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Medicare Part B: Reimbursement Guidelines
Don't miss this eye-opening and interactive discussion on how to secure complete and accurate Medicare reimbursement.


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.

Course Agenda:

  • 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

Classroom Presentation:

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.

Course Materials:

A course manual will be provided to each participant. No additional materials are required for this course.

Program Schedule

There are no classes scheduled for this topic at this time. PMI offers a number of distance learning options. Browse Audio Downloads, Live Webinars, and the Online Learning Center.




Certified Medical Coder (CMC) Certified Medical Insurance Specialist (CMIS) Certified Medical Office Manager (CMOM) Certified Medical Compliance Officer (CMCO)

More than 17,685 PMI Certifications have been earned to date.

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