Medicare Boot Camp® - Long-Term Care Version
Course Outline
DAY 1
Module 1: Overview of the Medicare Program/Research
- Types of Medicare programs
- Eligibility requirements
- Medicare regulation research:
- End your confusion over the CMS website and find what you need
Module 2: SNF Coverage and Documentation
- Technical Medicare requirements for admission to a SNF
- Starting and ending a benefit period
- "Skilling" basics
- Identify covered services and document appropriately
DAY 2
Module 3: The Resident Assessment Instrument and MDS 3.0
- Critical review of the MDS 3.0
- Concepts and constructs
- Coding for accuracy, coding for payment
- Problematic assessment and communication areas
- Linkage between interviews, culture change, and repeat business in the SNF
- Scheduling challenges posed by the new OMRA assessments (COT, EOT, SOT)
Module 4: SNF PPS Payment
- RUG-IV—acuity-based reimbursement
- Link payment items to the MDS assessment and ADLs
- Compute RUG rates
- Challenges of RUG-IV
- Determining payment days with both prospective and retrospective assessments
- Revenue projection challenges
- Strategies to bring in repeat business
DAY 3
Module 5: SNF Billing Under Part A
- Accurate UB-04 coding
- Billing challenges related to retrospective assessments
- Specialty claims: LOA, benefits exhaust, no pay
- Utilization of Medicare days
Module 6: SNF Consolidated Billing
- Knowing what is and what is not the responsibility of the SNF under consolidated billing
- Build your internal bill review processes
Module 7: Part B Outpatient Therapy and Billing
- Rules, regulations, documentation requirements for Part B therapy
- Completing the UB-04
- Adhering to the NCCI edits (-59 modifier, etc.)
Module 8: Part B Ancillary and DMEPOS
- Examine the facility requirements for each type of billable service
- Facility billing options
- Documentation requirements
DAY 4
Module 9: Diagnosis Coding for SNFs
- ICD-9-CM coding conventions and structure
- Coding examples
- Proper use of V codes
- Decision-making process regarding which codes to include on the UB-04
- Overcome transition challenges to ICD-10 and 5010
Module 10: Beneficiary Notices Initiative
- Types of notices: SNF ABN, ABN, NEMB, expedited review
- When and how to issue an ABN
Module 11: Medicare Medical Review and Appeals Process
- Preparing for external reviews: MAC, CERT, RAC, ZPIC
- Trigger points that may flag an audit or review
- Tips to reduce audit likelihood
- Audit case study for discussion
- Levels of appeal
- Timing
Module 12: Medicare Compliance and Risk Management
- Components of a compliance plan
- Ensuring data accuracy
- How to audit a record
- Documentation tips
- Education and training
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