As a Medicare provider, the physician agrees to fulfill certain contractual obligations with the government. Failure to have knowledge of and comply with these regulations can have a severe impact on revenue as well as subject the practice to allegations of fraud and abuse.
This course will assist the physician and staff members in compliance with Medicare Guidelines and the requirements necessary to receive accurate reimbursement for services provided.
This informative session will provide you with information on the statutory obligations of the Medicare provider and will provide the latest update on the AMA/HCFA documentation guidelines.
You will learn:
- When it is necessary to require a signed waiver in order to be paid.
- Statutory obligations of the Medicare providers.
- Medicare Authority to review records.
- Participating vs. non-participating providers, when and how you can change your status.
- What exactly does "assignment" mean under Medicare law?
- Can you write off the balance of a medically indigent patient?
- What is the difference between a non-covered medical service and a not medically necessary service? When can you bill to the patient?
- Where can you get a list of all non-covered services?
- What is the "Medicare Physician Fee Schedule Database?"
- What is the difference between preventive and a problem oriented service?
- RBRVS & your Medicare Fee Schedule.
The Appeals Process
Learn the correct steps required for the appeals process including:
- How to make payment inquiries
- How to provide documentation of medical necessity
- How to work with HCFA regional offices
- How the Medicare process and review works
- How to make sure you receive fair hearings
- The function of the administrative law judge
Medicare as a Secondary Payor
Learn the details of:
- Policies on disabled individuals
- Federal black lung
- Endstage renal disease
- Worker's compensation.
Learn the correct way to handle employed beneficiaries and their spouses as well as automobile medical and no-fault, general liability and veterans.
Correct Coding Policy
You will learn the latest version of the Correct Coding Policy (CCP) from the HCFA. For your practice to receive correct reimbursement, you must understand the terms "fragmenting", "bundling" and "unbundling", "sequential procedures and comprehensive and mutually exclusive codes", plus more.