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      Revenue Integrity and Chargemaster Boot Camp

      • Revenue Integrity and Chargemaster Boot Camp Photo #1
      1 of 1
      April 20, 2020

      Monday   8:00 AM - 5:00 PM (daily for 4 times)

      United States

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      Revenue Integrity and Chargemaster Boot Camp

      Revenue Integrity and Chargemaster Boot Camp
      About this Event


      Course Overview

      The Revenue Integrity and Chargemaster Boot Camp provides education on chargemaster and revenue integrity concepts in a classroom format. The program will relate the chargemaster function to revenue cycle and revenue integrity functions, including cost reporting and key operational issues, such as coverage, clinical documentation, charge capture, and coding.

      It will also provide context for chargemaster set-up and maintenance within revenue integrity with an objective to help avoid pre- and post- billing edits and payer denials.

      You will leave this program knowing how to:

      Provide formal, organized education and training for revenue integrity and chargemaster staff
      Provide context for the intersection of the chargemaster with clinical/revenue departments, charge capture, coding, finance, and patient access and billing
      Walk attendees through CMS regulatory requirements for pricing and charging patients, as well as key relationships between the chargemaster and provider cost reporting
      Give detailed instructions for the majority of revenue codes for optimal chargemaster setup, maintenance, charge capture, and documentation issues
      Review chargemaster issues for commercial/managed care versus CMS requirements

      Learning Objectives

      At the conclusion of this educational activity, participants will be able to:

      Equip hospital, payer and other healthcare specialists with effective and efficient strategies to obtain and maintain overall revenue integrity for both governmental and non-governmental payers
      Gain a working understanding of revenue integrity principles associated with eligibility, coverage, coding, billing and payment using fee-for-service Medicare requirements as a framework
      Explain standard charge description master (CDM) elements, design and relationship to the general ledger and revenue cycle processes of coding and billing
      Review claim requirements and specific issues of CDM set-up and maintenance by revenue code with associated cost reporting principles
      Exemplify outpatient and inpatient hospital prospective payment systems reimbursement and rate setting methodologies as well as appeal strategies to protect revenue


      Module 1: Revenue Integrity Overview and Resources

      Revenue integrity functions and key principles including how the chargemaster fits into over revenue integrity functions

      Medicare and other revenue integrity and chargemaster resources

      Understanding authoritative sources such as statutes, regulations, manuals, transmittals and other Medicare rules and guidelines

      Module 2: Eligibility Principles

      Review major and different types of medical insurances

      Principles of health insurance eligibility and verification of insurance

      Coordination of Benefits & Subrogation

      Medicare Secondary Payer (MSP) concepts

      Module 3: Benefits, Coverage and Medical Necessity

      Review how insurance benefits are structured for hospital and other services

      The importance of coverage, medical necessity and both implied and specifically excluded benefits

      Medicare’s prohibition against unbundling for inpatient and outpatient hospital services

      Pre-service coverage analysis and associated waiver/notice requirements

      Serious preventable events and relationship to risk management

      Investigational/experimental services and implications for coverage

      Module 4: Provider Types, Licensure, Enrollment, & Privileges

      Types of facilities, providers, physicians, practitioners and suppliers

      Provider-based department requirements including implications of Section 603 of the Bipartisan Budget Act of 2015

      Licensure, scope of practice, privileging and relationship to coverage

      Conditions of participation, survey & certification and accreditation

      Importance of medical staff bylaws & regulations and relationship to conditions of payment

      Exercises: Concepts of Revenue Integrity

      Module 5: Charge Description Master Structure and Charge Capture Principles

      Definition, purpose and key fields of a chargemaster

      Concepts for code set up in CDMs and relationship to HIM coding

      Principles of bundled services per CPT definition vs reporting packaged services and implications for separate charging of packaged services

      Strategies to address payer differences in the chargemaster

      The relationship of chargemaster to overall AR System

      Concepts for pricing services and why APCs are not a good gauge for pricing hospital services

