Courses
The Ignite Education Medicare Conferences 2010 courses for the New York and Connecticut locations are listed below with a brief description. Each conference is separated into two one-day tracks. One day is the Red Track which focuses on Medicare Part A, federally qualified health center, home health, and hospice education. The other day is the Orange Track which focuses on Medicare Part B education. Each complete one-day track of the conference will be worth six Medicare University Credits and six continuing education units granted by the American Academy of Professional Coders (AAPC).
Medicare Part A
Acute Care Hospital Inpatient Billing Situations
This session reviews various inpatient Medicare billing policies and situations and provides the appropriate UB-04 (CMS-1450) claim coding so that claims can be submitted accurately to Medicare. Topics include billing under the arrangement policy, transfers, readmissions, leaves of absence, claims submitted for Medicare Advantage Organization plan enrollees, never events, noncovered procedures during the inpatient stay (Change Request 6547), billing under the preadmission services window policy (i.e., DRG window), and more.
Acute Care Hospital Outpatient Prospective Payment System
Attendees from acute care hospitals become familiar with the concepts of the outpatient prospective payment system (OPPS). This session is a useful refresher for experienced billing personnel, and a good learning tool for new billing staff members or anyone who desires a better knowledge of the OPPS. Billing reminders and scenarios help providers avoid certain return-to-provider claims and/or claim rejections.
Acute Care Hospital Top Claim Errors
Attendees from acute care hospitals (ACH) are presented with the most common return-to-provider claims as well as rejected claims. Instructions for correcting the errors, and tips on preventing such errors in the future are also given. Understanding how to prevent claim errors and rejections will save time and resources for your ACH.
Cardiac and Pulmonary Rehabilitation Coverage Updates
Review the new Medicare coverage guidelines proposed in the Federal Register during this session. The most recent and updated information is covered and insight is given on the proposed changes.
Claim Corrections and Adjustments
Learn how to use the Fiscal Intermediary Standard System Direct Data Entry System to correct, adjust, and cancel Medicare claims.
Comprehensive Error Rate Testing and Recovery Audit Contractor
A basic overview of both programs and the impact on the provider community and the Medicare Trust Fund are provided during this session. A discussion on how these programs interact with National Government Services Medicare Administrative Contractor and the roles each contractor plays in the Medicare Program is discussed during this session. Also discussed are current and demonstration project results, and documentation tips and suggestions for decreasing errors.
Hospital Outpatient Psychiatric Services Coverage
The continuum of care for psychiatric services with emphasis on outpatient services is outlined in this session. The discussion includes information regarding incident to, covered and noncovered services, and documentation guidelines. In addition, the instructor touches on billing and coding, medical review findings/claim denials, and coverage criteria. Sample scenarios will draw on audience input and interaction to illustrate documentation of active treatment, as well as suggested content in session and progress notes. Attention is given to treatment plans and their content for audience consideration and establishing medical necessity in session/progress notes.
Local Coverage Determinations, National Coverage Determinations, and Additional Development Requests
A local coverage determination (LCD) and a national coverage determination (NCD) are defined and the differences between the two are described during this session. The presentation focuses on the nature of these tools and how to use them as valuable resources to aid in provider reimbursement, documentation guidelines, and in demonstrating medical necessity of services rendered and billed. This presentation dissects a sample LCD to show its value for coding recommendations, citations for research efforts, indications, and limitations of coverage. In addition, the session shows how supplemental instruction articles can augment the information found in an LCD. Lastly, there is discussion regarding additional development requests (ADR), how and when to respond to them, and where to locate information on the Fiscal Intermediary Shared System about your ADRs.
Medicare Appeals
The Medicare appeals process, including the types of situations that can be appealed, the five levels of appeal, documentation, and a brief overview of recovery audit contractor appeals are reviewed during this session. When claims have been denied by Medicare, the appeal process is the provider’s only recourse to have the claim reconsidered for payment; so it is important to understand the appeals process. Note: This session is not applicable to home health and hospice providers.
Medicare Coverage of Outpatient Therapy Services
This session is a review of the coverage guidelines for outpatient therapy services. Several scenarios explain the documentation needed to support the medical necessity of therapy services. Note: This session applies to both acute care hospitals and skilled nursing facilities and does not include psychotherapy.
Medicare Resources
This session introduces Medicare providers and staff members to the educational opportunities, reference materials, and other resources available through National Government Services and the Centers for Medicare & Medicaid Services.
