Live Virtual Revenue Integrity and Chargemaster Boot Camp for Critical Access Hospitals

Live Virtual Revenue Integrity and Chargemaster Boot Camp for Critical Access Hospitals

Course Overview

Charge capture’s importance is at an all-time high. Let our expert instructors peel back the layers of chargemaster and revenue integrity in the critical access hospital setting.

The Live Virtual Revenue Integrity and Chargemaster Boot Camp for Critical Access Hospitals provides education on chargemaster and revenue integrity concepts in a classroom format. The program will relate the chargemaster function to revenue cycle and revenue integrity functions, including cost reporting and key operational issues, such as coverage, clinical documentation, charge capture, and coding. It will also provide context for chargemaster setup and maintenance within revenue integrity to help avoid pre- and post-billing edits and payer denials. This Boot Camp reviews chargemaster coding requirements for critical access hospitals and excludes discussion of topics that are specific to coding for the Outpatient Prospective Payment System.

You will leave this program knowing how to:

• Provide formal, organized education and training for revenue integrity and chargemaster staff
• Provide context for the intersection of the chargemaster with clinical/revenue departments, charge capture, coding, finance, and patient access and billing
• Walk attendees through CMS regulatory requirements for pricing and charging patients, as well as key relationships between the chargemaster and provider cost reporting
• Give detailed instructions for the majority of revenue codes for optimal chargemaster setup, maintenance, and charge capture
• Understand documentation issues for critical access hospitals
• Review chargemaster issues for commercial/managed care versus CMS requirements for critical access hospitals

See the HCPro difference for yourself!

• Focus on the actual rules: Learn how to find and apply CMS rules and guidelines to ensure hospital services furnished to Medicare beneficiaries are billed accurately and appropriately.
• Tools and skills to navigate Medicare rules: Our instructors provide valuable tools and resources that will help you prioritize and research Medicare questions long after the Boot Camp ends.
• Case studies: Case studies ensure attendees understand the concepts and know how to apply them to real-world situations.
• Small class size: A low participant-to-teacher ratio is guaranteed.
• Highly rated, well-established program: Participants consistently give the course an overall rating of 4.75 or higher (on a 5.0 scale). We currently conduct more than 30 Medicare Boot Camp courses each year.

How does the Live Virtual Revenue Integrity and Chargemaster Boot Camp for Critical Access Hospitals work?

Class is held Monday – Thursday for two consecutive weeks from 12:00 p.m. to 4:15 p.m. Eastern time each day, for a total of eight classes.

Please Note: Four days before class starts, you will receive a welcome email that includes the dial-in information for the class.

Class is held Monday – Thursday for two weeks from June 1 – June 11. Registration cut-off date: 5/25/2026

For more information about our Boot Camps, contact us at 800-650-6787 or email sales@hcpro.com.

Looking to train your whole team? Our experts can provide virtual training for your organization! Learn more here!

Live Virtual Revenue Integrity and Chargemaster Boot Camp for Critical Access Hospitals

Course Outline

Module 1: Revenue Integrity Overview and Resources  

• Key concepts of revenue integrity and the revenue cycle
• Importance of HIPAA Administrative Simplification
• Web-based resources and authoritative sources such as statutes and regulations

Module 2: Providers, Suppliers, and Enrollment  

• Types of facilities, providers, and suppliers
• National provider identifier, enrollment and reassignment
• Overview of Conditions of Participation and Conditions for Coverage
• Special requirements for departments of facility providers
• Licensure, scope of practice, and privileging

Module 3: Insurance, Benefits, and Eligibility 

• Insurance plan basics and eligibility information
• Review of major payors and insurance types
• Common payor contracting terms and provisions
• Overview of contracting strategies and payor scorecards

Module 4: Coverage and Medical Necessity  

• Covered benefits and coverage policies
• Medicare coverage, NCDs, LCDs, and other coverage policies
• Coverage requirements beyond medical necessity
• Coverage and prior authorization by Medicare Advantage Plans
• Non-coverage and notice requirements

Module 5: Coding Edit Systems  

• Coding overview, including diagnosis and procedures codes, and modifiers
• Medicare Code Editor (MCE) and Integrated Outpatient Code Editor (IOCE)
• National Correct Coding Initiative (NCCI)
• Procedure-to-procedure (PTP), Medically Unlikely Edits (MUE), and Add-on code (AOC) edits, including proper modifier usage

Module 6: Claims Submission 

• Important UB-04 Claim Fields
• Claims formats and timely filing
• Repetitive and recurring service
• Billing for readmissions
• Medicare inpatient Part B claims

