Revenue Cycle A-Z Bootcamp for CAH and PPS Hospitals – Iive course

·       Explore the different types of patient medical coverage

·       Share the CMS and Noridian Medicare rules and regulation references

Preventative Services

·       Explore Medicare covered benefits and where to find instruction

·       Summarize ways of verifying eligibility (DDE, portal, clearinghouse access)

BREAK – 15 minutes

Compliance Program

·       Examine the Required Elements and Risk Assessment process

·       Set up Work Plan and monitoring

Deciphering the Medicare Program

·       Explain and understand NCCI, NCD, LCD, MUE edits

·       Describe the Medicare Notification Requirements

·       Review of recent cases that the Office of Inspector General (OIG) have performed and how they may affect your organization.

·       Share tips for coding and compliance departments.

Modifiers

·       Examine the modifiers available and proper use for compliant coding/billing

BREAK – 15 minutes

Observation & Emergency Department

·       Classify the Orders, level of care requirements, condition code 44 and patient notices

·       List the considerations for reporting of hours

·       Assess specifics to the charge capture for these departments

·       Discuss relative to drug administration services

·       Summarize the Coding and billing considerations

Claim Submission and Payment Posting 

·       Indicate the path of electronic claims and payment processing

·       Discuss the Remittance Advice code considerations – CARC/RARC

·       Discuss the impact Patient Access has on the overall Revenue Cycle processes

·       How to improve the patient experience

NPI & Enrollment

·       Define how billing is affected by NPI/Enrollment activities

Clinic & CAH Professional Services Billing

·       Explain the differences between Method I compared to CAH Method II billing

·       Define CRNA – Pass Thu Exemption

BREAK – 15 minutes

Medical Necessity, AWV and Updates to the E/M Guidelines

·       Review the 2023 E/M guidelines and documentation requirements

·       Explain the Medical decision-making instruction

·       Assess the Annual Wellness Visits and billing considerations when performed with E/M

·       Discuss, in detail, the 2023 updates to E/M verbiage

Surgery, Anesthesia, CRNA, Supplies, Pharmacy and Therapy Services

·       Compare the Charge structure and billing requirements

·       Analyze the challenges of reporting accurate pharmacy charges

·       Explore challenges of charge capture and documentation for compliant billing

·       Specify the Orders and documentation requirements

·       Generalize the rules for reporting common diagnostic services

·       Illustrate Telehealth service billing and remote monitoring

Home Health, Hospice & Behavioral Health

·       Discuss required documentation for home health & hospice

·       Summarize coding and billing considerations

·       Updates on Behavioral Health from the Physician Fee Schedule and OPPS final rules

BREAK – 15 minutes

CAH Billing and Reimbursement

·       Examine the unique qualifications for a CAH and payment methodology

·       Explore billing requirements for Inpatient and Swing Bed services including Shadow Billing

Rural Health Clinic

·       Define the requirements unique to RHC billing

·       Provide claim examples for billing reference

·       Review CMS roadmap for the end of the PHE

·       Discuss the allowance of telehealth for additional time beyond the end of the PHE

·       Explore mental health telehealth and proposals by Medicare

Denial Management

·       Analyze ways to leverage data analytics to manage denials

·       Implement processes to help you process your denials

·       Explore the Auditing Agencies

BREAK – 15 minutes

Price Transparency & No Surprises Act

·       Summarize the Reporting requirements – shoppable and searchable

·       Define the Estimator tools

·       Discuss Patient notification of potential of additional bills for services

Revenue Cycle Overview

·       Provide an overview of KPI’s and Report Monitoring recommendations

·       Examine ways to Analyze Accounts Receivable

Claim Form and Data Fields Examples

·       Explore the Reference Guide to the data fields of the UB-04 and CMS-1500 most common to CAH claim processing