HCPro Medicare Boot Camp Hospital Version May 6 10, 2013

Transcription

1 HCPro Medicare Boot Camp Hospital Version May 6 10, 2013 Metropolitan Chicago Healthcare Council 222 South Riverside Plaza (SE Corner of Canal & Adams Streets) 19th Floor Conference Center Co-hosted by the First Illinois Chapter HFMA PROGRAM OVERVIEW This intensive week-long class will provide hospital revenue cycle, finance, and compliance staff with the tools needed to master complex Medicare regulations and effectively prepare for government audits. Through a combination of lecture, class discussion, and hands-on exercises, attendees will learn how to identify and apply Medicare rules and guidelines to ensure that hospital services are billed accurately and appropriately; identify missed revenue opportunities and prevent denials; defend against Medicare Recovery Audit Contractor and other government audits; and ensure compliance with Medicare s complex rules and regulations. HCPro s expert faculty will empower attendees with the knowledge needed to research complex Medicare questions long after the class ends. A complete course outline as well as a list of available continuing education credits may be found on pages 4-6 of this brochure. WHO SHOULD PARTICIPATE This program is designed for hospital revenue cycle, finance and reimbursement, and compliance staff, including government billing specialists, PFS supervisors and managers, auditors and analysts, chargemaster coordinators, compliance officers, RAC liaisons, case managers, physician advisors, clinical documentation improvement specialists, and coders. Health information management, patient access management, and clinical managers and department heads will also benefit from this course. FACULTY Judith L. Kares, J.D., is a regulatory specialist and an expert in Medicare rules and regulations at HCPro, a leading provider of integrated information, education, training, and consulting products and services in the vital areas of healthcare regulation and compliance. Judith is a lawyer and consultant, providing legal and health care compliance services to a wide variety of clients, including hospitals, health systems, HMOs, third party payers, physician practices, and other health care entities. Prior to beginning her consulting practice, Judith spent a number of years in private law practice, representing hospitals and other health care clients, and then as Assistant General Counsel and Director of the Legal Department for Blue Cross and Blue Shield of Arizona, a fiscal intermediary and Medicaid managed care contractor, with oversight of federal and state health care programs. She also served as Deputy General Counsel, Regulatory and Contract Compliance, with Blue Cross and Blue Shield of the National Capitol Area in Washington, DC. Judith is an adjunct faculty member at the University of Phoenix, where she teaches courses in business and health care law and ethics.

2 DATES AND TIMES Registration and a continental breakfast will begin daily at 7:30 a.m. Lunch is included and provided onsite. Monday, May 6: Tuesday, May 7: Wednesday, May 8: Thursday, May 9: Friday, May 10: 8:00 a.m. 3:00 p.m. REGISTRATION AND FEES Advanced registration and payment are required, and registrations will not be confirmed until payment is received. Please reserve your place no later than Friday, March 1, This class is offered in a small classroom setting, and both minimum and maximum enrollments apply. The same person is expected to attend all five classes. Fees are per registrant and include daily continental breakfast, lunch, afternoon snacks, and all program materials. MCHC Members: $1,775 Non-Members: $1,850 TO REGISTER: Register Online and Pay by Credit Card Go to and select the "education" tab at the top of MCHC s home page to find this Webinar in the event listings. You must have an MCHC user name and password to register online, and both members and nonmembers are eligible to obtain these. (If you do not have a login, please select "Create User Login" on the top right hand side of the MCHC homepage before starting the registration process.) Register by Mail and Pay by Check Complete enclosed registration form and mail with payment to: Metropolitan Chicago Healthcare Council Attn: Donna Wallace 222 South Riverside Plaza, Suite 1900 Chicago, IL Make checks payable to MCHC-Service Corp. Please allow at least 7 days for mailing and processing. Registration and payment must be received by Friday, March 1, Registration forms will not be accepted without payment. Phone registrations are not accepted. Register by Fax and Pay by Credit Card Complete enclosed registration form and fax to Donna Wallace at

