don't incur travel costs and students won't be away from home.
An additional advantage is that the class is taught on your equipment, so students are learning in their work environment
rather than in a classroom setup. Client Site classes can also be tailored to meet your needs. You might shorten a 10-day class into a 5-day class, or combine portions of several related courses into a single course, or have the instructor vary the emphasis of topics depending on your staff's and site's requirements. We require a minimum of ten employees and above. |
Audience |
|
Prerequisites |
| Because of the fast-paced nature of the course, it is recommended (but not required) that 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. Familiarity with the ICD-9-CM and CPT coding systems is helpful, but not required. |
Course Aim |
| Medicare Boot Camp® – Hospital Version is an intensive, 5-day course on Medicare coverage, billing, coding and payment for hospital outpatient and inpatient services. The course is technically oriented and focuses on the Medicare regulations and guidelines applicable to hospital services. The course is taught using a combination of lecture, class discussion and hands-on exercises/case studies. The objective of the course is to provide course participants with a detailed understanding of the Medicare “rules” with a particular emphasis on the operational application of those rules. The course emphasizes both revenue optimization and compliance. |
Learning Objectives: |
| The objective of the course is to provide course participants with a detailed understanding of the Medicare “rules” with a particular emphasis on the operational application of those rules. The course emphasizes both revenue optimization and compliance. |
Topics Covered |
| Overview of the Medicare Program · The Role of the Intermediaries versus the Carriers · Part A versus Part B · UB-92 versus CMS-1500 · Researching Medicare Issues · Web Based Resources · Query Formulation · Statutes and Regulations · CMS Manuals · CMS Program Memos · Exercises/Case Studies Hospital Outpatient Claims · Using the UB-92 to Bill for Hospital Outpatient Services · Bill Types · Condition Codes · Occurrence Codes · Revenue Codes · HCPCS Codes · Diagnosis Codes · Attending/Referring Physician ID · The Outpatient Code Editor · Exercises/Case Studies Application of Medicare’s National Correct Coding Initiative to Hospital Outpatient Services · What is the NCCI? · Basis for the NCCI Edits · Using the NCCI Manual · The Comprehensive Code Edits · The Mutually Exclusive Code Edits · The Effect of Modifiers on NCCI Edits · Special NCCI Considerations for Hospitals · NCCI Revenue Enhancement Opportunities · NCCI Compliance Concerns · Exercises/Case Studies Diagnosis Coding; Orders · Who Can Order Outpatient Tests? · General Diagnosis Coding Guidelines for Outpatient Services · Specific Diagnosis Coding Guideline for Radiology, Lab, Surgical and Screening Services · Telephone Orders · Obtaining Diagnostic Information from the Patient · Documentation and Signature Requirements · Exercises/Case Studies Advance Beneficiary Notices/Non-Covered Services · The Social Security Act “Limitation on Liability” and “Refund Requirement” Provisions · Applicability of ABN Requirements to Hospitals · The Effect of Giving an ABN · CMS’s ABN Forms · When to Use/Not Use ABNs · Requirements for an ABN to be Effective · Limitations on the Use of ABNs · The Interplay Between ABNs and EMTALA · What to Do If the Patient Refuses to Sign an ABN · ABNs for Services Subject to Frequency Limitations · ABNs for an Extended Course of Treatment · Use of Occurrence Codes and Condition Codes In Connection with ABNs and Non-Covered Services · Exercises/Case Studies Outpatient Prospective Payment System (OPPS) Mechanics · Ambulatory Payment Classifications (APCs) and Packaging Under OPPS · Using Addendums A, B and D · Services Covered Under OPPS · Services Excluded from OPPS · Inpatient Only Procedures · OPPS Outliers · Exercises/Case Studies Drugs, Biologicals and Devices · Medicare Coverage of Outpatient Prescription Drugs · Packaged Drugs, Biologicals and Devices · Pass-Through Drugs, Biologicals and Devices · Separately Payable Non-Pass-Through Drugs, Biologicals and Devices · Wastage · Fraud & Abuse Concerns Relating to Supplying Non-Covered Drugs to Medicare Patients · Exercises/Case Studies Clinic, Emergency Department and Critical Care Services · Hospital Outpatient “Incident To” Requirements · The Hospital E&M Codes, Including Significant Differences Between Hospital and Physician Coding Guidelines · Differentiating Between New and Established Hospital Outpatients · Selecting an E&M Level for Hospital Outpatients · Treatment of Critical Care Under OPPS · Hospital E&M Services Provided on the Same Day as Other Non-E&M Services · What Does “Significant and Separately Identifiable” Mean? · Using Modifier -25 Appropriately · Multiple Hospital E&M Encounters on the Same Day · What Does “Separate and Distinct” Mean? · Using Modifier -27 Appropriately · Exercises/Case Studies Observation Services · Medicare Coverage Requirements for Intra-Facility Observation Admissions · Medicare Coverage Requirements for Direct Admissions to Observation · Packaged Observation Services · Billing Requirements Applicable to Observation Services · Exercises/Case Studies Surgical Services · The Multiple Procedure Reduction · Terminated Procedures · Bilateral Procedures · Exercises/Case Studies Clinical Diagnostic Lab Services · The Clinical Diagnostic Lab Fee Schedule · Clinical Diagnostic Lab National Administrative Policies · Orders · Coding/Claims · Repeat Services · Documentation Requirements · Frequency Screens · Clinical Diagnostic Lab National Coverage Determinations · Scope of the NCDs · Coding Guidelines · ABN Issues · Using the NCD Manual · Limitations on Billing for Outsourced Tests · Exceptions to the Limitations on Billing for Outsourced Tests · Exercises/Case Studies Imaging and Radiation Therapy Services · The Imaging APCs · Coverage and Billing for Contrast Studies and Supplies · Mammography · Screening versus Diagnostic · Computer Assisted Detection · Digital Technologies · Exercises/Case Studies Inpatient PPS Mechanics · Facilities Subject to IPPS · Inpatient Diagnosis and Procedure Coding · DRG Grouping and Relative Weight · Factors Driving Inpatient Payment · Exercises/Case Studies Inpatient PPS Coverage · Inpatient Coverage In General · Pre-Admission Services/72 Hour Rule · Exhausted Part A Benefits · Limitations on Coverage · Exercises/Case Studies Inpatient Admission, Discharge and Transfer · Admission Criteria · Discharges Treated as Transfers · Transfer DRGs · Payment for Transfer Cases · Swing Beds · Exercises/Case Studies Inpatient PPS Outliers · Overview of Inpatient Outliers · Calculating Inpatient Outlier Payments · Compliance Issues Relating to Inpatient Outliers · Exercises/Case Studies Supplemental Inpatient Payments · Disproportionate Share · Indirect Medicare Education · Graduate Medical Education · Capital Related Costs · Exercises/Case Studies Cost Reporting · Why the Cost Report Still Matters? · Cost-to-Charge Ratio Issues · Wage Index Issues · Exercises/Case Studies |