Understanding the world of utilization review in Medicare is difficult. The Medicare manuals are thousands of pages long and written in ways that even seasoned professionals have a hard time understanding. Many enter the field from clinical positions and are well acquainted with ordering and providing patient services but are completely unaware of the actual regulations and payment methods. Most teaching is done on the job leading to errors, misunderstandings, denials, and unhappy patients.

In this essential RACmonitor webcast, Dr. Ronald Hirsch will present the basics of Medicare that clinicians need to know to be successful as utilization review professionals. He’ll break down what Medicare does and doesn’t pay for, what services Medicare provides and how hospitals get paid for providing those services – including both inpatient and outpatient. Plus, you’ll learn how claims are prepared and how much patients must pay for their care. You’ll walk away with a new understanding of these issues and be better equipped to talk to patients, to their medical staff, and to their administrative team.

Why This Is Relevant:

Although clinicians are well acquainted with ordering and providing services, many are unaware of actual regulations and payment methods, resulting in errors, misunderstandings, claim denials and unhappy patients. Understanding what services Medicare provides and how hospitals get paid for providing those services is crucial to the success of the hospital and the person as a utilization review professional.

Learning Objectives:

• Understand the Medicare benefits available to beneficiaries
• Describe the differences between Medicare and Medicare Advantage
• Demonstrate the payment methods for inpatient and outpatient hospital care
• Explain Medicare fee schedules and demonstrate their use
• Understand the use of modifiers and condition codes

Who Should Attend:

Those who will benefit most from this webcast include those in utilization review, revenue cycle, revenue integrity, case management and compliance, as well as chief financial officers, physicians and physician advisors, and billing and coding professionals.