Medicare Utilization Review Intensive Bootcamp

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*Registration payment includes Credit Cards and Interfund Transfers ONLY.

Description

This is a one day program that is being offered on September 24 OR September 25. Please choose the date that is more convenient for you at the time of registration.

Patient Status Update
• OIG Report on Implementation of 2 Midnight Rule
• Current BFCC QIO Change in Audit Strategy
• FY2019 Regulatory Change to Inpatient Order and Certification Requirements
• Program Integrity Manual and Benefit Policy Manual Updates

The Problem of Observation and Custodial Care
• Identifying Medically Necessary Observation vs. Custodial Care
• Custodial Care and the Safe Discharge Dilemma
• Notices for Non-covered Observation and Impact on Uncompensated Care
• Facility Payment and Patient Responsibility for Observation

Appropriate Payment under Part A: The 2-Midnight Rule and Related Policies
• Details of the Inpatient-Only Rule and the Exceptions
• CY2018 and CY2019 Changes to Inpatient-Only Procedures, including Total Knee Arthroplasty
• 2-Midnight Intricacies
       o How do Transfers Affect the Two Midnight Requirement
       o Delays in Care, Convenience Care and Other Time that ‘Doesn’t Count’
       o Unforeseen Circumstances Resulting in Shorter Stay
• Case-by-Case Admission
• What do CMS and the QIOs Say About Documentation and Screen Criteria
• Patient Responsibility, including Benefit Periods and Regular, Co-Insurance, and Lifetime Reserve Days

Utilization Review Determinations and Their Effect on Payment
• Requirements for All UR Determinations
• Special Requirements for Using Condition Code 44 and Changing Patient to Outpatient
• Using Self-Denial Process to Maintain Revenue
• Comparing Condition Code 44 and Self-Denial Process; Leveraging Self-Denials for Efficiency
• Special Claims and Payment Considerations for CCW2/Self-Denial Process

IMPORTANT REGISTRATION NOTICE:
* Atrium employees: please use registration code provided by your manager.
* Non-Atrium employees please call (704-512-3459) or email Kandyce.Schofield@atriumhealth.org to get registration code.


Kimberly Anderwood Hoy Baker, JD, CPC
Kimberly Anderwood Hoy Baker, JD, CPC, is the director of Medicare and compliance for HCPro. She is a lead regulatory specialist for HCPro's Revenue Cycle Institute and is the lead instructor for HCPro's Medicare Boot Camp®—Hospital Version and Medicare Boot Camp®—Utilization Review Version. She is also an instructor for HCPro’s Medicare Boot Camp®—Critical Access Hospital Version. She is a former hospital compliance officer and in-house legal counsel, and has 10 years of experience teaching, speaking and writing about Medicare coverage, payment and coding regulations and requirements.

CREDITS

AAPC
This program has been approved by the AAPC for 7.5 continuing education hours. Granting of prior approval in no way constitutes endorsement by AAPC of the program content or the program sponsor.

American Health Information Management Association (AHIMA)
This program has been approved for 7.5 CE credits for use in fulfilling the continuing education requirements of the American Health Information Management Association (AHIMA).

Association of Clinical Documentation Improvement Specialists (ACDIS)
This program has been approved for 7.5 continuing education units towards fulfilling the requirements of the Certified Clinical Documentation Specialist (CCDS) certification, offered as a service of the Association of Clinical Documentation Improvement Specialists (ACDIS).

American Nurses Credentialing Center (ANCC)
HCPro is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation. This educational activity for 7.5 nursing contact hours is provided by HCPro.

California Board of Registered Nursing
HCPro is approved by the California Board of Registered Nursing to provide 9 nursing contact hours. California BRN Provider #CEP 14494.

Commission for Case Manager Certification (CCMC)
This program has been pre-approved by the Commission for Case Manager Certification to provide 7.5 continuing education credit to Certified Case Managers (CCMs).

ACCME
HCPro is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. HCPro designates this educational activity for a maximum of 7.5 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

National Association of Healthcare Revenue Integrity (NAHRI)
This program has been approved for 7.5 continuing education units towards fulfilling the requirements of the Certification in Healthcare Revenue Integrity (CHRI), offered as a service of the National Association of Healthcare Revenue Integrity (NAHRI).

National Association of State Boards of Accountancy (NASBA)
Earn up to 9 CPE Credits!
Program Level: Basic
Delivery Method: Group-Live
Field of Study: Specialized Knowledge and Applications
HCPro is registered with the National Association of State Boards of Accountancy (NASBA) as a sponsor of continuing professional education on the National Registry of CPE Sponsors. State boards of accountancy have final authority on the acceptance of individual courses for CPE credit. Complaints regarding registered sponsors may be submitted to the National Registry of CPE Sponsors through its website: www.learningmarket.org.

Disclosure Statement:
HCPro has confirmed that none of the faculty/presenters, planners, or contributors have any relevant financial relationships to disclose related to the content of this educational activity.

Objectives

  • Describe CMS’ Changes to order and certification requirements for inpatients
  • Identify One Significant Finding from the OIG Report on the 2-Midnight Policy Implementation and explain how it may affect your patient status determinations
  • Identify two elements physicians should including in documentation for medically necessary observation stays
  • Describe two benefits of delivering ABNS for non-covered observation
  • Identify two significant changes to the inpatient only list in 2018 and 2019
  • Explain how delays in care affect the two midnight benchmark
  • Describe how case-by-case admissions differ from admissions under the two midnight benchmark
  • Identify three requirements of a valid determination under the UR
  • Explain proper use of Condition Code 44 and W2

Contact

Kandyce Schofield, BA

Electives

Choose day you want to attend this program

Status
Open
Date(s)
Sep 24, 2019
Time
8:00 AM - 5:00 PM
Check-In Time
7:30 AM
Location
Charlotte AHEC
Room
Classroom 17/18
Status
Open
Date(s)
Sep 25, 2019
Time
8:00 AM - 5:00 PM
Check-In Time
7:30 AM
Details
Status
Open
Date(s)
Sep 24 - 25, 2019
Location
Charlotte AHEC
Room
Classroom 17/18
Fees
$465.00
Registration fee Atrium employees. Includes breakfast, lunch and materials. Use code provided by your manager to register.
$465.00
Registration fee Non-Atrium employees Includes breakfast, lunch and materials. Please call to get registration code.