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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
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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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