Revenue Integrity

COURSE
HC Pro
18 hrs 55 mins

Revenue Integrity

COURSE
HC Pro
18 hrs 55 mins
$399per person
$399per person

Library Overview

Revenue Integrity Essential Skills Online Learning covers a range of critical billing, reimbursement, and compliance topics to help hospitals to train a wide range and large number of healthcare professionals on the core concepts of revenue integrity. This library provides the information needed to educate and update staff on revenue integrity fundamentals as well as the latest regulatory changes in an engaging, interactive learning format.


Library Objectives

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

  • Describe the government’s rules and regulations related to the design and operation of Medicare’s inpatient prospective payment system (IPPS) for short-term acute care hospitals
  • Understand the most significant aspects of and recent changes to Medicare’s inpatient prospective payment system (OPPS)
  • Describe the rules and regulations that must be followed to ensure correct patient assignments
  • Identify how to proceed when a physician incorrectly assigns a patient to inpatient status
  • Discuss National and Local Coverage Determinations and coverage with evidence development
  • Discuss CMS’ process in identifying coding changes and explain the importance of compliance with the National Correct Coding Initiative edits
  • Describe the role of the charge description master in revenue integrity and recognize ways to ensure accurate charges for specific departments and services
  • Articulate strategies for a comprehensive audit system that reviews charges, denials, external reports, and regulatory changes
  • Identify challenges related to drug administration billing and coding, both inpatient and outpatient
  • Discuss the importance of complying with claims submission requirements, ensuring billing accuracy, and selecting proper revenue and HCPCS codes

Contributor Bios

Kimberly Anderwood Hoy Baker, JD, CPC, is the director of Medicare and compliance for HCPro. She is a lead regulatory specialist for HCPro's Revenue Cycle Institute and is the lead instructor for HCPro's Medicare Boot Camp®—Hospital Version and Medicare Boot Camp®—Utilization Review Version. She is also an instructor for HCPro’s Medicare Boot Camp®—Critical Access Hospital Version. She is a former hospital compliance officer and in-house legal counsel, and has 10 years of experience teaching, speaking, and writing about Medicare coverage, payment, and coding regulations and requirements.

Steven A. Greenspan, JD, LLM,is vice president of regulatory affairs at Executive Health Resources (EHR) in Newtown Square, Pennsylvania. He is responsible for overseeing regulatory research and hospital advocacy efforts, and collaborates closely with EHR’s appeals management teams to offer support on complex Medicare, Medicaid, and commercial appeals matters. During his 18-year career, Greenspan has overseen the adjudication of more than 200,000 appeals and personally authored more than 10,000 appeal decisions. Prior to joining EHR, he served as vice president and project director for MAXIMUS Federal Services, Inc., overseeing the company’s Part A East QIC project.

Judith L. Kares, JD, Esq., is an expert in Medicare rules and regulations and is an instructor for HCPro's Medicare Boot Camp—Hospital Version®. She spent a number of years in private law practice, representing hospitals and other healthcare clients, and then served as in-house legal counsel for two large third-party payers. For the past 20 years she has continued to provide legal and related compliance services on a consulting basis. These services include development of strategic compliance programs; establishment of baseline risk assessments; creation of appropriate compliance documents (e.g., codes of conduct, corporate policies and procedures); creation of reporting mechanisms; development of training and communication plans, including related materials; compliance reviews and audits; research and advice regarding specific risk areas; and development of corrective action plans.

Elizabeth Lamkin, MHA, ACHE, is CEO of PACE Healthcare Consulting, LLC, in Hilton Head, South Carolina. She has 20 years of hospital CEO experience. Lamkin is a nationally known speaker and author on billing compliance, including CMS Recovery Auditors.

Shannon E. McCall, RHIA, CCS, CCS-P, CPC, CPC-I, CEMC, CCDS, is the director of HIM and coding for HCPro. She oversees all of the Certified Coder Boot Camp programs. McCall developed the Certified Coder Boot Camp®—Inpatient Version, the Evaluation and Management Boot Camp™, and the HCPro ICD-10 Basics Boot Camp™. McCall works with hospitals, medical practices, and other healthcare providers on a wide range of coding-related custom education sessions.

Valerie A. Rinkle, MPA, is a lead regulatory specialist and instructor for HCPro’s Revenue Integrity and Chargemaster Boot Camp®, as well as an instructor for HCPro’s Medicare Boot Camp®—Hospital Version and Medicare Boot Camp®—Utilization Review Version. Rinkle is a former hospital revenue cycle director and has over 30 years in the healthcare industry, including over 12 years of consulting experience in which she has spoken and advised on effective operational solutions for compliance with Medicare coverage, payment, and coding regulations.

