HCPro Boot Camp: Medicare Utilization Review Version: Oct. 5-6

Time: 8:00 AM


Participants may attend this program in person or via livestream. Options are:

IHA’s Naperville Conference Center
1151 E. Warrenville Road
Naperville, IL 60563

IHA’s Springfield Conference Center
700 S. 2nd St.
Springfield, IL 62704



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.

IHA Member Fees
Individual Rate: $1,569

Group Discount: $1,469 per person for two to six registrants from one IHA-member hospital or health system office

Volume Discount: $1,369 per person for seven or more registrants from one IHA-member hospital or health system office
Non-IHA Member Fees
Individual Rate: $1,919

Group Discount: $1,819 per person for two to six registrants from a hospital or health system office not affiliated with IHA

Volume Discount: $1,719 per person for seven or more registrants a hospital or health system office not affiliated with IHA

Virtual attendees must register by Friday, Sept. 15 to ensure receipt of program materials.

Register Online

IHA is offering industry leader HCPro’s popular Medicare Boot Camp®—Utilization Review Version as part of a multiyear commitment to members’ utilization review (UR) educational needs. The intensive two-day program focuses on Medicare rules and regulations related to patient status and the role of the 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 critical to proper compliance, correct reimbursement and stabilizing inpatient payments.

This expert-led program will:

  • Teach using the actual rules—you will learn how to find and apply rules and guidelines from the Centers for Medicare & Medicaid Services 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.

New this year: Participants will study clinical examples and resources from Livanta National Medicare Claim Review Contractor, the entity performing Medicare short stay reviews (formerly called Two-Midnight rule reviews). Expert faculty will also cover facet joint interventions/injections, the new service added to the prior authorization list in 2023.


Module 1: Medicare Program, Contractors and Resources

  • Overview of Medicare Part A, B, C and D

  • Medicare contractors, including the MAC, RAC and QIO

Module 2: Medical Necessity Rules and Policies

  • Medicare coverage, including guidelines for evaluating medical necessity

  • Medicare Coverage Center, including LCDs, NCDs and CED

  • Prior authorization for specified outpatient procedures and services

Module 3: Coverage of Observation

  • Coverage of observation services

  • Coding and billing of observation

  • Payment for observation including at PPS and CAH hospitals

Module 4: Medicare Outpatient Notices

  • The Medicare Outpatient Observation Notice (MOON)

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

Module 5: Inpatient Orders and Certification

  • Inpatient order requirements

  • Inpatient certification requirements, including 96-hour CAH certification

Module 6: Inpatient Admission Guidelines

  • Inpatient-only procedures

  • The Two-Midnight Benchmark

  • Admission on a case-by-case basis

  • Livanta Guidance, including clinical examples

Module 7: Inpatient Utilization Review and Billing Requirements

  • Utilization review requirements and self-denials

  • Concurrent review and billing with condition code 44

  • Inpatient Part B payment and billing with condition code W2

Module 8: Medicare Inpatient Notices

  • Important Message from Medicare (IM)

  • Detailed Notice of Discharge (DN)

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

Module 9: Overview of Inpatient Payment Systems and Patient Liability

  • 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)

Module 10: Outpatient Payment Systems and Patient Liability

  • Basics of the Outpatient Prospective Payment System (OPPS)

  • Encounter-based Comprehensive Ambulatory Payment Classifications (C-APCs)

  • Patient coinsurance under Part B

The course outline is subject to change.


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

  • Apply Medicare observation coverage rules

  • Evaluate the appropriate application of ABNs for observation patients

  • Comply with inpatient order and certification requirements

  • Breakdown the 2-midnight rule benchmark

  • Identify exceptions to the 2-midnight benchmark

  • Assess the effect of the inpatient-only list on utilization review and payment

  • Differentiate between condition codes 44 and W2

  • Quantify inpatient and outpatient deductibles and co-payments

Who Should Attend

  • UR coordinators

  • UR committee members

  • UR physician advisors

  • Utilization management managers and directors

  • 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 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.