Catalog Number : cca1993
Title : CAHs and RHCs: Compliant Coding and Billing
Speaker : Duane Abbey

Webplay Recording Date : 3-16-2017
Webplay Price : $ 150 for two weeks viewing

Webinar Description:

Rural Health Clinics (RHCs) and Critical Access Hospitals (CAHs) are both special types of Medicare providers. RHCs have recently started using CPT/HCPCS codes for their claims. The use of CPT/HCPCS for RHCs has generated a number of questions surrounding the concept of a visit. For Medicare, RHCs are paid through an All Inclusive Rate (AIR) that is driven by the charges made for a visit. For physician services, CAHs also have a special mechanism for gaining additional reimbursement for outpatient services. This is the Method II billing process. For CAHs that have provider-based clinics or otherwise have physicians providing outpatient services, there is the possibility of gaining increased reimbursement. Of course, for both RHCs and CAHs there are a host of compliance concerns revolving around proper coding and billing. This workshop addresses both the RHC use of CPT/HCPCS codes and Method II billing for CAHs.

Webinar Objectives:

• review the reimbursement process for Rural Health Clinics (RHCs)
• discuss what constitutes a visit and what services do not constitute a visit
• review some of the idiosyncrasies surrounding coding and billing for RHCs
• express the difficulties for RHCs in filing claims with CPT/HCPCS codes
• discuss compliance issues surrounding proper coding and billing using CPT/HCPCS codes and modifiers
• review the reimbursement process for Critical Access Hospitals
• review the features and requirements of Method II billing
• explain the special coding and billing requirements for physicians using MPFS (Medicare Physician Fee Schedule)
• review how to set up the chargemaster to accommodate professional coding and billing
• discuss special billing requirements for information that is on the 1500 claim form but not on the UB-04
• discuss additional compliance requirements for Method II billing for CAHs

Target Audience: 

RHC and CAH Coding Personnel, Billing and Claims Transaction Personnel, Nursing Staff, Outpatient Service Area Personnel, Chargemaster Coordinators, Financial Analysts, Compliance Personnel, Physicians, Revenue Cycle Specialist, Practitioners and Other Interested Personnel

A Few of the Topics that will be covered:

• Overview
  • Rural Health Clinics (RHCs)
  • Critical Access Hospitals (CAHs)
  • Cost-Based Reimbursement
  • Method II Billing for CAHs
• Rural Health Clinics
  • Special Characteristics and Requirements
  • Provider-Based vs. Independent
  • Cost-Based Reimbursement through the All Inclusive Rate (AIR)
  • Definition of a Visit
• RHCs - Coding and Billing Requirements
  • Use of CPT/HCPCS Codes
  • Use of Modifiers
  • UB-04 Claim Formatting
  • Compliance Issues
• Critical Access Hospitals
  • Special Characteristics and Requirements
  • Provider-Based Clinics and Physician Outpatient Services
  • Method I vs. Method II Billing for Physician Services
  • The Medicare Physician Fee Schedule (MPFS)
• CAH - Method II Billing and Reimbursement
  • Coding and Billing Process
  • Claims Filing Professional on UB-04
  • Chargemaster Concerns
  • Physician Reassignment - CMS-855-R
  • Compliance Concerns
• Additional Concerns
  • Telemedicine
  • Rural Healthcare Designations
  • Case Studies
• Sources for Further Information

Contact Hours:

• Nursing participants: Instruct-online has approved this program for 1.8 contact hours, Iowa Board of Nursing Approved Provider Number 339

• All other participants: Must attend the entire Webinar and complete a Webinar critique to receive a 1.5 Hour Attendance Certificate for each program.

Full tuition is refunded immediately on request if the participant has not been sent the program materials and instructions. Once the instructions (including access codes) have been sent, a full refund will be issued only after the program runs and it is verified that the participant did not access the program.