Module 7: Medicare Critical Access Hospital (CAH) Reimbursement  

• Components of the cost-based payment system
• Method I and Method II billing
• CRNA pass-through exemption

Module 8: Rural Health Clinic (RHC) Reimbursement and Special Billing Issues  

• Identifying and billing Qualifying Visits
• Telehealth, mental health, preventative services and other special billing issues
• Visit rate and calculation of the patient coinsurance amounts

Module 9: Swing Bed Coverage and Special Billing Issues  

• Swing bed coverage, including preceding hospital stay
• Documentation and notice requirements
• Professional services during swing bed stays
• Billing swing bed services and hospital services for swing bed patients

Module 10: Overview of Inpatient and Outpatient Payment Systems and Methodologies  

• Inpatient payment methodologies
• Outpatient payment methodologies, including prospective vs. fee schedule payment, and bundled vs. packaged services
• Medicare Physician Fee Schedule (MPFS) key concepts
• Clinical Laboratory Fee Schedule

Module 11: Chargemaster Terms and Concepts   

• Key fields of a chargemaster
• Discuss hospital outpatient hospital payment systems, including OPPS & APCs, eAPGs, fee schedules, and percent of charges 
• Relationship of the chargemaster to cost reporting and coding
• Requirements for charges, guidance on routine and ancillary services
• Documentation of charge structure, and annual chargemaster updates
• Price Transparency and public reporting of charges

Module 12: Inpatient and Outpatient Room Services  

• Inpatient coverage rules and policies
• Room rates and policies
• Inpatient accommodation revenue codes
• Methods to charge outpatients in beds, including observation
• Labor Delivery and Obstetrics

Module 13: Surgical Services, Supplies and Implants 

• Surgery coverage rules
• Surgery and post-surgery revenue codes
• Surgical charging and coding issues
• Supplies and implantable devices

Module 14: Visits and Related Services  

• Emergency department charging policies
• Charging for non-RHC clinic services, including preventative care and behavioral health services
• Physical therapy, occupational therapy, and speech language pathology
• Coding and editing issues related to visit services

Module 15: Other Ancillary Services  

• Other ancillary departments
• Pharmacy, and infusions, including chemotherapy services
• Renal dialysis
• Coding and edit issues for revenue codes associated with ancillary services

Module 16: Diagnostic Services  

• Diagnostic Services
• Laboratory services, including send out testing
• Coding and editing issues for revenue codes associated with diagnostic services

*Agenda subject to change.

Live Virtual Revenue Integrity and Chargemaster Boot Camp for Critical Access Hospitals

Schedule

June — Class Schedule (Eastern time)

Live Virtual Revenue Integrity and Chargemaster Boot Camp for Critical Access Hospitals

Learning Outcomes

At the completion of this Boot Camp, participants will be able to:

• Construct effective and efficient strategies for hospitals, payers, and other healthcare specialists to obtain and maintain overall revenue integrity for governmental and non-governmental payers
• Develop a working understanding of revenue integrity principles associated with eligibility, coverage, coding, billing, and payment using fee-for-service Medicare requirements as a framework
• Identify how the chargemaster fits into revenue integrity functions
• Anticipate requirements and issues associated with provider-based status
• Analyze standard chargemaster elements, design, and relationship to the general ledger and revenue cycle processes of coding and billing
• Examine claim requirements and specific issues of chargemaster setup and maintenance by revenue code with associated cost reporting principles
• Break down concepts of pricing different services
• Compare critical access hospital cost-based reimbursement, including Method I and Method II, as well as appeal strategies to protect revenue

Continuing Education

AAPC
This program has prior approval of the AAPC for 30 Continuing Education Units. Granting of this approval in no way constitutes endorsement by the AAPC of the program, content or the program sponsor.

AHIMA
This program has been approved for 30 continuing education unit(s) (CEUs) for use in fulfilling the continuing education requirements of the American Health Information Management Association (AHIMA). Granting of Approved CEUs from AHIMA does not constitute endorsement of the program content or its program provider.

NAHRI
This program has been approved for 30 continuing education units towards fulfilling the requirements of the Certification in Healthcare Revenue Integrity (CHRI), offered as a service of the National Association of Healthcare Revenue Integrity (NAHRI).

Disclosure Statement:
HCPro has confirmed that none of the faculty/presenters, planners, or contributors have any relevant financial relationships to disclose related to the content of this educational activity.

