This course may be used to fulfill a voluntary compliance program's training component, as recommended by the Office of the Inspector General.
- This important primer course takes participants through the statutory obligations, rights, roles and responsibilities of the Medicare provider.
- Receive tips on how to work with the CMS and Medicaid regional offices.
- More than 25,000 medical office staff across the country have benefited from this class.
- Understanding Medicare's Correct Coding Initiative
- RBRVS and your Medicare fee schedule
- How to get a list of all non-covered services
- Proper use of the GA, GY, and GZ modifiers for successful payment
- Advance Beneficiary Notice guidelines
- What "assignment" means under Medicare law
- Determining whether Medicare is primary or secondary payer
- The dangers of fragmenting, bundling, unbundling
- Correct use of comprehensive and mutually exclusive codes
- Preventive vs. problem-oriented services
- Differences between PAR, non-PAR and opting out of Medicare
- Caring for the indigent Medicare patient
- Billing for services that are not medically necessary
- Proper documentation for medical necessity
- Uncovering the Medicare appeals process and review
- Your rights in making sure you receive a fair hearing
- Interacting with an administrative law judge
- New Time-based E/M codes you must review with your physicians
- Review of the most current OIG Work Plan and review of key caution areas
- Current information on incentive programs, including PQRS, Meaningful Use, and Primary Care (including an overview of penalties for non-participation in HER and other government quality reporting programs by 2015 and beyond
- E-prescribing program updates
- New CPT® codes in 2013 for transitional care management
- Impact of 2013 Medicare Fee Schedule payments by specialty
- Physician-based value modifier
Physicians and coding staff will get answers to their most pressing Medicare questions. Get tips such as: why you should never appeal a Medicare claim before reviewing Medicare's National Correct Coding Policy. Plus, receive the latest information on documentation guidelines for E&M services, and more.
Who Should Attend:
Designed for providers, coding and billing staff, and compliance officers seeking a detailed overview of the Medicare reimbursement system.
A course manual will be provided to each participant. No additional materials are required for this course.