3 CANCELLATION POLICY Written notice of cancellation may be made via to Donna Wallace at A $50 service charge applies to any refund of registration fees. Cancellations will be accepted and refunds issued for requests received by the registration deadline. After Mach 1, 2013, cancellations will be accepted and refunds issued only if there is a waiting list for the class and another paid registrant is available. Substitutions may be made at any time, and we appreciate being informed of any name changes in advance of the program. MCHC will make every effort to fulfill special requests for accommodations made at the time of advanced registration. LOCATION MCHC is located in the building that is bordered by Adams Street on the north, Jackson Street on the south, Canal Street on the west, and the Chicago River on the east. The main entrance to our building, Fifth Third Center, faces Adams Street. Ample public parking is available, with the closest lot being the Union Station Self-Park, 320 S. Canal, which has entrances on Canal and Clinton. The Council is adjacent to Union Station and directly over the tracks (from Union Station tracks, come up the escalator towards Canal Street, around the staircase to the lobby, and take the elevator to the 19th floor), two blocks south of the Northwestern Station (Metra Ogilvie Transportation Center), and easy access from CTA bus and L stops. Please note: The management of MCHC s headquarters building has instituted enhanced security measures for the safety of all staff and visitors. Please allow extra time prior to the scheduled start of the program to obtain a visitor s badge at the security desk in the lobby. ADDITIONAL INFORMATION For more questions about registration and payment, please contact Donna Wallace, support and training specialist, at 312/ , dwallace@mchc.com. Questions about program content may be directed to Helena Lefkow, project manager, patient financial services, at 312/ , hlefkow@mchc.com. 3

4 COURSE OVERVIEW 1. Finding and Understanding Medicare Guidance a. Overview of Medicare Parts A, B, C and D b. Researching Medicare issues and finding Medicare resources c. How to understand statutes, regulations, manuals, transmittals and other Medicare rules and guidelines d. The role of Medicare contractors, including MAC and RAC 2. Decoding the UB-04 a. Key UB-04 fields applicable to hospital services, including proper use of condition codes, revenue codes, and HCPCS codes b. Review of ICD-9 coding for outpatient services c. Review of POA coding guidance 3. Medicare Claims Submission Fundamentals a. Timely Filing b. Repetitive, non-repetitive and recurring services c. The three-day payment window and preadmission services 4. Medicare Systems and Processes Related to Claims a. Medicare claims flow and processing systems, including the outpatient code editor and Medicare (inpatient) code editor b. Medicare Secondary Payer, including conditional payments c. Medicare appeals process 5. Coverage of Hospital Outpatient Services a. Requirements for Coverage of Outpatient Therapeutic Services b. Requirements for Coverage of Outpatient Diagnostic Services c. Coverage of drugs, including self-administered drugs d. Application of National and Local Coverage Determinations e. National coverage determinations for laboratory services 6. Outpatient Medical Necessity and ABNs a. Overview of limitations of liability and when notice is required b. The Advanced Beneficiary Notice (ABN) forms and instructions c. How to bill for non-covered outpatient services 7. Correct Coding Edits, including the Proper Use of Modifiers a. Column 1/Column 2 (bundling) and mutually exclusive edits b. Medically Unlike Edits (MUEs) for excessive units of service c. Proper use of modifiers with NCCI edits 8. Nuts and Bolts of the Outpatient Prospective Payment System a. Overview of the OPPS system and ambulatory payment classifications (APCs) b. How to use Addendum A and B and status indicators to understand APCs c. Determining how separately paid services are paid d. Determine services that are packaged e. Understand composite APCs 9. Calculating Outpatient Payment and Outliers a. How to calculate the Medicare allowable for a HCPCS b. How to calculate the patient s coinsurance c. Understand and calculate outpatient outlier payments 4

