Intensive, hands-on healthcare coding,
Medicare billing and compliance training
courses offered nationwide

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

Medicare Boot Camp® - Hospital Version

Course Outline

Module 1: Researching Medicare Issues

Review role of Fiscal Intermediaries, Carriers, and Medicare Administrative Contractors
Review Medicare Part A and Part B
Researching Medicare Issues
Finding Medicare Resources on the Web
Working With Statutes, Regulations, Manuals, Transmittals and Other Medicare Rules and Guidelines

Module 2: Hospital Claims

The UB-04 Form/Format
Key UB-04 Fields Applicable to Hospital Services
National Provider Identifiers
Repetitive, Non-Repetitive and Recurring Services
The Outpatient Code Editor
The Medicare (Inpatient) Code Editor
Medicare Claims Flow and Processing Systems

Module 3: National Correct Coding Initiative

Overview of National Correct Coding Initiative (NCCI), including Basis for NCCI Edits
Composition of NCCI Edits
Application of NCCI Edits
The Effect of Modifiers on the Column 1/Column 2 and Mutually Exclusive Edits
Special Considerations for Hospital related to NCCI Edits
Practical NCCI Issues

Module 4: Outpatient Advanced Beneficiary Notices and Non-Covered Services

Medicare's Financial Liability Protections
Overview of Limitations of Liability and When Advanced Notice is Required
The Outpatient Advanced Beneficiary Notice (ABN) Forms and Instructions
Considerations for an Effective ABN
Limitation on the Use of Outpatient ABN
The Notice of Exclusion From Medicare Benefits (NEMB) Form
Billing Non-Covered Services Where an Effective ABN was Given
Billing Non-Covered Services Where an ABN was Required but not Given
Billing Non-Covered Services at the Request of the Beneficiary (Demand Bills)
Billing Non-Covered Services for Denial Notices for Secondary Payors

Module 5: Outpatient Prospective Payment System (OPPS) Mechanics

Overview of the OPPS system
Unconditional and Conditionally Packaging, T-Packaged Codes and STVX Packaged Codes
Review of Addendum B
Ambulatory Payment Classifications (APC) and Addendum A
Deductibles and Coinsurance
Calculating the Medicare Allowable and Coinsurance
Outliers
Transitional Outpatient Payments and Rural Sole Community Hospital Adjustment

Module 6: Drugs, Biologicals and Devices

Coverage of Drugs, including Self Administered Drugs
Packaged Drugs, Biologicals and Devices, including Procedure to Device edits
Pass Through Drugs, Biological and Devices
Non-pass Through Drugs and Biologicals, including Radiopharmaceuticals and Brachytherapy Sources
Billing for Take Home Drugs
Billing Units of Service for the Supply of Drugs and Biologicals
Billing for the Wastage of Drugs

Module 7: Clinic, Emergency Department and Critical Care Services

Coverage of Hospital Outpatient Services
Billing for Clinic and Emergency Encounters
Payment for Clinic and Emergency Encounters
Billing and Payment for Critical Care Services
Billing and Payment for Trauma Activation
Application of Modifier 25 and 27
Active Wound Care

Module 8: Observation Services

Coverage of Observation Services.
Billing for Observation Services, including importance of Billing of Packaged Observation
Extended Assessment and Management Composite APCs

Module 9: Outpatient Surgical and Radiology Services

Cardiac Electrophysiologic and Prostate Brachytherapy Composite APCs
The Multiple Procedure Reduction
Terminated/Discontinued Procedures
Bilateral Procedures
Drug Eluting Stents
Angiography Performed at the Time of Cardiac Catheterization
Reporting Conscious Sedation for "Bull's Eye" Procedures
Packaged Surgical and Radiology Services
Inpatient Only Procedures
Mammography

Module 10: Outpatient Clinical Diagnostic Laboratory Services

The Lab National Coverage Determinations
Application of the Clinical Diagnostic Lab Fee Schedule to Hospitals
Payment to Hospitals under the Clinical Diagnostic Lab Fee Schedule
Billing Issues related to Clinical Diagnostic Lab Furnished by Hospitals
Special Rules related to Reference Laboratory Services
Blood, Blood Products and Blood Processing and Storage

Module 11: Inpatient Coverage

Definition of Inpatient
Limitations on Coverage
Changing Patient Status, including Proper use of Condition Code 44
Date of Admission
Patient Responsibility
Payment under Part B for Services Furnished to Inpatients
Treatment of Conditions Arising During or From a Non-Covered Stay
Application of Limitation on Liability to Inpatient Services, including Hospital Issued Notices of Non-Coverage
Packaging of Pre-Admission Services

Module 12: Inpatient Prospective Payment System (IPPS) Mechanics