HCPro Medicare Boot Camp® Utilization Review: Oct. 13-14

Time: 8:00 AM


In person at IHA's Naperville office or IHA's Springfield office via videoconferencing. The instructor will be at IHA's Naperville office. Virtual webinar participation is also an option.

The boot camp will be held from 8 a.m. to 4:30 p.m. on Oct. 13-14.


IHA Members
Individual Rate: $1,495
Group Discount: $1,395 per person for two to six registrants from one IHA-member hospital or health system
Volume Discount: $1,295 per person for seven or more registrants from one IHA-member hospital or health system

Non IHA Members
Individual Rate: $1,845
Group Discount: $1,745 per person for two to six registrants NOT from an IHA-member hospital or health system
Volume Discount: $1,645 per person for seven or more registrants NOT from an IHA-member hospital or health system

Virtual attendees must register by Friday, September 30 to ensure receipt of program materials.

Tuition covers program materials, including an extensive program workbook, as well as continental breakfast, lunch and refreshments each day for in-person attendees. Travel expenses are the responsibility of the registrant.

Register Online

IHA has partnered with industry leader HCPro to offer the Medicare Boot Camp®– Utilization Review Version course. This rigorous 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 proper compliance, correct reimbursement and stabilizing inpatient payments.

The boot camp will also address significant regulatory changes such as:

  • In 2022, the Centers for Medicare & Medicaid Services (CMS) reversed course on the inpatient-only list elimination and adopted a new strategy for auditing services removed from the inpatient only list.

  • The U.S. Department of Health and Human Services’ Office of the Inspector General also announced it would start patient status-directed audits after a seven-year hiatus.

Expand your Medicare knowledge with this expert-led program, which will:

  • Focus on the actual rules; you will learn how to find and apply CMS rules and guidelines to ensure Medicare beneficiaries are placed in the correct status and billed correctly for the services they receive;

  • Supply you with the resources and skills needed to navigate the Medicare website and to research and prioritize your Medicare questions long after the boot camp ends; and

  • Examine case studies to help you understand the concepts and apply them to real-world situations.


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

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)

Course Outline/Agenda subject to change.


At the conclusion of this educational activity, you'll be able to:

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

  • Discuss the appropriate application of ABNs for observation patients

  • State the inpatient order and certification requirements

  • Explain CMS’ 2-midnight rule benchmark

  • 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.