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Medicare Boot Camp® - Long-Term Care Version

Learning Objectives

Module 1: Overview of the Medicare Program/Research
  • Identify the key differences between the Medicare Programs (Part A, Part B, Part C and Part D).
  • Be able to differentiate between covered items and services under Medicare Part and Medicare Part B.
  • Be able to discuss Medicare eligibility requirements.
  • Be able to locate key Medicare sources of Medicare authority on the Internet.
  • Be able to differentiate between statutes, regulations, CMS manuals, CMS transmittals and other interpretive guidance.
Module 2: SNF Coverage/Admission
  • Be able to define the Medicare qualifying stay requirement for admission into a skilled nursing facility.
  • Be able to identify the criteria for determining a skilled need.
  • Be able to describe the services covered in a skilled stay.
  • Be able to identify Physician certification and re-certification requirements for a skilled stay.
  • Define and calculate a Medicare Benefit Period.
Module 3: The Resident Assessment Instrument and the Minimum Data Set
  • Understand and describe the purpose of the Resident Assessment Instrument (RAI).
  • Be able to identify key criteria in coding an accurate MDS.
  • Be able to troubleshoot problematic areas with appropriate solutions for the use of the RAI and MDS.
  • Be able to describe the documentation within the medical record when completing the MDS.
Module 4: SNF PPS Payment
  • Describe the difference between a cost-based reimbursement system and a prospective payment system.
  • Describe the MDS requirements for the PPS reimbursement system.
  • Differentiate between a Hierarchical and Case Mix Index Maximization case mix system.
  • Be able to compute a RUG score.
  • Understand the impact of the ARD on reimbursement.
  • Be able to compute a RUG reimbursement rate.
Module 5: SNF Billing
  • Be able to complete a UB-92 correctly for a SNF claim.
  • Define CMS requirements for Medicare exhaust and no-pay claims.
  • Be able to describe the services excluded from SNF consolidated billing.
  • Determine admission dates, discharge dates, and utilization days appropriately.
  • Identify billing requirements when a Payment Ban is in effect.
Module 6: SNF Consolidated Billing
  • Be able to describe the services excluded from SNF consolidated billing.
  • Be able to use the HCPC Help file to determine financial responsibility of services provided.
  • Identify key processes in reviewing invoices received for outside provider services.
Module 7: Diagnosis Coding for SNF Services
  • Be able to describe the general diagnosis coding guidelines as appropriate for use of ICD-9-CM codes.
  • Be able to determine how to utilize ICD-9CM codes for completion of the MDS.
  • Be able to determine the difference between acute care ICD-9-CM codes and late effect ICD-9-CM
Module 8: Beneficiary Notices Initiative
  • Be able to discuss the applicability of ABN requirements to long term care.
  • Be able to identify the requirements of a SNFABN being effective.
  • Be able to identify the limitations on the use of ABNs.
  • Be able to discuss the requirements for the Expedited Review process.
Module 9: Medicare Medical Review
  • Be able to identify the different types of Medical Review.
  • Be able to identify the bill review Requirements.
  • Be able to discuss the bill review process.
  • Be able to identify the potential bill review outcomes.
Module 10: Medicare Appeals
  • Be able to identify correct level of appeals process.
  • Be able to identify reopening vs. an appeal.
  • Be able to identify requirements for Medicare claims appeals.
  • Be able to identify CMS forms used during the appeals process.
Module 11: Part B Outpatient Therapy
  • Be able to identify and describe the physician order and documentation requirements for the provision of outpatient therapy.
  • Be able to complete a UB-92 form correctly for a Part B therapy claim.
  • Select appropriate CPT and ICD-9-CM codes for the provision of outpatient therapy services.
  • Be able to differentiate between timed and service based CPT codes.
  • Understand the recent changes with regards to outpatient therapy caps.
Module 12: Part B Ancillary Services and DMEPOS
  • Be able to identify services billable by a SNF to Medicare Part B.
  • Be able to identify the component parts of a NCD.
  • Identify billing requirements for Pneumoccoccal pneumonia, Influenza, and Hepatitis vaccinations.
  • Be able to define a DMERC.
  • Be able to identify coverage of DMEPOS in a nursing facility.
  • Be able to describe the difference between claims that are submitted to the DMERC vs. the FI.


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