Revenue Cycle A-Z Bootcamp for CAH and PPS Hospitals – Iive course
Downloadable Materials:
Session 1:
Preventive Services 01.27.23.pdf
Compliance Risk Mitigation 01.27.23.pdf
Deciphering Medicare Program – NCCI MUE ABN and Notifications 01.27.23.pdf
Health Plans & Medicare – 01.27.23.pdf
Session 3:
Clinic and Professional Services 02.24.23.pdf
NPI and Enrollment 02.24.23.pdf
Surg Anesth Pharm Therapy 02.24.23.pdf
Session 4:
Rev Cycle A-Z Outpatient Diagnostic Services.pdf
PPS & CAH Billing & Reimbursement -03.10.23.pdf
Updated – 2023 Texas HHH Rev Cycle A-Z.pdf
Session 5:
Price Transparency and No Surprises Act 03.24.23.pdf
Revenue Cycle Overview 03.24.23.pdf
Agenda:
Day 1 – Friday, January 27, 2023 – 9:00 AM to 1:00 PM Central Time
Health Plans & Medicare Instruction
· 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 |
Day 2 – Friday, February 10, 2023 – 9:00 AM to 1:00 PM Central Time
Recent OIG Cases
· 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 |
Day 3 – Friday, February 24, 2023 – 9:00 AM to 1:00 PM Central Time
Patient Access & Up-front Collections
· 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 |
Day 4 – Friday, March 10, 2023 – 9:00 AM to 1:00 PM Central Time
Outpatient Diagnostic Services
· 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 |
Day 5 – Friday, March 24, 2023 – 9:00 AM to 1:00 PM Central Time
PHE Waivers
· 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 |