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Medical Billing and Coding: Medicare - Long Term Care 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

Reimbursement Directors and Staff Finance Directors and Staff Business Office Managers and Staff Administrators and Administrative Staff Directors of Nursing and Nursing Department Staff MDS Coordinators Quality Assurance Managers and Staff Compliance Officers and Auditors Carrier/Fiscal Intermediary Personnel Long Term Care Lawyers Consultants and CPAs

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 long term care setting. However, the course starts with Medicare fundamentals and does not assume that participants have any particular background or experience. Familiarity with the MDS and the ICD-9-CM and HCPCS coding systems is helpful, but not required.

Course Aim

Medicare Boot Camp® – Long Term Care Version is an intensive, four-day course on Medicare coverage, billing, coding and payment for long term care services, including skilled nursing facility (SNF) services and Medicare Part B services provided to nursing facility residents. The course is technically oriented and focuses on the specific Medicare regulations and guidelines applicable to long term care services. The course is taught using a combination of lecture, class discussion and hands-on exercises/case studies.

Learning Objectives:

The objective of the course is to provide course participants with a detailed understanding of the Medicare “rules” applicable to long term care services, with a particular emphasis on the real world application of those rules.

Topics Covered

Overview of the Medicare Program The Role of the Intermediaries and Carriers Part A versus Part B UB-92 versus CMS-1500 Billing Cost-Based versus Prospective Payment Researching Medicare Issues Exercises/Case Studies SNF Coverage/Admissions Qualifying Hospital Stay Requirement Determining Skilled Need Limitations on SNF Coverage Physician Admission Orders Documentation and Signature Requirements Exercises/Case Studies SNF Billing Using the UB-92 Format for SNF Billing Bill Types, Condition/Occurrence Codes Use of Revenue Codes HCPCS and Diagnosis Codes Exercises/Case Studies Diagnosis Coding for SNF Services General Diagnosis Coding Guidelines ICD-9-CM and the MDS Use of Acute Care Versus Late Effect Codes Exercises/Case Studies The Resident Assessment Instrument and the Minimum Data Set Importance of the RAI/MDS Completing the MDS Common MDS Problems and Solutions Medical Record Documentation Requirements Exercises/Case Studies SNF PPS Payment RUGs Overview Computing the RUGs Score Determining SNF Payment Exercises/Case Studies Part B Outpatient Therapy Use of the UB-92 for Outpatient Services Bill Types, Condition/Occurrence Codes CPT and Diagnosis Codes Revenue Codes Therapy Caps Documentation and Order Requirements Exercises/Case Studies Part B DMEPOS DMEPOS Coverage DMEPOS Supplier Enrollment Role of the DMERCs Use of the CMS-1500 Format for DMERC Claims HCPCS and Diagnosis Codes for DMEPOS Medical Policy Requirements Fraud and Abuse Concerns Exercises/Case Studies Part B Ancillary Services Laboratory Services Radiology Services Drugs/Medical Supplies Fraud and Abuse Concerns Exercises/Case Studies Advance Beneficiary Notices/Non-Covered Services The Social Security Act ABN Provisions Applicability of ABN Requirements to LTC 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 What to Do If the Patient Refuses to Sign Billing for Non-Covered Services Exercises/Case Studies Cost Reporting Why the Cost Report Still Matters? Cost-to-Charge Ratio Issues Wage Index Issues Exercises/Case Studies

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