Conference Description:

Medicare Boot Camp®—Rural Health Clinic Version


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Course Overview

Medicare Boot Camp®—Rural Health Clinic Version is a one-day intensive course on Medicare coverage, coding, billing, and payment for rural health clinics (RHC). It gives you the knowledge and tools to find the answers to your most compelling Medicare billing questions pertaining to this unique setting.

This one-of-a-kind, custom class will show you which rules apply to you so you can successfully process claims and get paid without disruption to your revenue stream. It will also teach you how to research Medicare regulations to resolve billing issues and respond to denials and audits.

The Medicare Boot Camp—Rural Health Clinic Version will give you the knowledge and confidence to:

Find the answers to your specific Medicare questions relating to RHCs
Understand reporting of revenue codes, HCPCS codes, and related charges for all services provided
Submit accurate claims to Medicare, including independent and provider-based RHCs
Ensure appropriate reimbursement from Medicare and application of the patient’s financial responsibility


Who should attend?

Billing specialists

Coding specialists

Provider-based RHC personnel

Chargemaster coordinators and managers

Clinic managers and department heads

Compliance officers

Finance and reimbursement managers

Healthcare consultants, CPAs, and lawyers

Health plan financial analysts, claims processing, and provider relations professionals

HIM directors and managers

Medicare administrative contractors

Patient access/admitting staff

Auditors and analysts


See the HCPro difference for yourself!

Focus on the actual rules: Learn how to find and apply CMS rules and guidelines to ensure hospital services furnished to Medicare beneficiaries are billed accurately and appropriately.

Tools and skills to navigate Medicare rules: Our instructors provide valuable tools and resources that will help you prioritize and research Medicare questions long after the Boot Camp ends.

Hands-on learning: Attendees are provided a set of exercises after each module to ensure they understand the concepts and know how to apply them to real-world situations.


Learning Objectives

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

Locate key sources of Medicare authority on the Internet

Explain the definition of an RHC and the criteria for certification

Describe covered RHC services provided by physicians, physician assistants, nurse practitioners, clinical nurse midwives, clinical psychologists, and social workers, as well as services provided “incident to”

Explain billing requirements related to medical visits, preventive services, laboratory services, and other special services offered by RHCs

Identify what constitutes an “encounter” for payment purposes

Explain the AIR payment in independent and provider-based RHCs, including the application of Medicare Part B deductible and coinsurance




Course Outline/Agenda

Module 1: Medicare Overview, Contractors, Research, and Resources
Overview of Medicare Part A, B, C, and D
Role of Medicare contractors
Medicare source laws, including statutes and regulations
Medicare sub-regulatory guidance, including manuals and transmittals
Links to Medicare information and resources for staying current



Module 2: Designation as a Rural Health Clinic (RHC) and Required Practitioners and Services
Definition and purpose of an RHC
Certification criteria, including location, staffing, and required services
Basic requirements for services furnished by RHC practitioners or incident to an RHC practitioner, including requirements for direct supervision
Services that are excluded from the RHC benefit
Distinguish between an independent and provider-based RHC



Module 3: Application of Medicare Coverage and the Advance Beneficiary Notice
Medicare Coverage Center, including LCDs and NCDs, and Laboratory Manual
Coverage of drugs, including self-administered drugs
Coverage requirements for outpatient diagnostic services, including laboratory services
Limitations of liability statute and notice requirements
Advance Beneficiary Notice (ABN) form and instructions



Module 4: General Billing Requirements for Rural Health Clinic (RHC) Services
Claims processing requirements, including type of bill, revenue codes, HCPCS codes, modifiers, and charge reporting
Coverage and billing for a medical visit and mental health visit
Coverage and billing for preventive services
Coverage and billing for special services, including diagnostic services, vaccines, injections, and other incident-to services
Coverage and billing for laboratory services
Special circumstances for billing transitional care management (TCM), chronic care management (CCM), and telehealth



Module 5: Basic Reimbursement Principles for Rural Health Clinic (RHC) Services
Identification of an "encounter" for payment purposes
Basic all-inclusive rate (AIR) reimbursement methodology for provider-based and independent RHCs
Application of upper payment limit for freestanding and provider-based RHCs
Application of Part B deductible and coinsurance



Module 6: Appendixes of Source Authority
Key government documents to support appropriate billing


Course Outline/Agenda subject to change.



Please contact the event manager Marilyn ([email protected] ) below for:

- Multiple participant discounts
- Price quotations or visa invitation letters
- Payment by alternate channels (PayPal, check, Western Union, wire transfers etc)
- Event sponsorships