      Chargemaster, general ledger and relationship to cost reporting

      Module 6: Claims Submission Fundamentals and Code Edits

      Key UB-04 fields applicable to hospital services

      HIPAA transaction sets including ICD-10 and HCPCS codes

      Common claim edits including NCCI and MUEs

      Other transaction sets applicable to the revenue cycle such as eligibility, payment, claim status and denial transaction sets

      Module 7: Special Medicare Billing Issues

      Billing requirements for outpatient repetitive versus non-repetitive recurring and non-recurring services

      The three-day payment window and outpatient services billed on inpatient claims

      Billing of non-covered inpatient and outpatient services

      Patient status and billing inpatient non-medically necessary services

      Exercises: CDM Structure, Claims and Billing Issues

      Module 8: Strategies and Key Issues by Revenue Code: Routine Services and Observation

      Key concepts for accommodation codes and routine services, including outpatients in beds, specialty care units and observation services

      Coding and edit issues for revenue codes associated with routine services and observation

      Major factors of coverage for these services

      Applicable inpatient and outpatient payment concepts

      General ledger and finance considerations including pricing and charge capture

      Module 9: Strategies and Key Issues by Revenue Code: Ancillary Services

      Key concepts for major ancillary service departments, including peri-operative services, emergency, cardiology, diagnostic imaging, pharmacy and supplies

      Coding and edit issues for revenue codes associated with ancillary services

      Major factors of coverage for these services

      Applicable inpatient and outpatient payment concepts

      General ledger and finance considerations including pricing and charge capture

      Module 10: Strategies and Key Issues by Revenue Code: Other Departments

      Key concepts for other common ancillary service departments, including respiratory therapy, clinics, behavioral health, and preventive services

      Coding and edit issues for revenue codes associated with other departments

      Major factors of coverage for these services

      Applicable inpatient and outpatient payment concepts

      General ledger and finance considerations including pricing and charge capture

      Exercises: Routine and Ancillary Services by Revenue Code

      Module 11: Introduction to Payment Systems

      Review inpatient payment systems including DRGs, APR-DRGs, Case Rates and Per Diems

      Discuss hospital outpatient hospital payment systems including OPPS & APCs, eAPGs, fee schedules and percent of charges

      Review outpatient surgery payment methodologies such as ASC and ambulatory fee schedules

      Review other ambulatory service payment systems such as the physician fee schedule (MPFS), DMEPOS, Clinical Lab Fee Schedule

      Review emerging payment methodologies such as Bundled/Episode Payments (CJR) and Value-Based Purchasing

      Module 12: Outpatient Prospective Payment System (OPPS)

      Understanding OPPS payable services and structure of APCs

      Learn how to determine whether services are paid separately or packaged

      Understand C-APCs and complexity adjustments

      Understand impact of inpatient deductible cap on co-payments for beneficiaries

      Module 13: Medicare Physician Fee Schedule (MPFS)

      The resource-based relative value system

      Relative value unit (RVU) structure

      Site of service adjustments for facility and non-facility services

      Global versus technical and professional components

      Payment policy indicators

      Exercises: Payment Systems

      Module 14: Charge Description Master Management and Maintenance Strategies

      Issues surrounding the annual chargemaster updates including pricing, HCPCS codes, charge items with no volume

      Strategies to work collaboratively with departments

      Importance of patient account and charge reconciliation

      Tracking CDM changes for compliance

      Charge integrity monitoring and reducing unexplained variation in claims

      Module 15: Denial Management

      Principles of denial management

      Adjustment claims and automated provider reopening

      Initial and revised determinations and appeal rights

      Levels of appeal and timelines for filing

      Types of auditors including external auditors from commercial plans

      Module 16: Payer Contracting Strategies

      Concept and criteria for carve out options

      Importance of tracking administrative cost by payer and developing and trending payer scorecards

      Contract negotiations and annual price increase limits/caps applicable to chargemaster

      Exercises: Strategies for CDM Management, Denials and Payer Contracting

      Course Outline/Agenda subject to change.


      Coming Soon!

      Cost: $1,489

      Categories: Conferences & Tradeshows

      This event repeats daily for 4 times:

      Event details may change at any time, always check with the event organizer when planning to attend this event or purchase tickets.

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