Take this course focusing on the Medicare regulatory requirements for patient status and the role of the utilization review (UR) committee.

Managing patient status plays a critical role in proper compliance, correct reimbursement, and stabilizing inpatient payments for the hospital. Managing patient status plays a critical role in proper compliance, correct reimbursement, and stabilizing inpatient payments for the hospital.

Medicare Advantage Plans must also follow the Two-Midnight rule and inpatient only list. Understanding the intricacies of these rules and the CMS guidance will be critical to ensure plans are compliant with their obligations to patients and providers. Short stay auditor Livanta has also concluded their first year of audit with over half of denials for admission related to the circulatory and digestive systems.

Don’t become a target or leave money on the table—have confidence in the UR determinations you and your facility are making.

Medicare Boot Camp—Utilization Review Version also answers all your questions about navigating the CMS website and finding Medicare requirements. You will be able to find answers to your questions long after the Boot Camp is over.

You will leave this program knowing:

• How to apply the 2-midnight benchmark, including cases with observation
• CMS’ current strategy related to the inpatient only list 
• CMS guidance on case-by-case admissions
• The differences between post-discharge versus concurrent patient status reviews
• When self-denial is appropriate to take advantage of Part B payment for an inpatient case
• How NCDs, LCDs, and coverage with evidence development (CED) affect coverage of cases that meet the 2-midnight benchmark
• The observation coverage rules and how they interact with the 2-midnight benchmark
• When ABNs and HINNs should be used for stays that don’t meet medical necessity requirements