Medicare Secondary Payer Billing
Receive an overview of how to bill Medicare as the secondary payer after the primary payer has made partial or full payment, and how to bill Medicare conditionally when the primary payer has not made payment promptly or for a valid reason. Receive detailed instructions on how to complete the appropriate UB-04 (CMS-1450) claim form locators (FL) in order to submit Medicare Secondary Payer (MSP) and conditional claims to Medicare. The instructor reviews the coding that must be reported on MSP claims when the provider has received less than was expected from the primary payer due to their application of a deductible, coinsurance, and/or co-payment. Electronic claim submission (837I) instructions are not included in the session; however, references to such instructions are provided.
Medicare Secondary Payer Fundamentals
Be introduced to admissions and registration of Medicare Secondary Payer (MSP). Receive an overview of MSP including the following:
- What MSP is
- MSP provisions
- A provider’s general MSP responsibilities, such as identifying and billing payers that are primary to Medicare
- The various types of MSP claims; and
- MSP resources for providers are (e.g., National Government Services Web site, the Centers for Medicare & Medicaid Services Web site, Internet-Only Manuals, the Coordination of Benefits Contractor, and the MSP recovery contractor)
Note: Some general billing guidelines are provided, however detailed MSP billing instructions are not.
Preventive Services
The Centers for Medicare & Medicaid Services (CMS) is committed to promoting the appropriate use of Medicare preventive benefits. Medicare covers a broad range of services to prevent disease, detect disease early when it is most treatable and curable, and manage disease so that complications can be avoided. Unfortunately, older adults are not receiving all recommended preventive services, even with frequent visits to physician offices. Reasons for this vary but highlight the opportunity to improve preventive care for older adults. This training session is designed to ensure that Medicare Part A providers are aware of what benefits are available, how they are administered, and how to bill them correctly. Some of the preventive services covered during this session are:
- Colorectal cancer screening
- Screening mammography
- Screening pap test and pelvic examination
- Prostate cancer screening
- Cardiovascular disease screening
- Diabetes screening
- Glaucoma screening
Provider Enrollment Chain and Ownership System (PECOS)
The Centers for Medicare & Medicaid Services (CMS) has implemented an online system whereby provider and supplier organization that are eligible to enroll in the Medicare Program may use the Internet to submit enrollment applications, view and update information, voluntarily terminate from the Medicare Program, and track the status of an application submitted via the Internet. This session highlights the top reasons that CMS-855A applications are returned to the provider, tips to avoid having the CMS-855 returned, and how to use the Internet-based PECOS.
Skilled Nursing Facility Billing
Review topics that are relevant to the skilled nursing facility (SNF) billing staff during this session. Instructors address, in detail, the billing guidelines for SNF benefits exhaust claims, as well as the requirements for the SNF no-payment claims. Medicare billing requirements for SNF beneficiaries who are enrolled in a Medicare Advantage Organization (MAO) plan are reviewed, and clarification on some current Medicare guidelines as they pertain to billing SNF claims to Medicare is provided.
Skilled Nursing Facility Clinical Overview
This session is designed for the provider new to the Medicare Program or as a refresher course. Discussion includes a breakdown of the skilled nursing facility (SNF) Part A benefit, common denial reasons found upon medical review of records, and documentation suggestions.
Skilled Nursing Facility Clinical Scenarios
A brief overview and analysis of the skilled nursing facility (SNF) Part A benefit and seven clinical scenarios pulled from actual medically reviewed claims is offered during this session. The goal is to provide information regarding coverage, medical necessity, and documentation for common clinical situations facing SNF providers. The use of a scenario and analysis allows you to visualize how information provided through documentation impacts medical necessity decisions. Review of available references and how to find them is also included.
Skilled Nursing Facility Consolidated Billing
Medicare skilled nursing facilities (SNF) are reimbursed under a prospective payment system (PPS). This payment methodology requires all entities that provide services to Medicare SNF patients to follow very specific guidelines. Detailed instructions for the billing of services that have been designated as excluded from the SNF PPS payment methodology, as well as those services that have been determined to be included in the SNF PPS reimbursement, are provided during this session. Billing examples, manual references, and Web site resources are also provided.
Skilled Nursing Facility Top Claim Errors
This session is designed specifically for skilled nursing facility (SNF) billing staff. During this session, instructors discuss the most common return-to-provider (RTP) claims, as well as rejected claims that the SNFs receive from Medicare. Instructions for correcting the errors, as well as suggestions for avoiding the claim errors and rejections are provided. Understanding how to prevent claim errors and rejections will save time and resources for your SNF and help increase your Medicare cash flow.
