Course Code: REL-RCC-REV-CCI-A01
Hours: 0.5
Type: Online Course
Content Expiration Date: 12/31/2025
Learning Objectives:
Identify how the phrase "reasonable and necessary" applies to billing.
Identify how diagnosis and procedure codes work to provide acceptable billing submissions.
Recall that the Social Security Act, the Secretary of Health and Human Services, National Coverage Determinations (NCDs), and Local Coverage Determinations (LCDs) all provide important levels of detail to the definitions of covered services.
Identify the acceptable elements of physician documentation.
Apply the guidelines for Advance Beneficiary Notices (ABNs).
Recognize which services CMS has applied prior authorizations.
Outline:
Section 1: Introduction
About This Course
Learning Objectives
The Medicare Act of 1965
Medical Necessity Edits
Covered Services
Review
Section 2: NCDs and LCDs
National Coverage Determination
National Coverage Determination Example
Local Coverage Determinations
Local Coverage Determinations and Policy Article
Review
Local Coverage Determinations: Example
Local Coverage Determination Rejections
Review
Advance Beneficiary Notice
Process Summarized
Review
Section 3: Other Factors
Physician Documentation
Medical Necessity Documentation
Physician Documentation Tidbits
Review
Pre-authorization
Review
Section 4: Conclusion
Course Summary
Course Contributors
Resources
Bibliography
References
Subject Matter Expert: Jean C. Russell, MS, RHIT
Jean Russell has over thirty years of healthcare and information system experience. Her areas of expertise include the Medicare outpatient prospective payment systems (APCs, and APGs), as well as ICD-10-CM/PCS training, Charge Description Master (CDM), admission status reviews, and outpatient coding and compliance. She is a frequent speaker at the national, state and local levels for HFMA and AHIMA professional groups. Jean has her Masters from the University of Houston in Biomedical Engineering; her Bachelors from Colgate University in Biology; and her RHIT from the independent study program through the American Health Information Management Association.
Subject Matter Expert: Veronica Ziac, MBA
Veronica Ziac, MBA has over twenty years of healthcare administration experience. Her areas of expertise include revenue cycle, information systems, population health and physician practice management. Most recently, she was the Director of Revenue Cycle Integrity at Cobleskill Regional Hospital. Prior to that, Veronica was the Chief Operating Officer for a large multispecialty hospital-based physician practice based in New York. Veronica has an MBA in Healthcare Administration from Union College and a bachelor’s degree from the University at Albany. She is a member of HFMA and MGMA and has been Certified in Healthcare Compliance (CHC) by the Healthcare Compliance Association.
Target Audience:
The target audience for this course is: Coding Specialists; in the following settings: Acute Care Facility.
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All courses offered by Relias Learning, LLC are developed from a foundation of diversity, inclusiveness, and a multicultural perspective. Knowledge, values and awareness related to cultural competency are infused throughout the course content.
To earn continuing education credit for this course you must achieve a passing score of 80% on the post-test and complete the course evaluation.
Course Delivery Method and Format
Asynchronous Distance Learning with interactivity which includes quizzes with questions/answers, and posttests.