In the complex world of healthcare, maintaining compliance with federal regulations is crucial for the integrity of healthcare providers. The landscape of billing, coding, and claims processes is constantly evolving. “Mastering Compliance in Federal Health Care Program Billing, Coding, and Claims Training” is designed to equip you with the knowledge needed to navigate these complex systems with confidence. Whether you’re a seasoned professional or new to this field, this course will provide the tools necessary to ensure that your practices are in full alignment with federal requirements.
What You Will Learn:
- Accurately applying the correct billing standards
- Common coding errors that lead to compliance issues
- The processes for submitting claims to federal healthcare programs
- Potential legal consequences for non-compliance in billing, coding, and claims submission
Details:
Course length: 1 hour and 15 minutes; CME: 1.25
Languages: American English
Key features: Audio narration, learning activity, and post-assessment.
Get Certified
American Medical Compliance (AMC) is a leader in the industry for compliance, Billing, and HR solutions. To become certified, please visit us at: American Medical Compliance (AMC).
Reach out for other courses by visiting the AMC Course Library.
Title XVIII and Title XIX of the Social Security Act
Understanding Title XVIII and Title XIX of the Social Security Act is foundational for mastering compliance in federal healthcare program billing. Title XVIII, commonly known as Medicare, provides health coverage for individuals aged 65 and older. Title XIX, better known as Medicaid, offers health coverage for low-income individuals and families, including children and those with disabilities. These two titles establish the framework for billing and claims submission. In this course, we delve into the intricacies of both Medicare and Medicaid. By mastering these aspects, you will reduce the risk of errors.
Hospital Insurance (HI), Also Known as Part A
Hospital Insurance (HI), or Part A of Medicare, plays a crucial role in providing coverage for inpatient care in hospitals and certain home health services. As one of the core components of Medicare, Part A helps to cover the costs of essential medical services for eligible beneficiaries. Understanding how to bill for services under Part A is essential for compliance with federal healthcare program regulations.
Healthcare providers must be aware of the specific criteria for inpatient admissions. In this course, we will explore the key billing and coding guidelines associated with Hospital Insurance (Part A). Mastering these aspects of Part A billing and coding will help prevent costly errors.
HI Eligibility and Premiums
Hospital Insurance (HI), or Part A of Medicare, is generally provided to individuals aged 65 and older who are eligible for Social Security or Railroad Retirement benefits. This coverage is available regardless of whether beneficiaries have chosen to claim their monthly benefits. As long as individuals meet the eligibility criteria, they are automatically enrolled in Part A.
For healthcare providers, it’s essential to understand the eligibility rules associated with Part A to ensure proper billing. Knowing when a patient qualifies for premium-free Part A and the circumstances under which they may need to pay the premiums helps healthcare professionals navigate this system accurately. In this course, we will break down the eligibility requirements for premium-free Part A.
Inpatient Hospital Care
Inpatient hospital care under Medicare Part A provides coverage for individuals who are admitted to a hospital for treatment that requires an overnight stay or longer. This type of care is essential for patients who need intensive monitoring or surgery that cannot be outperformed on an outpatient basis. Inpatient hospital care typically covers services such as room and board and other necessary hospital services.
For healthcare providers, properly classifying a patient as an inpatient is critical to ensure compliance with billing requirements. Incorrectly billing for inpatient care when a patient should be classified as an outpatient can lead to denied claims and potential penalties. In this course, we will discuss the key billing and coding guidelines for inpatient hospital care. By understanding these nuances, healthcare professionals can safeguard against errors.
Medicare+Choice Plans and Eligibility
Most individuals enrolled in both Hospital Insurance (HI) and Supplementary Medical Insurance (SMI) have the option to participate in a Medicare+Choice plan. These plans allow beneficiaries to receive their Medicare benefits through private insurance companies, offering an alternative to the traditional FFS model. Medicare+Choice plans often provide additional benefits, such as prescription drug coverage and wellness programs.
For healthcare providers, understanding how to navigate the Medicare+Choice plan structure is essential for ensuring compliance. Organizations that wish to contract as Medicare+Choice plans must meet the specific requirements set by the Centers for Medicare & Medicaid Services (CMS). These include ensuring compliance with various regulatory and financial standards to ensure the claims are processed accurately. In this course, we will explore the requirements for organizations seeking to become Medicare+Choice plan providers.
