Intensive, hands-on healthcare coding,
Medicare billing and compliance training
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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)
  • Differentiate between covered items and services under Medicare Part A and Medicare Part B
  • Discuss Medicare eligibility requirements
  • Locate key Medicare sources of authority on the Internet
  • Differentiate between statutes, regulations, CMS manuals, CMS transmittals, and other interpretive guidance

Module 2: SNF Coverage/Admission

  • Define the Medicare qualifying stay requirement for admission into a SNF
  • Identify the criteria for determining a skilled need
  • Describe the services covered in a skilled stay
  • Identify physician certification and recertification requirements for a skilled stay
  • Define and calculate a Medicare benefit period

Module 3: The Resident Assessment Instrument and the Minimum Data Set 3.0

  • Understand and describe the purpose of the RAI
  • Identify key criteria in coding an accurate MDS 3.0
  • Troubleshoot problematic areas with appropriate solutions for the use of the RAI and MDS 3.0
  • Describe the documentation within the medical record when completing the MDS 3.0

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
  • Compute a RUG score
  • Describe the impact of the ADLs and ARD on reimbursement

Module 5: SNF Billing Under Part A

  • Complete a UB-04 correctly for a SNF claim
  • Define CMS requirements for Medicare exhaust and no-pay claims
  • Describe the services excluded from SNF consolidated billing
  • Determine admission dates, discharge dates, and utilization days appropriately

Module 6: SNF Consolidated Billing

  • Describe the services excluded from SNF consolidated billing
  • 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: Part B Outpatient Therapy

  • Identify and describe the physician order and documentation requirements for the provision of outpatient therapy
  • Complete a UB-04 form correctly for a Part B therapy claim
  • Select appropriate CPT and ICD-9-CM codes for the provision of outpatient therapy services
  • Differentiate between timed and service-based CPT codes
  • Understand the recent changes with regards to outpatient therapy caps

Module 8: Part B Ancillary Services and DMEPOS

  • Identify services billable by a SNF to Medicare Part B
  • Identify the component parts of an NCD
  • Identify billing requirements for pneumococcal, influenza, and hepatitis vaccinations, as well as all other preventative services
  • Identify DMEPOS covered services in a nursing facility
  • Describe the difference between claims that are submitted to the DMERC vs. the MAC

Module 9: Diagnosis Coding for SNFs

  • Describe the general diagnosis coding guidelines as appropriate for use of ICD-9-CM codes
  • Determine how to utilize ICD-9-CM codes for completion of the MDS
  • Determine when to use V codes and late-effects codes

Module 10: Beneficiary Notices Initiative

  • Discuss the applicability of ABN requirements to long-term care
  • Identify the requirements of a SNF ABN being effective
  • Identify the limitations on the use of ABNs
  • Discuss the requirements for the Expedited Review process

Module 11: Medicare Medical Review and Appeals Process

  • Identify the different types of Medical Review, including: MAC, RAC, ZPIC, and CERT
  • Identify the bill review requirements, process, and outcomes
  • Identify the correct level of appeals process
  • Identify reopening vs. an appeal
  • Identify requirements for Medicare claims appeals
  • Identify CMS forms used during the appeals process

Module 12: Medicare Compliance and Risk Management

  • Discuss the requirements of a compliance plan
  • Describe a method to ensure that documentation matches the MDS, the medical record, and the care plan
  • State the relationship between CMS' Corporate Compliance Guidelines and assessment and payment areas
  • Link changes in resident condition to one risky communication practice
  • Construct a staff training strategy to educate different levels of staff on the MDS 3.0


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