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Who should attend Medicare And HIPAA Rules And Regulations
This seminar is designed for attorneys, business and office managers, compliance officers, human resource directors, health care providers, administrators, nurses, billing managers and accountants.
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Medicare And HIPAA Rules And Regulations  

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Seminar Summary:

This lecture will start with a presentation of HIPAA issues as related to Portability and Accountability, transitioned into Medicare and HIPAA, then completed with a discussion about Medicare issues and updates for 2003-2004. (see full course description)

 
 

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Training Course Syllabus:


This seminar is designed for attorneys, business and office managers, compliance officers, human resource directors, health care providers, administrators, nurses, billing managers and accountants.

The Social Security Amendments of 1965 established the national program of health insurance for the aged know as Medicare. It was the culmination of many years of national and congressional debate and was of great historic importance. The amendments also included the program Medicaid, which provided medical assistance to groups other than the elderly. Title XVIII, Health Insurance for the Aged (Medicare), has two parts:

• Part A: Hospital Insurance Benefits. This insurance program provides basic protection against the costs of hospital and related post-hospital services.

• Part B: Supplemental Medical Insurance (SMI) Benefits. This is a voluntary insurance program financed by enrollee premium payments (25%) and federal funds (75%)

Over the last three years, the government has issued many Medical updates, especially pertaining to HIPAA privacy and transmission, fraud, and reimbursement and coding, among others. This lecture will start with a presentation of HIPAA issues as related to Portability and Accountability, transitioned into Medicare and HIPAA, then completed with a discussion about Medicare issues and updates for 2003-2004.

Topics to be discussed include:

• Health Insurance Portability And Accountability Act Of 1996

• HIPAA And Patient Access To Protected Health Information

• Relevant Medicare History, Laws, And Updates

• Audits, Abuse, And Fraud Issues

• Completion Of CMS-1500 Forms And HIPAA Compliance Issues

• Medicare Compliance And Its Audit Plan

8:30 a.m. - 10:30 a.m.

I. Health Insurance Portability And

Accountability Act Of 1996

A. HIPAA Dilemma

B. HIPAA Compliance – Steps?

C. Transactions Standards And Codes Sets

D. HIPAA – FAQs

E. HIPAA For Medical Practices

F. HIPAA For Hospitals

10:30 a.m. - 10:40 a.m.

Break

10:40 a.m. - 12:00 p.m.

II. HIPAA And Patient Access To

Protected Health Information

A. Non-HIPAA Compliance Issues

B. Right Of Access To PHI

C. Anticipation Of Legal Proceeding

D. CLIA

E. Promise Of Confidentiality

F. Provision Of Access

G. Denial Of Access

H. Request Of Amendment

I. Accepting The Amendment

J. Denying The Amendment

III. Relevant Medicare History, Laws,

And Updates

A. Introduction To Medicare

B. Medigap Plans And Coverage

C. CMS Regional Offices

D. Regional DME Carriers

E. Medicare Updates 2003-2004

12:00 p.m. - 1:00 p.m.

Lunch (On Your Own)

1:00 p.m. - 2:35 p.m.

IV. Audits, Abuse, And Fraud Issues

A. Centers For Medicare And Medicaid Services

B. Office Of Inspector General, Investigations, Audit, And Analysis And Inspection

C. Medicare Carrier Background

D. Fraud And Abuse

E. HIPAA Of 1996

F. Federal Health Crimes

G. Civil Monetary Penalties

H. Fraud Defined

I. Anti-Kickback Harbors

J. Stark II

K. Breach Of Assignment

L. Exclusion From Medicare Program

M. HHS Monetary Penalties

N. HHS Permissive Exclusions

2:35 p.m. - 2:45 p.m.

Break

2:45 p.m. - 3:30 p.m.

V. Completion Of CMS-1500 Forms

And HIPAA Compliance Issues

A. CMS-1500 Completion Instructions

B. Place Of Service Codes

C. Place Of Service Definitions

D. Physician Codes

E. Type Of Service Codes

F. Services Subject To Waiver

G. Claims Adjustment Reason

H. Medicare MIA/MOA Codes

I. Reassignment Of Benefits

J. Waiver Of Liability

K. Review Of EOMB

VI. Medicare Screens, Coverage, And

Resources

A. Medicare Coverage And Limitation

B. Physician Services

C. Private Practice

D. Hospital Setting

E. Physician Directed Claims

F. Services Of A PA, NP, SW, NMW, And Other Therapists

G. Covered And Non-Covered Services

H. Medicare Prepayment Screens And Parameters

3:30 p.m. - 4:30 p.m.

VII. Medicare Hearing Process

A. Initial Determination

B. Starting The Review Process

C. Sample Review Letter

D. Medicare Hearing Process

E. Sample Notice Of Hearing Letter

F. Sample Dismissal Letter

G. Hearing Officer Assignment

H. Administrative Law Judge Hearing

VIII. Medicare Compliance And Audit

Plan

A. Compliance Plan Elements

B. Auditing And Monitoring

C. Standards And Procedures

D. Designation Of Compliance Officer

E. Conducting Training And Education

F. Developing Corrective Actions

G. Developing Lines Of Communication

H. Enforcing Disciplinary Standards

I. Sample Compliance Plan And Policy

Seminar Summary:

This lecture will start with a presentation of HIPAA issues as related to Portability and Accountability, transitioned into Medicare and HIPAA, then completed with a discussion about Medicare issues and updates for 2003-2004. (see full course description)

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