Registration

Join us for this Medicare Boot Camp—Utilization Review for Critical Access Hospitals, an intensive course focusing on the Medicare regulatory requirements for patient status and the role of the utilization review (UR) committee. This is the only course of its kind catered exclusively to the needs of Critical Access Hospitals (CAH).

CAHs have a unique set of issues related to UR, including the complexities of swing bed admissions. CMS has directed Medicare Advantage plans to follow the fee-for-service Medicare UR rules and CAHs must be prepared to ensure plans understand the CAH environment to ensure plans are compliant with inpatient admissions and observation stays. Don’t become a target or leave money on the table—have confidence in the UR determinations you and your facility are making.

This course will also answers all your questions about navigating the CMS website and finding Medicare resources.

Instructor:

Gina M. Reese, RN, JD, is an expert in Medicare rules and regulations and is an instructor for HCPro's Medicare Boot Camp-Hospital Version®, Utilization Review Version® and Provider-Based Departments Version®. She is also the author of Provider-Based Entities.

 A Guide to Regulatory and Billing Compliance, published by HCPro. As a registered nurse and attorney, Ms. Reese has specialized for more than 30 years in assisting health care providers in Medicare regulatory interpretation, survey preparation, compliance with Medicare certification and Joint Commission accreditation requirements, responses to adverse certification/accreditation findings, appeals of reimbursement disputes, utilization management, and representation in fraud/abuse investigations and disclosures.

Target Audience:

Who should attend? With a more clinical focus than other boot camp courses, this class is designed for the physicians and nurses involved in the Medicare utilization review process, as well as the revenue cycle people who support them. The course is also helpful for staff dealing with inpatient and outpatient denials and appeals.

Objectives:

You will leave this program knowing:

• How to apply the 2-midnight benchmark, including cases with observation
• How the inpatient-only provisions apply to CAH services
• CMS guidance on case-by-case admissions
• The observation coverage rules and how they interact with the 2-midnight benchmark
• Rules for inpatient admission determinations by Medicare Advantage Plans
• The differences between post-discharge and concurrent patient status reviews
• When self-denial is appropriate to take advantage of Part B payment for an inpatient case
• How National and Local Coverage Determinations (NCDs, LCDs) affect coverage of cases that meet the 2-midnight benchmark
• When ABNs and HINNs should be used for stays that don’t meet medical necessity requirements
• Requirements for swing bed coverage

This boot camp will help you to:

• Determine the correct inpatient or outpatient status of a patient under Medicare guidelines
• Conduct compliant utilization review of Medicare patient’s status
• Implement condition code 44 or self-denial processes correctly and compliantly
• Understand the role of a utilization review team in your organization and how they contribute to compliance and accurate reimbursement

Contact:

Renee Friesen, CCS, CCS-P, CAH-CBS, AHIMA ICD-10 Approved Trainer, RWHC, rfriesen@rwhc.com, 608-643-1065.
 

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