Live Virtual Revenue Integrity and Chargemaster Boot Camp for Critical Access Hospitals

Things to Know Before Attending Class

What Is Included With Your Purchase 

When you purchase a seat for our live virtual Boot Camps, you get online access for one participant to the live sessions, a hard copy of our printed workbook materials, and access to the recordings of the sessions. HCPro reserves the right to revoke your access if we find that you are sharing your login or any of the class information. 

Course Materials 

You will receive a hard copy of the class materials. These will be shipped to you via UPS. If ordering on our website, please be sure to enter the physical address where these materials should be shipped. If you order over the phone or if you are unsure of what address we have on file, please ask the person you are speaking with to verify your address information and update accordingly or call our customer service department. Materials should arrive approximately two business days prior to the start of class.  

Virtual Boot Camp Platform 

We use GoToMeeting to present our virtual Boot Camps. To ensure your system supports GoToMeeting, use this link: https://support.goto.com/meeting/system-check. We will send out access information for the class four business days prior to the class start and again one business day prior. 

Session Recordings 

You will have access to the recordings of each class session via a password-protected page on our website. You will be given the page location in the welcome email. Recordings will be added to the page within one business day following the live session. You will have access to this page for 60 days after the final live session.  

Continuing Education Credits 

To receive continuing education credits, you will be required to successfully complete a 40-question quiz that is based off of the content covered throughout the course. Successful completion is achieved by getting at least 80% of the multiple-choice questions correct. 

What to Bring to Class 

We suggest that you have the following available during the class: 

• Highlighter 
• Notepaper 
• Sticky notes/flags 
• Pen/pencil  

Contact Information 

For more information about our Boot Camps, contact us at 800-650-6787 or email sales@hcpro.com.

We Look Forward to Having You In Class!

Live Virtual Revenue Integrity and Chargemaster Boot Camp for Critical Access Hospitals

Questions/Answers

What is the focus of the Live Virtual Revenue Integrity and Chargemaster Boot Camp for Critical Access Hospitals? 
The Live Virtual Revenue Integrity and Chargemaster Boot Camp for Critical Access Hospitals educates those who work within the critical access hospital setting about chargemaster and revenue integrity concepts. Some of these concepts include revenue cycle and revenue integrity functions, as well as cost reporting and key operations issues like coverage, clinical documentation, charge capture, and coding. It also gives attendees context about chargemaster setup and maintenance within revenue integrity and provides education about pre- and post-billing edits and payer denials. 

What computer setup do I need to attend this class? 
This class will be hosted on the GoToMeeting platform. Attendees should have access to a computer that has a microphone and speakers to participate. There is also an option to dial in over a phone line if you need to connect on your phone. You can read the full system requirements for GoToMeeting by visiting https://support.goto.com/meeting/help/system-requirements-for-attendees-g2m010003. You can also test your system by visiting https://support.logmeininc.com/gotomeeting/get-ready. 

Does HCPro offer an "on-site" version of this Boot Camp? 
In addition to our open registration courses, we also offer this Boot Camp as an on-site program (with a substantial discount) for organizations that have a number of employees who need training. For more information on hosting an on-site Boot Camp, click on "Host an On-Site Course.”  

What if I need to cancel or transfer my registration? 
Please click here to view our cancellation policy. 

Who typically attends the Live Virtual Revenue Integrity and Chargemaster for Critical Access Hospitals Boot Camp? 

• Reimbursement managers
• Revenue integrity staff
• Chargemaster staff
• Chargemaster managers
• Finance and reimbursement staff
• Finance and reimbursement managers & directors
• Claims auditors
• Payer relations staff
• HIM directors and managers
• Compliance officers, directors, and managers
• Coding directors and managers
• RAC coordinators

What material does the course cover? 
To view the course outline, click on "Course Outline" above. 

How is the course taught? 
The course is taught using a combination of lecture, class discussion, and hands-on exercise/case studies. 

What should I have available for each session? 
For each class, participants should have their packet of materials and may wish to also have available a highlighter, a notebook for taking notes, and sticky notes/flags. 

What if I have a question that didn’t get addressed in class? 
The course offers open office hours each week to address topics related to the course materials and class discussion. Questions should be related to the course and topics discussed throughout the course. Instructors are not able to address questions outside the scope of the course. 

Does HCPro ever share contact information (e.g., name, address, phone number, email address, etc.) with other companies? 
Historically, we have not shared contact information with anyone outside of our company. However, it is possible that at some point we might share contact information with other companies that offer products and services that we think would be of interest to our customers. If you would like us to keep your contact information confidential, please let us know so that we can flag your information in our customer database as "Do Not Share." 

How do I get more information? 
Contact our sales team at 800-650-6787 or email sales@hcpro.com.