|
|
| |
HCPro Boot Camps
Formerly HRAI Coding Specialists
200 Hoods Lane,
Marblehead, MA 01945
Phone: (877) 207-4036
Fax: (800) 738-1553
Copyright 2000-2008,
HCPro, Inc., All Rights Reserved
|
|
|
Medicare Boot Camp® - Hospital Version
Course Outline
Medicare Research: End your confusion over the CMS Web site and find what you need
- Review role of Fiscal Intermediaries, Carriers, and Medicare Administrative Contractors
- Review Medicare Part A and Part B
- Researching Medicare Issues
- Finding Medicare Resources on the Web
- Working With Statutes, Regulations, Manuals, Transmittals and Other Medicare Rules and Guidelines
UB04, ICD-9-CM, NPI, OCE and Other Must-Know Billing Fundamentals
- The UB-04 Form/Format
- Key UB-04 Fields Applicable to Hospital Services
- National Provider Identifiers
- Repetitive, Non-Repetitive and Recurring Services
- The Outpatient Code Editor
- The Medicare (Inpatient) Code Editor
- Medicare Claims Flow and Processing Systems
NCCI, MUEs, Modifiers and Other Must-Know Coding Fundamentals
- Overview of National Correct Coding Initiative (NCCI), including Basis for NCCI Edits
- Composition of NCCI Edits
- Application of NCCI Edits
- The Effect of Modifiers on the Column 1/Column 2 and Mutually Exclusive Edits
- Special Considerations for Hospital related to NCCI Edits
- Practical NCCI Issues
Medical Necessity and Non-Coverage: What to know when Medicare is not paying the bill
- Medicare's Financial Liability Protections
- Overview of Limitations of Liability and When Advanced Notice is Required
- The Outpatient Advanced Beneficiary Notice (ABN) Forms and Instructions
- Considerations for an Effective ABN
- Limitation on the Use of Outpatient ABN
- The Notice of Exclusion From Medicare Benefits (NEMB) Form
- Billing Non-Covered Services Where an Effective ABN was Given
- Billing Non-Covered Services Where an ABN was Required but not Given
- Billing Non-Covered Services at the Request of the Beneficiary (Demand Bills)
- Billing Non-Covered Services for Denial Notices for Secondary Payors
Tools for Understanding and Predicting Medicare Outpatient Revenue: Overview of the OPPS system
- Overview of the OPPS system
- Unconditional and Conditionally Packaging, T-Packaged Codes and STVX Packaged Codes
- Review of Addendum B
- Ambulatory Payment Classifications (APC) and Addendum A
- Deductibles and Coinsurance
- Calculating the Medicare Allowable and Coinsurance
- Outliers
- Transitional Outpatient Payments and Rural Sole Community Hospital Adjustment
The Essentials of Drugs, Biologicals and Devices: How are they covered and how are they paid?
- Coverage of Drugs, including Self Administered Drugs
- Packaged Drugs, Biologicals and Devices, including Procedure to Device edits
- Pass Through Drugs, Biological and Devices
- Non-pass Through Drugs and Biologicals, including Radiopharmaceuticals and Brachytherapy Sources
- Billing for Take Home Drugs
- Billing Units of Service for the Supply of Drugs and Biologicals
- Billing for the Wastage of Drugs
Hospital provider- based departments: E/M services, critical care, and other hot topics
- Coverage of Hospital Outpatient Services
- Billing for Clinic and Emergency Encounters
- Payment for Clinic and Emergency Encounters
- Billing and Payment for Critical Care Services
- Billing and Payment for Trauma Activation
- Application of Modifier 25
- Active Wound Care
New Composite APCs: How you still get paid for observation
- Coverage of Observation Services.
- Billing for Observation Services, including importance of Billing of Packaged Observation
- Extended Assessment and Management Composite APCs
Surgical and Radiology Services Under OPPS: Discounts, modifiers and more
- Cardiac Electrophysiologic and Prostate Brachytherapy Composite APCs
- The Multiple Procedure Reduction
- Terminated/Discontinued Procedures
- Procedures implanting devices received and reduced or no cost
- Bilateral Procedures
- Drug Eluting Stents
- Angiography Performed at the Time of Cardiac Catheterization
- Reporting Conscious Sedation for "Bull's Eye" Procedures
- Packaged Surgical and Radiology Services
- Inpatient Only Procedures
- Mammography
Let's not forget about the lab: Coverage, blood products and more
- The Lab National Coverage Determinations
- Application of the Clinical Diagnostic Lab Fee Schedule to Hospitals
- Payment to Hospitals under the Clinical Diagnostic Lab Fee Schedule
- Billing Issues related to Clinical Diagnostic Lab Furnished by Hospitals
- Special Rules related to Reference Laboratory Services
- Blood, Blood Products and Blood Processing and Storage
From Three days Before Admission to Post-discharge: What you need to know about Medicare's inpatient policies
- Limitations on Coverage
- Changing Patient Status, including Proper use of Condition Code 44
- Date of Admission
- Patient Responsibility
- Payment under Part B for Services Furnished to Inpatients
- Treatment of Conditions Arising During or From a Non-Covered Stay
- Application of Limitation on Liability to Inpatient Services, including Hospital Issued Notices of Non-Coverage
- Packaging of Pre-Admission Services
Tools for Understanding and Predicting Medicare Inpatient Revenue: Overview of the IPPS system
- Overview of IPPS
- Medicare Severity Diagnosis Related Groups (MS DRGs), including MS-DRG Grouping
- IPPS Payment Calculation
- Medicare Dependent Hospitals and Sole Community Hospitals
When the DRG Payment is not What You Expect: Post-acute care transfers and new technology add-ons explained
- 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
- New Technology Add-On Payment
Outlier payments: How far in the red do you have to be to qualify?
- Calculating Outlier Payments
- Reconciliation
- Outlier Payments for Transfer DRG Cases.
The Basics of Graduate Medical Education Payments: How to calculate direct payments and indirect adjustments
- Indirect Medical Education ("IME") Adjustment
- Direct Graduate Medical Education ("DGME") Payments
|
|
|
|
