This course will teach the principles of Medicare coverage, billing, coding and payment for both inpatient and outpatient services. It will provide students with the knowledge and tools for developing the skills needed to submit accurate claims to Medicare, maintain compliance, prevent potential missed revenue and avoid unnecessary claim and coding denials.
- Research Medicare issues and updates, and locate resources available through the Internet.
- Develop an understanding of statutes, regulations, manuals, transmittals, and other Medicare rules and guidelines.
- Identify the role of Medicare contractors.
- Develop an understanding of the different types of Medicare coverage.
- Develop an understanding of the types of Medicare monitoring programs.
- Identify the various Medicare appeal levels and timeframes.
- Demonstrate an understanding of outpatient outlier payments.
- Demonstrate composition and application of National Correct Coding Initiative.
- Demonstrate understanding of the Inpatient and Outpatient Perspective Payment Systems used for Medicare claims.