The Outpatient Advance Beneficiary Notice of Noncoverage
Medicare delivery requirements for issuing the outpatient Advance Beneficiary Notice of Noncoverage (ABN) to Medicare beneficiaries are reviewed during this session. It is important to know when you should issue an ABN so that facilities can be protected from unnecessary financial liability. The session also includes information on the voluntary ABN, completing the notice, and the appropriate modifiers to be used on the claim(s). Note: ABNs for home health or hospice providers are not reviewed during this session.
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Federally Qualified Health Center
Federally Qualified Health Center Billing
Federally qualified health center (FQHC) staff receive an understanding of the coverage and billing criteria for submission of claims to the Medicare Program. The session includes the type of professionals that may bill the program, the services that are covered under the FQHC benefit, noncovered services, and preventive services. In addition, you learn the requirements for submitting FQHC claims to the fiscal intermediary.
Federally Qualified Health Center Coverage
Receive a better understanding of the application of national coverage determinations to federally qualified health centers (FQHC) and a better ability to locate and apply regulations in local coverage determinations (LCD). Also gain a working knowledge of FQHC requirements for coverage, increase your understanding of medical review and Comprehensive Error Rate Testing review of FQHC claims, and increase awareness of documentation requirements by services provided and the application of LCD requirements.
Federally Qualified Health Center Claims Correction Process and the Appeals Process
Learn how to review, resolve, and prevent the top claim errors from being rejected or returned to your facility due to missing, invalid, or incorrect information. Information on the appeals process is also provided.
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Home Health
Home health sessions are not offered in Connecticut locations.
Home Health Billing
Learn claim submission steps, as well as billing errors and resolutions for the request for anticipated payment (RAP) and the home health episode claim. Detailed examples of the most common errors assigned to home health RAPs and claims are a focus during the session and how to resolve the errors and avoid them in future billing are discussed.
Home Health Coverage/Home Health Advance Beneficiary Notice of Noncoverage
The coverage guidelines for skilled therapy and nursing services provided under the home health benefit are reviewed. Several scenarios explain the documentation needed to support the medical necessity of home care services. You will gain a better understanding of the coverage guidelines for skilled therapy and nursing services in home care, a better understanding of the documentation necessary to demonstrate medical necessity, and understand common denial reasons. The Home Health Advance Beneficiary Notice of Noncoverage is also reviewed during this session.
Home Health Top Claim Errors/Appeals Process
Learn how to review, resolve, and prevent the top claim errors from being rejected or returned to your facility due to missing, invalid, or incorrect information. Information on the appeals process is also provided.
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Hospice
Hospice sessions are not offered in Connecticut locations.
Hospice Billing
Learn the different notices and claim requirements under the Medicare hospice benefit. The session focuses on the claim submission steps, as well as the billing transactions that are used to report situations to Medicare, such as elections, revocations, transfers, corrections to the Common Working File, and change of ownership. Information on how to access these notices/claims and the required fields for each of these billing transactions are provided.
Hospice Coverage
The medical review process, top medical review denials, documentation, and coverage issues for hospice services are reviewed. First-hand information on top medical review denials and ways to avoid these denials are given. Information and steps on the progressive corrective action (PCA) process and the difference between a probe review and targeted medical review are also identified.
Hospice Top Claim Errors/Appeals Process
Learn how to review, resolve, and prevent the top claim errors from being rejected or returned to your facility due to missing, invalid, or incorrect information during this session. Information on the appeals process is also provided.
Medicare Part B
Advance Beneficiary Notice of Noncoverage
Learn how to properly administer the Advance Beneficiary Notice of Noncoverage (ABN) within the office practice. This seminar is aimed at the billing staff in the physician’s office or those interested in learning more about the ABN process. Topics include when to use an ABN, the benefits of properly issuing an ABN, how to sufficiently document that the ABN is on file, and choosing the correct modifier when an ABN is issued.
Chiropractic Medical Review and Documentation Guidelines
Information on medical review denials and coverage guidelines is given and topics such as local coverage determination, top medical review denials, coverage guidelines, documentation, and Advance Beneficiary Notice of Noncoverage are explored. After attending this session, you will have an understanding of Medicare guidelines for coverage and medical necessity of chiropractic services.
