Back-to-the-basics tutorial for utilization review of what Medicare provides and doesn’t provide and how Medicare pays hospitals for services for both inpatient and outpatient.
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Doctors go to medical school. Nurses go to nursing school. But there is no utilization review school per se. Most teaching is done on the job with the “this is how we do it here” method. In some instances, it is “watch one, do one, teach one.” The Medicare manuals are thousands of pages long and written in ways that even seasoned professionals have a hard time understanding. And that is why the world of utilization review in Medicare is so difficult. Many enter the field from clinical positions, often as doctors or nurses, and are well acquainted with ordering and providing patient services but are completely unaware of the actual regulations and payment methods. They then start their new position and often get thrown into the day-to-day work without a basic foundation to understand the why behind the what. This leads to errors, misunderstandings, denials, and unhappy patients.
Fortunately, this webcast, led by Dr. Ronald Hirsch, addresses those core issues. Those of you who attend this exclusive RACmonitor webcast will learn what Medicare provides and doesn’t provide. You will learn how Medicare pays hospitals for their services both inpatient and outpatient. You will also learn how much patients have to pay for their care. You will learn how claims are prepared. The educational value of this webcast will help prepare your staff to better understand these issues and be better able to talk to patients, to their medical staff, and to their administrative team.
Frankly, it’s not easy to understand what services Medicare provides and how hospitals get paid for providing those services. But your understanding of these issues is crucial to the success of your hospital and as a utilization review professional. As always, Dr. Hirsch will present the crucial information you need in a way that is easily understood and quickly translated into daily improvement in your work. Register now.
Why This is Relevant:
Errors, misunderstandings, claim denials and unhappy clients oftentimes result from well-intended healthcare professionals who enter the utilization management environment from clinical positions, often as doctors or nurses. Although they are well acquainted with ordering and providing patient services, many are completely unaware of actual regulations and payment methods.
Understand the Medicare benefits available to beneficiaries
Learn how to describe the differences between Medicare and Medicare Advantage
Demonstrate the payment methods for inpatient and outpatient hospital care
Understand the Medicare fee schedules and demonstrate their use
Learn the correct usage of modifiers and condition codes
Who Should Attend:
Those who will benefit most from this webcast include those in utilization review, revenue cycle, revenue integrity, case management and compliance, as well as chief financial officers, physicians and physician advisors, and billing and coding professionals.
Ronald Hirsch, MD, FACP, CHCQM-PHYADV, CHRI, FABQAURP is vice president of the Regulations and Education Group at R1 Physician Advisory Services. Dr. Hirsch’s career in medicine includes many clinical leadership roles at healthcare organizations ranging from acute-care hospitals and home health agencies to long-term care facilities and group medical practices. In addition to serving as a medical director of case management and medical necessity reviewer throughout his career, Dr. Hirsch has delivered numerous peer lectures on case management best practices and is a published author on the topic. He is a member of the Advisory Board of the American College of Physician Advisors, a member of the American Case Management Association, and a Fellow of the American College of Physicians. Dr. Hirsch is a member of the RACmonitor editorial board and is regular panelist on Monitor Mondays.
The opinions expressed are those of the author and do not necessarily reflect the views, policies, or opinions of R1 RCM, Inc. or R1 Physician Advisory Services (R1 PAS).
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