HCM Marketplace

AUDIOCONFERENCE ON CD OR AUDIO ARCHIVE

Sponsored by Medicare Boot Camp – Hospital Version

presented on October 24, 2007

Medicare’s “incident-to” requirements are often viewed as a physician billing issue. However, Medicare has a separate set of “incident-to” requirements that specifically apply to hospitals—particularly in the emergency department and outpatient clinic settings. A hospital’s failure to fully comply with the hospital “incident-to” billing requirements can have serious consequences. Noncompliance could cost your facility reimbursement to which it is legally entitled—or worse—expose your organization to false claims liability.

Listen to Medicare coding and billing expert Hugh E. Aaron, MHA, JD, CPC, CPC-H, and revenue cycle management specialist William L. Malm, ND, RNfor this 90-minute audioconference “Hospital Incident-To Requirements: Limits on Medicare coverage for ED and clinic visits.”

Our speakers explain the requirements that hospitals must meet in order to qualify for “incident-to” coverage, including the physician ordering, physician supervision, and physician follow-up requirements.    They also address the top "incident-to" compliance challenges for hospitals, as well as strategies to ensure full and appropriate Medicare payment for emergency department and clinic visits.

At the end of this audioconference, you and your staff will be able to:

• Identify the requirements that hospital’s must meet in order to qualify for “incident-to” coverage by Medicare
• Avoid false claims liability in the emergency department and outpatient clinics
• Recognize how to capture all appropriate emergency department and clinic revenue

AGENDA

• Application of “incident-to" to hospital outpatient services
• Overview of hospital “incident-to” coverage requirements
• Why “incident to” matters - financial and compliance ramifications
• When “incident-to” requirements must generally be met in order to obtain Medicare coverage
• When it is not necessary to meet “incident to” requirements in order to obtain Medicare coverage
• Specific “incident-to” requirements − including technical nuances  
• Provider-based setting requirement
• Physician ordering
• Physician supervision (on-campus and off-campus provider-based)
• Physician follow-up
• Differences between the “incident-to” rule applicable in a hospital setting v. a physician practice setting
• Differences between the two “incident-to” rules
• How to apply the rule in different settings
• Special incident-to challenges
• Patient self refers
• Patient leaves without seeing physician
• Patient fails to follow-up with physician
• Patient being treated by non-physician practitioner
• Clinic fails to meet provider-based requirements
• No physician present at off-campus clinic
• “Incident to plus” requirements − scenarios where merely meeting incident-to isn’t enough
• Hypobaric Oxygen?
• Cardiac Rehab?
• Other?
• “Incident to” Case Study
• Off-campus clinic - patient sees physician
• Off-campus clinic - patient does not see physician
• Q&A session

MEET THE SPEAKERS

Hugh E. Aaron, MHA, JD, CPC, CPC-H, is HCPro's senior vice president for compliance and regulatory affairs/regulatory counsel. Prior to joining HCPro, he practiced health law for approximately 13 years and was the founder and president of HRAI Coding Specialists, LLC, a national training firm. Mr. Aaron’s work focuses primarily on coding and billing accuracy with a particular emphasis on Medicare billing compliance.

William L. Malm, ND, RN, is the practice director for Revenue Cycle Management Consulting and the Center for Revenue Cycle Excellence within the consulting division at HCPro, Inc. He has more than 20 years of experience in a combination of clinical and financial healthcare, including as a compliance officer, revenue cycle specialist, and chargemaster specialist. He has clinical experience in emergency services, cardiac care nursing, cardiothoracic post-operative care nursing, and oncology and has presented at numerous national seminars on OPPS. 

WHO SHOULD LISTEN?

• Compliance officers
• Revenue integrity officers
• Billing office professionals
• Clinic and emergency department staff
• Chief financial officer
• Reimbursement professionals
• Internal auditors
• Coding professionals

PROGRAM MATERIALS
Audioconference materials are provided with PDF links.

NEW PURCHASE OPTION: Audio Archive

In addition to the regular purchase options for HCPro audioconferences, audio CD, we are pleased to offer a new option, an audio archive. An audio archive allows you to download the program and play it back at your convenience on your computer or MP3 player. Purchase a CD or audio archive of the program and listen when you can. It's also a perfect training tool for new staff or as a refresher for veteran staff.

• Audioconferences

• Other Corporate Compliance Products