Medicare 101 Series - Coming Spring 2019
Module 1: Coverage
Module 2: Inpatient Prospective Payment System
Module 3: Outpatient Prospective Payment System
The Centers for Medicare and Medicaid Services (CMS) issue updates to the Medicare payment rules for inpatient and outpatient services, multiple times each year1. These rules issue new regulations or changes to existing regulations2.
Many of these rules affect the hematopoietic stem cell transplantation (HCT) population who use Medicare to pay for the HCT procedure and related services3,4,5. Many of the financial staff who work at transplant centers are nurses and many
of the staff who work directly with financial coordinators are nurses6. This is why it’s important that nurses know correct coding, billing, and reimbursement practices for Medicare.
This series of modules moderated by Janelle Roghair (NMDP/Be The Mach) will provide participants with the knowledge they need to perform correct coding and billing practices for HCT. The first module, “Coverage”, will illustrate what conditions are covered under Medicare for HCT and how HCT items and services are covered by Medicare. The second module will explore how HCT items and services are coded, billed for, and reimbursed by Medicare in inpatient settings. Finally, the third module in this three part series will explore how HCT items and services are coded, billed for, and reimbursed by Medicare in outpatient settings.
By the end of these modules, participants should be able to:
Module 1 Coverage:
- Describe Medicare coverage for HCT.
- Apply concepts to their own practice.
Module 2 Inpatient Prospective Payment System:
- Describe the Medicare hospital inpatient prospective payment system (IPPS).
- Identify correct HCT billing codes for inpatient hospital settings.
- Describe how billing claims are used to develop reimbursement rates for HCT in hospital inpatient settings.
- Apply knowledge of how inpatient claims are used to develop reimbursement rates to their own practice.
Module 3 Outpatient Prospective Payment System:
- Describe the hospital outpatient prospective payment system (OPPS).
- Identify correct HCT billing codes for outpatient hospital settings.
- Describe how billing claims are used to develop reimbursement rates for HCT in hospital outpatient settings.
- Apply knowledge of how outpatient claims are used to develop reimbursement rates to their own practice.
Accreditation and CertificationNurses: The National Marrow Donor Program is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation (COA).
Up to 1.0 contact hours may be claimed for this live educational activity.
Insurance case managers: This activity will be submitted to The Commission for Case Manager Certification program for approval.
Participants must complete all three modules and their corresponding evaluations to receive continuing education credit.
If you have any questions regarding this activity or for assistance for people with disabilities, grievances, please email firstname.lastname@example.org.
6 Via BMT Financial Forum (Request access here): https://groups.yahoo.com/neo/groups/BMTFinancialForum/conversations/messages