CMS-1500 and Common Submission Errors
A claim, whether submitted electronically or by paper, is the only way a beneficiary or a provider can receive reimbursement from Medicare. If there are discrepancies, the provider may not receive full benefits. Information that will allow you to file claims accurately and reduce your chances of receiving ‘’unprocessable claim’’ rejections are provided during this session. Medicare is prohibited by law from paying paper claims except for those from small providers and under other limited circumstances. In this session, the CMS-1500 claim form (08/05) is used to teach the attendee about claim requirements for the paper form, how to use the CMS-1500 claim form, define unprocessable claims, identify late filing rules, and define the requirements of filing claims on behalf of beneficiaries.
Common Modifiers
The proper use of the most frequently used modifiers, modifiers that identify split/shared visits, and modifiers that cause the most claim denials are reviewed during this session. An overview of the National Correct Coding Initiative (NCCI) edits, how to find the NCCI edit tables, and how/when modifiers are used in relation to NCCI are also discussed.
Common Pitfalls of Evaluation and Management Services Coding and Documentation
Common evaluation and management (E&M) services errors identified through CERT and medical review are examined and suggestions are offered for improving E&M code selection and documentation.
Comprehensive Error Rate Testing and Recovery Audit Contractor
A basic overview of both programs and the impact on the provider community and the Medicare Trust Fund are covered. How these programs interact with National Government Services as a Medicare administrative contractor, the roles each contractor plays in the Medicare Program, current and demonstration project results, documentation tips, and suggestions for reducing errors are all discussed.
Consultation Coding Changes
An explanation of the recent changes in Part B Medicare coding and payment policy for consultation services is given. Assistance to the provider community in complying with the new guidelines that were effective January 1, 2010, is also discussed.
Drugs and Biologicals—Coverage and Billing for Erythropoeitin Stimulating Agents for Patients Not Receiving Renal Dialysis
The main focus of this session is to provide guidance to providers on coverage and billing of erythropoietin stimulating agents for nondialysis patients by reviewing the local coverage determination and national coverage determination. The current medical review focus on drugs and biologicals and the overall finding of those medical review audits are also provided.
Electronic Data Interchange Process and Top Errors
Have you ever wondered what electronic options were available for your office? Even if you are a current electronic submitter, there are other options available to make your office more efficient. Types of electronic transactions and how they can make your office efficient by saving time and money are covered. The electronic reports you receive, the most common electronic data interchange front-end rejections, why they are occurring, and how to avoid them in the future are discussed.
Global Surgery
The global surgery concept and billing are reviewed. Learn how to use the payment policy indicators to identify different global surgery situations and how these indicators, as well as the proper use of modifiers, are related to billing and reimbursement under the global surgery rules.
Introduction to Using the Internet-Based Provider Enrollment Chain and Ownership System (PECOS)
The Centers for Medicare & Medicaid Services (CMS) has implemented an online system, called Internet-based PECOS, whereby provider and supplier organizations can submit new Medicare enrollment applications, view and update existing enrollment information, voluntarily terminate from the Medicare Program, and track the status of an application using a secure Internet application. This session demonstrates the ease and many benefits of Internet-based PECOS. Resources and tips for streamlining the Medicare enrollment process are also discussed. This is a great opportunity for any provider type to see the ease of navigating through Internet-based PECOS by following the step-by-step completion of an CMS-855I enrollment application.
Local Coverage Determinations, National Coverage Determinations, and Additional Development Requests
A local coverage determination (LCD) and a national coverage determination (NCD) are defined and the differences between the two are described. The session focuses on the nature of these tools and how to use them as valuable resources in provider reimbursement, documentation guidelines, and in demonstrating medical necessity of services rendered and billed. A sample LCD is dissected to show its value for coding recommendations, citations for research efforts, and indications and limitations of coverage. In addition, supplemental instruction articles are introduced to show how they can augment the information found in an LCD. Lastly, a discussion regarding how and when to respond to additional development requests takes place.
Medicare Part B Facts about Billing for Diagnostic Radiology Services
Diagnostic radiology billing concepts and guidelines are reviewed and a better understanding Medicare program billing requirements to decrease claim submission billing errors are discussed. The following topics are also reviewed:
- Medical necessity/local coverage determinations
- Referring/ordering physicians
- Physician self-referrals
- Billing for bilateral services
- Physician supervision of diagnostic tests
- ICD-9-CM coding for diagnostic tests
- Repeat services on the same day
- Reinterpretations
- Multiple procedures payment reduction on certain diagnostic imaging procedures
- Payment cap on the TC payment of certain imaging procedures
- Diagnostic tests subject to the antimarkup pricing limitation
- Portable x-rays
- Radiology
- The National Correct Coding Initiative
Medicare Part B Podiatry Claim Submissions—How to Avoid Common Billing Errors
If you are a Medicare Part B provider billing for podiatry services, take this session to help decrease your podiatric specialty billing error rate on claim submissions to National Government Services. During this session the top podiatry billing errors are reviewed individually, describing the error and tips on how to avoid the error in future claim submissions are provided. Medical review audit findings are also discussed, and as a resource/tool, a sampling of local coverage determinations are provided.