Jugna Shah, MPH, is the president and founder of Nimitt Consulting Inc., a firm specializing in case-mix payment system design, development, and implementation. She has extensive experience helping providers understand and address the ongoing clinical, operational, and financial implications of Medicare’s outpatient prospective payment system based on APCs. She has educated and audited hospitals on their drug administration coding and billing practices. She has contributed to several books and numerous OPPS/APC articles over the past 15 years. She is also a contributing editor of HCPro’s Briefings on APCs. Dr. Keith I. Stokes, MD, is a board-certified physician with a diverse career that includes experience as a clinic medical director, hospital chief of staff, hospitalist, consultant, and physician advisor. He is COO of DocuComp, LLC, and a member of the steering committee for the Association for Integrity in Health Care Documentation. Dr. Stokes is also a member of the Society of Hospital Medicine and the American College of Physician Advisors. He has served as a consultant for numerous hospitals, primarily focused in the areas of utilization management and clinical documentation improvement. Denise Williams, RN, COC, AHIMA ICD-10 ambassador, is senior vice president of the revenue integrity division and compliance auditor at Revant Solutions. She has more than 30 years of healthcare experience, including a background in multiple areas of nursing. For the past 20 years, Williams has been in the field of coding and reimbursement and has performed numerous E&M, OP surgical, ED, and observation coding chart reviews from the documentation, compliance, and reimbursement perspectives. She serves as a contributing author to articles published in HCPro’s APC Insider and Briefings on APCs and is a nationally recognized speaker on the OPPS, as well as various coding and reimbursement topics. Ralph Wuebker, MD, MBA, is chief medical officer for EHR in Newtown Square, Pennsylvania. He is board certified and currently serves as a member of EHR’s physician education and audit team. Wuebker regularly visits EHR’s client hospitals to provide medical executives and staff members with ongoing education on a variety of topics, including Medicare and Medicaid compliance and regulations, medical necessity, recovery audit contractors, utilization review, denials management, and length of stay.


Audience

Who should attend?

  • Revenue integrity managers/directors and staff
  • Compliance managers/directors and staff
  • Billing managers and staff
  • Finance professionals
  • HIM managers/directors and staff
  • Case managers
  • Case management directors/managers
  • UR managers/directors
  • Physician advisors

Accreditation Statement for Library as a Whole

NOTE: Credits are only offered after completion of all courses and the final exam.

AAPCThis program has the prior approval of AAPC for 16 continuing education hours. Granting of prior approval in no way constitutes endorsement by AAPC of the program content or the program sponsor.

American Health Information Management Association (AHIMA)This program has been approved for 16 CE credits for use in fulfilling the continuing education requirements of the American Health Information Management Association (AHIMA).

American Nurses Credentialing Center (ANCC)HCPro is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.

This educational activity for 27.2 nursing contact hours is provided by HCPro.

Commission for Case Manager Certification (CCMC)This program has been pre-approved by The Commission for Case Manager Certification to provide continuing education credit to CCM board certified case managers. The course is approved for 16.5 CE contact hours.

Compliance Certification Board (CCB)The Compliance Certification Board (CCB) has approved this event for up to19.9 CCB CEUs. Continuing Education Units are awarded based on individual attendance records. Granting of prior approval in no way constitutes endorsement by CCB of this program content or of the program sponsor.


Duration

18 hours 55 minutes

Learning
Inpatient Prospective Payment System Regulations and Reimbursement
Module Theoryinteractive
Module Webinarinteractive
Module Examinteractive
Outpatient Prospective Payment System Coverage and Payment Calculations
Module Theoryinteractive
Module Webinarinteractive
Module Examinteractive
Patient Status: The 2-Midnight Rule and Observation Services
Module Theoryinteractive
Module Webinarinteractive
Module Examinteractive
Condition Codes 44 and W2 and Part B–Only Claims
Module Theoryinteractive
Module Webinarinteractive
Module Examinteractive
Coverage Determinations: NCDs, LCDs, and CED
Module Theoryinteractive
Module Webinarinteractive
Module Examinteractive
Claim Edits: National Correct Coding Initiative Edits and Medically Unlikely Edits
Module Theoryinteractive
Module Webinarinteractive
Module Examinteractive
Chargemaster Structure and Capture
Module Theoryinteractive
Module Webinarinteractive
Module Examinteractive
Strategies and Focus Areas for Audits and Appeals
Module Theoryinteractive
Module Webinarinteractive
Module Examinteractive
Billing and Coding for Drugs and Biologicals
Module Theoryinteractive
Module Webinar 1: Ancillary Bedside Procedures: Determine What to Charge Beyond the Room Rateinteractive
Module Webinar 2: Improve Documentation and Coding for Injections and Infusionsinteractive
Module Examinteractive
Medicare Claims Submission Fundamentals
Module Theoryinteractive
Module Webinarinteractive
Module Examinteractive
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