HCPro Medicare Boot Camp® Utilization Review Version – Oct. 14-15

Time: 8:00 AM


Virtual Event

8 am to 5 pm


IHA Members
Individual Rate: $1,379
Group Discount: $1,279 per person for two or more registrants from one IHA-member hospital or health system

Individual Rate: $1,739
Group Discount: $1,639 per person for two or more registrants NOT from an IHA-member hospital or health system

Tuition includes program materials, including an extensive program workbook.

Attendees must register by Friday, Oct. 8, 2021 to ensure receipt of program materials.

Cancellation Deadline
Cancellations after Sept. 10, 2021 will be charged 50% of the registration fee. Registrants who do not cancel and do not attend are liable for the entire fee.

Register Online

IHA has partnered with industry leader HCPro to offer Medicare Boot Camp®– Utilization Review Version. This intensive two-day program focuses on Medicare rules and regulations related to patient status and the role of the utilization review (UR) Committee.

Participants will dive into the complex world of Medicare regulations through the boot camp’s nationally recognized curriculum. The course will provide a foundational understanding of Medicare regulations that are critical to attaining compliance and correct reimbursement. It will also address the significant changes the Centers for Medicare & Medicaid Services made in 2021 to the inpatient-only list and strategies for ongoing changes on auditing patient status.

Due to the rigorous nature of the course, the class size is limited to 35 participants.


Module 1: Medicare Overview, Contractors and Resources

  • Medicare Part A, B, C and D overview

  • Medicare contractors, including the Medicare administrative contractor (MAC), recovery audit contractor (RAC) and quality improvement organization (QIO)

  • Medicare Coverage Center, including Local Coverage Determinations (LCDs), National Coverage Determinations (NCDs) and Coverage with Evidence Development (CED)

  • Prior authorization for specified outpatient procedures and services

Module 2: Outpatient Observation

  • Observation services coverage

  • Medicare Outpatient Observation Notice (MOON)

  • Advanced Beneficiary Notice (ABN) for non-covered observation

  • Observation coding and billing

  • Payment for observation under the Observation Comprehensive Ambulatory Payment Classification (C-APC)

  • Payment for observation at a Critical Access Hospital

Module 3: Coverage of Inpatient Admissions

  • Inpatient order requirements

  • Inpatient certification requirements, including 96-hour CAH certification

  • Inpatient criteria and the Two-Midnight Rule Benchmark

  • Inpatient-only procedures

  • Admission on a case-by-case basis

  • Documentation and use of screening tools

  • QIO short stay audits

Module 4: Inpatient Utilization Review and Notices

  • Utilization review requirements and self-denials

  • Concurrent review and billing with condition code 44

  • Inpatient Part B payment and billing with condition code W2

  • Important Message from Medicare (IM)

  • Detailed Notice of Discharge (DN)

  • Hospital Issued Notice of Non-Coverage (HINN) for non-covered inpatient services

Module 5: Medicare Payment Fundamentals and Patient Responsibility

  • Basics of the Outpatient Prospective Payment System (OPPS)

  • Patient coinsurance under Part B

  • Basics of the Inpatient Prospective Payment System (IPPS)

  • Three-day payment window and pre-admission services

  • Medicare-severity diagnosis related groups (MS-DRGs)

  • Payment for transfers and post-acute care transfers

  • Inpatient deductible, coinsurance and lifetime reserve days (LRDs)


At the conclusion of this educational activity, participants will be able to:

  • Define observation coverage, billing, coding, and payment rules.

  • Discuss the appropriate application of ABNs for observation patients.

  • State the new/revised inpatient order and certification requirements.

  • Explain CMS’ 2-midnight rule benchmark.

  • Describe the effect of hospital practice patterns on the 2-midnight presumption.

  • Recognize exceptions to the 2-midnight benchmark.

  • Describe the impact of LCD/NCD/CED criteria on inpatient coverage.

  • State the rules for “inpatient-only” procedure billing and reimbursement.

  • Describe the differences between condition codes 44 and W2.

  • Use appropriate billing codes for full Part B payment for inpatient cases, including for “self-denials.”

  • Differentiate inpatient and outpatient deductibles and co-payments.

Who Should Attend

  • Utilization review (UR) coordinators

  • Utilization management managers and directors

  • UR committee members

  • UR physician advisors

  • Case managers and care coordinators

  • Nurse managers

  • Nurse auditors

  • Compliance officers, auditors and staff

  • Revenue cycle staff

  • Revenue integrity staff


Kimberly A. H. Baker, JD, CPC, is the director of Medicare and compliance for HCPro. She is a lead regulatory specialist for HCPro’s Revenue Cycle Advisor and the lead instructor for HCPro’s Medicare Boot Camp®—Hospital Version, Medicare Boot Camp®—Utilization Review Version and HCPro’s Medicare Boot Camp®—Provider-Based Department Version. Baker is a former hospital compliance officer and in-house legal counsel with over 25 years of healthcare experience, including 10 years teaching, speaking and writing about Medicare coverage, payment and coding regulations and requirements.