Intensive, hands-on healthcare coding,
Medicare billing and compliance training
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Medicare Boot Camp® - Physician Services Version

Course Outline

Module 1: Introduction; Researching Medicare Issues
  • 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 2: Credentialing and Enrollment
  • Enrollment process.
  • National Provider Identifiers (NPIs)
  • Participation vs. non-participation
  • Opt-out/private contracts
Module 3: Non-Physician Practitioner Services
  • Billing "Incident to" services
  • Qualifications for "incident to" coverage.
  • "Separate enrollment" coverage for nurse practitioners and physician assistant services
Module 4: RBRVS Mechanics
  • 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 5: Claims for Physician/Practitioner 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 6: Advanced Beneficiary Notices and Non-Covered Services
  • 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 7: The National Correct Coding Initiative
  • 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 8: Evaluation and Management 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.
  • Consultations
  • Critical Care Services
  • Concurrent Care Services.
  • Care Plan Oversight Services
Module 9: Surgical Services
  • 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 10: Diagnostic Testing
  • 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 11: Teaching Physician Issues
  • 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.
Module 12: Audits and Appeals
  • 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


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