Medicare Part B: Reimbursement Guidelines


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Course Description

Earn 3 CEUs Practice Management Institute

Billing errors and denials cost providers millions of dollars each year in lost income and productivity. This class will cover all the statutory obligations, rights, roles and responsibilities of the Medicare provider. Participants will return to the office with new knowledge and skills aimed at improving Medicare claim accuracy.

Get answers to your most pressing Medicare questions. Even if your office does not process Medicare claims, most private carriers use Medicare guidelines as the foundation for payment models.

  • Medicare coverage policies, reimbursement and payment systems have been widely adopted by private insurers.
  • Stop second-guessing claims. Get access to the latest documentation guidelines and instruction on the CMS Correct Coding Policy.
  • Increase Medicare aptitude and decrease denials. Classroom participation stimulates peer-to-peer interaction and improves problem-solving skills.
  • Accurate claim submissions support medical ethics and trust.
  • Receive tips for working with CMS and Medicaid regional offices.

Key Highlights of The Session:

  • Understanding Medicare’s Correct Coding Policy for use of comprehensive and mutually-exclusive codes
  • RBRVS and your Medicare fee schedule
  • How to get a list of all non-covered services
  • Advance Beneficiary Notice guidelines
  • What “assignment” means under Medicare law
  • Medicare as primary or secondary payer
  • The dangers of fragmenting, bundling and unbundling
  • Preventive vs. problem-oriented services
  • Differences between PAR, non-PAR and opting out of Medicare
  • Caring for the indigent Medicare patient
  • Improve understanding of audit triggers
  • Stark laws and the dangers of courtesy discounts and kickbacks
  • Your rights during a carrier audit
  • How to avoid billing for services that are not medically necessary
  • Proper documentation for medical necessity
  • Uncovering the Medicare appeals process and review
  • Your rights in making sure you receive a fair hearing
  • The administrative law judge’s role in handling appeals

Target Audiences:

  • Coders
  • Auditors
  • Billers
  • Physicians
  • Mid-Level Providers
  • CDI Specialists
  • Consultants
  • Office Managers
  • Administrators

Meet The Presenter:

Pam Joslin, MM, CMC, CMIS, CMOM, CMCO, CEMA has more than 20 years of medical practice management, coding, reimbursement and compliance experience. She has managed medical practices ranging from single to multi-specialty groups, including an ASC. She is an advocate of process improvement and empowering employees to bring about the “best practice” results for their organization. Ms. Joslin maintains memberships in professional organizations to support her continuing cycle of learning in the ever-changing healthcare industry. In 2014 she joined the faculty of Practice Management Institute (PMI) ® – a leading provider of continuing education for medical office professionals. Prior to joining the PMI Instructor team, Pam was an Adjunct Instructor and served on three advisory boards at a community college in San Antonio, Texas.

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