Medicare Resources
Medicare providers and staff members are introduced to the many educational opportunities, reference materials, and other resources available through National Government Services and the Centers for Medicare & Medicaid Services.
Navigating the Medicare Physician Fee Schedule Data Base
Explains where the Medicare Physician Fee Schedule Database (MPFSDB) is located and the steps to access it. Also learn to read and understand the MPFSDB columns through screen shots enabling you to apply database information to your Medicare billing for successful claims processing.
Outpatient Physical Therapy and Occupational Therapy
Learn about the coverage and billing requirements for outpatient physical therapy and occupational therapy services as outlined in the National Government Services’ local coverage determination (LCD L26884). This session for physician office billing staff and anyone interested in learning more about these services.
Physician Quality Reporting Initiative and Electronic Prescribing (eRx)
Outlines the tools and resources needed to successfully implement and utilize the 2010 Medicare Physician Quality Reporting Initiative (PQRI) and Electronic Prescribing (eRx) incentive programs within the office setting. Learn the benefits of each program, the changes in the programs from last year, how to properly report participation in each program, and how incentive payments are determined.
Preventive Medicine
The Centers for Medicare & Medicaid Services (CMS) is committed to promoting the appropriate use of Medicare preventive benefits. Medicare covers a broad range of services to prevent disease, detect disease early when it is most treatable and curable, and manage disease so that complications can be avoided. Unfortunately, older adults are not receiving all recommended preventive services, even with frequent visits to physician offices. Reasons for this vary but highlight the opportunity to improve preventive care for older adults. This session is designed to ensure that Medicare Part B providers are aware of what benefits are available, as well as, the coverage requirements and billing guidelines for these services. Some of the preventive services covered during this session are:
- Colorectal cancer screening
- Screening mammography
- Screening pap test and pelvic examination
- Prostate cancer screening
- Cardiovascular disease screening
- Diabetes screening
- Glaucoma screening
Show Me the Medicare Money!
Learn about financial incentives offered by Medicare, such as a two percent incentive for electronic prescribing and PQRI. Or learn more about the $19 billion allocated for Medicare physicians who implement electronic medical records as part of the American Recovery and Reinvestment Act. We show you the Medicare money and help your office realize the incentive potential and the many monetary benefits and practice management improvements of these initiatives. The objective is simple: to help you understand the many financial incentives available and how to best obtain them.
Taking the Mystery Out of Medicare Secondary Payer Part B
Does it cause confusion and frustration in your office when you have to submit a Medicare Secondary Payer (MSP) claim to Medicare? Are you receiving denials for improperly submitted MSP claims? Have you ever wondered how Medicare computes MSP payments made to providers? If so, you will not want to miss this seminar! This class is for those providers who already are aware of the MSP provisions and know how to identify MSP situations. During this course, attendees learn how to properly complete an MSP claim using the paper CMS-1500 claim form (or its electronic equivalent) as well as how Medicare determines provider payments and beneficiary liability for MSP claims. Upon completion of this session, you will be able to:
- properly submit MSP Part B claims both on paper and electronically;
- understand how Medicare determines MSP payment amounts;
- appropriately determine any beneficiary liability amounts; and
- forecast MSP payments for claims submitted to Medicare.
The Ins and Outs of Incident-To Billing for Medicare Part B
The requirements and situations of appropriate billing of incident-to services to Medicare (e.g., who can render, who can supervise incident-to services, which place of service is allowed, what types of services are or are not allowed to be rendered incident to) are reviewed. The initial service, subsequent services, active participation, documentation requirements, and completing the CMS-1500 claim form items are also discussed.
The Medicare Appeals Process
It is vital that providers understand that the Medicare appeals process, such as when a claim has been denied by Medicare, is the only recourse to having that claim reconsidered for payment in certain situations. The entire Medicare appeals process, including the five levels of appeal, the types of denials that can be appealed, how to properly request an appeal, and the time frames involved when requesting an appeal, are reviewed during this session.
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