Self-Administered Drugs
Master Billing Complexities and Avoid Compliance Pitfalls
Product Description:
AUDIO CONFERENCE ON CD OR ON-DEMAND
Sponsored by: Medicare Boot Camp® - Hospital Version
Presented on October 11, 2011
Medications that can be self-administered (such as insulin) are usually not covered under Medicare Part B, with few exceptions. Deciding when to bill Medicare and when to directly bill outpatients for non-covered self-administered drugs can be difficult, yet merely writing off the charges entails compliance risks.
During this two-hour audio conference, our expert speakers outline CMS rules, payment and billing guidelines, and strategies to improve your billing practices and help patients better understand why they are being billed for these non-covered drugs.
Note: This is an intermediate level program. Listeners should have knowledge of outpatient coding and types of drugs (e.g., over-the-counter, oral, topical, and self-injectable)
Learning Objectives
- Explain more clearly to patients why their SADs are not covered
- Explain the differences between Part B and Part A coverage rules for SADs
- Identify SADs that cannot be billed directly to the patient.
- Create compliant billing procedures for SADs5. Identify when to waive collection of non-covered SADs and not trigger anti-kickback rules
Agenda
- Self-administered drugs (SAD)
- Definition
- Part B coverage rules
- Part A Differences
- Changes to the Part B benefit over time
- Part D coverage impact
- Voluntary waiver notices
- Definition
- Correct billing of SADs
- Revenue codes
- Modifiers
- Hospital collection of non-covered SAD and waivers
- .Discounting and pricing structure
- Informing and billing patients
- Safety/operational considerations to patients bringing their own medications to the hospital
- Anti-kickback liability
- Implications for Medicare Advantage plans
- A questions and answer session follows the presentation.
BONUS TOOLS INCLUDED IN YOUR MATERIALS PACKET:
In addition to the expertise and advice presented during this audio conference, you’ll also receive a slide presentation of the program materials and tools, including:
- High-level PowerPoint suitable for presentation to the board of directors
MEET THE SPEAKERS
Kimberly Anderwood Hoy, JD, CPC, is the director of Medicare and compliance for HCPro, Inc. She is a lead regulatory specialist for HCPro’s Revenue Cycle Institute and is the lead instructor for HCPro’s Medicare Boot Camp® – Hospital Version and Medicare Boot Camp® – Critical Access Hospital Version.
Valerie A. Rinkle, MPA, is revenue cycle director for Asante Health System in Medford, OR. She has more than 20 years of healthcare reimbursement experience including 11 years in nationwide consulting to hospitals and physicians regarding Medicare and Medicaid payment systems and compliance.
CONTINUING EDUCATION CREDITS
AAPC: This program has prior approval of AAPC for 2.0 Continuing Education Units. Granting of this approval in no way constitutes endorsement by AAPC of the program, content or the program sponsor.
AHIMA: This program has been approved for 2.0 continuing education unit for use in fulfilling the continuing education requirements of the American Health Information Management Association (AHIMA).
Please note the expiration date for this audio is 10/11/12.
WHO SHOULD LISTEN?
Revenue cycle managers/directors and staff ; outpatient coders/billers, compliance officers/staff, auditing professionals, pharmacy managers, chargemaster managers and staff, patient relations, risk management, CFO, patient safety
AUDIO ON-DEMAND
Purchase a CD or an audio on-demand of the audio conference and listen when you can. It's also a perfect training tool for new staff or as a refresher for veteran staff.
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