5 10. Outpatient Hospital Visit and Therapy Services a. E/M coding for Clinics and Emergency departments b. Critical care and trauma activation c. Proper application of modifier- 25 d. Sometimes Therapy Services e. Therapy Services Billing 11. Drugs, Biologicals and Devices a. Billing of packaged drugs, biologicals, and devices b. Separately paid drugs, biologicals, and devices c. Discarded Drugs 12. Surgical and Radiology Services under OPPS a. Terminated/discontinued surgical and radiology procedures b. Surgical procedures implanting devices received at reduced cost c. Proper reporting of bilateral procedures d. Never Event Procedures 13. Laboratory Services a. Clinical Diagnostic Laboratory Fee Schedule b. Reference laboratory billing c. Blood, blood products, and blood processing and storage 14. Patient status: Observation Services and Inpatient Admissions a. Coverage and proper billing of observation services b. Identification and billing of inpatient only procedures c. Inpatient coverage rules 15. Inpatient Non-Coverage and Special Billing issues a. Changing patient status with condition code 44 b. Part B payment for services furnished to non-covered inpatients c. Hospital Issued Notices of Non-coverage (HINNs) d. How to bill conditions arising during or from a non-covered stay 16. Inpatient Payment System and Patient Responsibility a. Overview of the Inpatient Prospective Payment System b. Medicare severity diagnosis related groups (MS DRGs) c. Hospital Acquired Conditions (HACs) d. Inpatient deductible, coinsurance, and life time reserve days 17. Inpatient Payment Factors a. How to find and use standardized amounts and wage indices b. The Value Based Purchasing adjustment c. The Hospital Readmission Reduction Program adjustment d. The Indirect Medical Education adjustment e. The Disproportionate Share Hospital adjustment 18. Inpatient Payment Adjustments a. Payment for transfers and the post acute care transfer policy b. Policy for devices received without cost or with substantial credit c. New technology add-on payment d. Inpatient outlier basics Course agenda subject to change. 5

6 CONTINUING EDUCATION UNITS AAPC This program has been approved by the American Academy of Professional Coders for 35 continuing education hours. Granting of prior approval in no way constitutes endorsement by AAPC of the program content or the program sponsor. Compliance Certification Board (CCB) This program has been approved for 42 Certification Compliance (CCB) Continuing Education Units in Compliance Training and Education and Auditing and Monitoring for Compliance. Granting of prior approval in no way constitutes endorsement by CCB of the program content or the program sponsor. American Nurses Credentialing Center (ANCC) HCPro, Inc. is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center s Commission on Accreditation. This educational activity for 35 nursing contact hours is provided by HCPro, Inc. Nurses should only claim credit commensurate with the extent of their participation in the activity. California Board of Registered Nursing HCPro, Inc., is approved by the California Board of Registered Nursing to provide 42 nursing contact hours. California BRN Provider #CEP Continuing Medical Education HCPro, Inc., is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. HCPro, Inc. designates this educational activity for a maximum of 35 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 42 CPE Credits! Program Level: Basic Delivery Method: Group-Live HCPro, Inc. 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. Complaints regarding registered sponsors may be addressed to the National Registry of CPE Sponsors, 150 Fourth Avenue North, Suite 700, Nashville, TN, Web site: Commission for Case Manager Certification (CCMC) This program is pending approval by the Commission For Case Manager Certification for 35 Continuing Education Units. Disclosure Information: The planners and presenter(s) of this activity have disclosed no relevant financial relationships with any commercial companies pertaining to this activity. 6

7 PROGRAM REGISTRATION HCPro Medicare Boot Camp Hospital Version May 6-10, 2013 Co-hosted by the First Illinois Chapter HFMA Organization: Telephone: Contact Person: REGISTRANTS: Name Title PROGRAM FEES (per registrant): MCHC Members $1,775 Non-Members $1,850 TOTAL AMOUNT DUE: $ PAY BY CHECK: Please make checks payable to MCHC-Service Corp. and mail check with completed registration form to: Metropolitan Chicago Healthcare Council Attn: Donna Wallace 222 South Riverside Plaza, Suite 1900 Chicago, IL Please allow at least 7 days for mailing and processing. Registration forms will not be accepted without payment. PAY BY CREDIT CARD: Fax completed registration form to Donna Wallace at ( ) VISA ( ) MasterCard ( ) AMEX Acct. no.: Name on card: Exp. Date (mm/yy): Signature: Registrations and payment must be received by Friday, March 1, 2013.