Understand the role of a utilization review team in your organization and how they contribute to compliance and accurate reimbursement.Implement condition code 44 or self-denial processes correctly and compliantly.Conduct compliant utilization review of Medicare patients.Determine the correct inpatient or outpatient status of a patient under Medicare FFS guidelines.When ABNs and HINNs should be used for stays that don’t meet medical necessity requirements.
The observation coverage rules and how they interact with the 2-midnight benchmark.How NCDs, LCDs, and coverage with evidence development (CED) affect coverage of cases that meet the 2-midnight benchmark.
- When self-denial is appropriate to take advantage of Part B payment for an inpatient case.
- The differences between post-discharge versus concurrent patient status reviews.
- CMS guidance on case-by-case admissions.
- How the inpatient only provisions apply to CAH services.
- How to apply the 2-midnight benchmark, including cases with observation.
- How coverage, notices, and billing for inpatient admissions work in a critical access hospital (CAH).
- You will be able to find answers to your questions long after the Boot Camp is over. Medicare Boot Camp-Utilization Review for Critical Access Hospitals also answers all your questions about navigating the CMS website and finding Medicare requirements. Don’t become a target or leave money on the table-have confidence in the UR determinations you and your facility are making. In recent years, CMS has made multiple changes to the inpatient only provisions and application of these changes to CAHs can be confusing The OIG also announced they will start patient status directed audits after a seven-year hiatus. Managing patient status plays a critical role in proper compliance, correct reimbursement, and stabilizing inpatient payments for the hospital. This is the only course of its kind catered exclusively to the needs of Critical Access Hospitals (CAH).ĬAHs have a unique set of issues related to UR, including the complexities of swing bed admissions. Master Medicare rules for UR in just four 4-hour live online sessions. The Live Virtual Medicare Boot Camp®-Utilization Review for Critical Access Hospitals is an intensive course focusing on the Medicare regulatory requirements for patient status and the role of the utilization review (UR) committee. Live Virtual Medicare Boot Camp®-Utilization Review for Critical Access Hospitals Course Overview Classes are led by our expert instructors, typically take place over the course of a week or two, and allow instructor/student interaction and engagement. This live virtual boot camp is perfect for those looking to expand their Medicare knowledge with instructor-led education that can be accessed from the comfort of your own home.