Online Training Course

Prod ID: 337
Medicare Part A: Reimbursement Guidelines

Learn the basics of Medicare Part A reimbursement guidelines, payer credentialing principles, the appeals process, and a variety of billing situations in inpatient healthcare settings.




360 min



In this course, the participant will learn about:

  • the coverage and costs under Original Medicare Part A.
  • how copays/coinsurances vary depending on the type of service a beneficiary receives and whether the provider is a participating, non-participating, or opt-out provider.
  • key areas of Medicare payment and policies for hospital settings.
  • how to properly submit claims in order to receive Medicare reimbursement as well as identify audit triggers.
  • the latest reimbursement trends that Medicare is implementing.

Audrey Coaxum


Audrey E. Coaxum is an influential leader with more than twenty-five years of relevant experience involving many facets of healthcare operations. She is recognized for having an exceptional ability to analyze systems and processes, create best practices, develop policy and procedures, as well as, diverse methods that are compliant, proactive and geared towards eliminating waste and revenue losses, while enhancing operational efficiencies and achieving strategic goals. Audrey has a sterling reputation across the healthcare community as a customer-service oriented strategic problem solver and trusted advisor. She has extensive knowledge and experience in leadership development, medical billing and coding, reimbursement and comprehensive clinical and business operations.

Audrey has served as a C-suite executive for many organizations where her skills as a progressive analyst afforded her the opportunity to champion initiatives involving the implementation of Value-Based Payment Models and the benchmarking of Key Performance Indicators in productivity, patient volume, budget performance and clinical quality outcomes. Motivated by her desire for change and to overcome concerns, she has overseen a range of activities directed towards the evolution and refinement of quality improvement, risk management and practice administration needed to diminish the day to day challenges facing today's medical practices.

Audrey's professional interests focus on various aspects of compliance that streamline operations and enhance profitability without compromising quality of care. As a strong advocate of hands-on, inquiry based learning, she currently spearheads activities related to compliance education and training. She conducts audits and reviews to identify trends, issues and potential areas of risk to assist her in developing technology-infused training programs geared towards educating clinicians, administrators and support staff.

Participants will learn about the major health insurance programs, differences between Part A, Part B, Part C, and Part D coverage, payer credentialing, the differences between PAR, non-PAR, and opting out of Medicare, what "assignment” means under Medicare law, Medicare as a primary or secondary payer, preauthorization, eligibility and benefits, notice of Medicare Non-coverage, Medicare’s Correct Coding Policy for use of comprehensive and mutually-exclusive codes, billing coverage and utilization, and much more.

This is a basic-level course designed for providers, managers, and staff at hospitals who need a general understanding of Medicare Part A reimbursement guidelines.  

  1. Identify major health insurance programs
  2. Demonstrate the differences between Part A, Part B, Part C, and Part D coverage
  3. Review Medicare’s Correct Coding Policy for use of comprehensive and mutually exclusive codes
  4. Explain billing coverage and utilization
  5. Go through the basic flow of an inpatient hospital stay from billing through receipt of payment
  6. Explain the purpose of the appropriateness evaluation protocols
  7. Describe criteria used for admission screening
  8. Define the 72-hour rule, and CMS 72-hour rule combining accounts
  9. Review the 3 Day Hospital Stay requirement
  10. Define provider preventable conditions
  11. Explain Rules for Prospective Payment System
  12. Talk about reimbursement for physicians that work out of a hospital-owned facility
  13. Review CMS Value-based purchasing
  14. Introduce quality measurement, and STAR ratings
  15. Processing an Advanced Documentation Request
  16. Improve understanding of audit triggers
  17. Go through your rights during a carrier audit, and ensuring a fair hearing
  18. Uncover the Medicare appeals process and review
  19. Learn about the administrative law judge’s role in handling appeals

Self-paced online program includes unlimited review of previously recorded instruction and the downloadable digital companion materials for 6 months.

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