Medicare Boot Camp® - Physician Services Version
Module 1: Introduction; Researching Medicare Issues
Module 2: Credentialing and Enrollment
- Key sources of Medicare authority
- Working with statutes, regulations, transmittals and other interpretative guidance.
- Efficient ways to keep up with operational changes in the Medicare program.
Module 3: Non-Physician Practitioner Services
- Enrollment process.
- National Provider Identifiers (NPIs)
- Participation vs. non-participation
- Opt-out/private contracts
Module 4: RBRVS Mechanics
- Billing "Incident to" services
- Qualifications for "incident to" coverage.
- "Separate enrollment" coverage for nurse practitioners and physician assistant services
Module 5: Claims for Physician/Practitioner Services
- Medicare payment under the physician fee schedule.
- Using the relative value file/physician fee schedule database to make operational billing decisions.
- Deductibles and coinsurance
- Unusual circumstances (modifiers -22 and -52 )
Module 6: Advanced Beneficiary Notices and Non-Covered Services
- The role, function and jurisdiction of the Medicare carrier.
- Claim Form, CMS-1500 08-05 data set instructions
- Site of service and the effect of site of service on payment.
- Assigned versus non-assigned claims.
- Reassignment limitations
- Limitation on coverage for services furnished to a relative.
- Consolidated billing limitations on services to SNF residents.
Module 7: The National Correct Coding Initiative
- Implications of Medicare's "financial liability protections" on billing for professional services.
- Applicability of ABNs to professional services.
- Circumstances when an ABN would be ineffective or invalid.
- Appropriate use of an NEMB.
- ABNs for extended courses of treatment
- Applications of a routine ABN
- Billing for non-covered services, including the appropriate use of modifiers.
Module 8: Evaluation and Management Services
- Accessing the NCCI Policies and Edits On-Line
- Applicability of NCCI edits to outpatient claims
- Column 1/Column 2 Code Edits vs. mutually exclusive NCCI edits
- Billing for code pairs and the appropriate use of "correct coding modifiers"
- Detecting automatic denials for Medically Unlikely Edits
Module 9: Surgical Services
- Billing for the "Welcome to Medicare" visit.
- Billing for E/M services furnished to a hospital inpatient.
- Billing for E/M services furnished to a hospital observation patient.
- Billing for E/M services furnished in an emergency department.
- Billing for E/M services furnished to a nursing facility patient.
- Critical Care Services
- Concurrent Care Services.
- Care Plan Oversight Services
Module 10: Diagnostic Testing
- The Global Surgical Package
- Billing for services furnished during the postoperative period that are not included in the surgical package, including the use of appropriate modifiers
- The Multiple Procedure Payment Reduction
- Bilateral surgeries
- Billing for Co-Surgeons, Team Surgeons and Assistant Surgeons
Module 11: Teaching Physician Issues
- The Professional versus the Facility Component (Including Modifier Usage)
- Physician Order/Supervision Requirements for Diagnostic Testing
- Purchased Diagnostic Tests and Interpretations
- Diagnostic Radiology Services Furnished in a Professional Practice Setting
- CLIA Issues Applicable to Laboratory Services Furnished in a Professional Practice Setting
- Payment Under the Clinical Diagnostic Laboratory Services Fee Schedule
- Laboratory NCDs/Billing Issues
Module 12: Audits and Appeals
- Coverage of Services Furnished By Interns and Residents
- Attending Physician Issues
- Billing for resident involvement of patient care, including modifier usage and documentation requirements
- Billing for services when an intern or resident functions as an assistant surgeon
- Moonlighting residents.
- The Medicare program integrity function applicable to services furnished in a professional practice setting.
- "Medical review" vs. "Benefit integrity"
- Responding to audit notices
- The Part B Appeals Process