01/06/2009: DME Modifiers and Oxygen Billing
Durable Medical Equipment is dependent on the use of modifiers to ensure correct reimbursement. This session will review the DME modifiers and their specific use. Additionally, the session will offer an overview of home oxygen therapy billing requirements.

Time: 2:00PM Eastern Time

Who Should Attend: Claims Processors – Quality Improvement – Claim Supervisors – Contract Management – Educators

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02/03/2009: NCCI Edits and Modifiers
Although simple in its methodology, NCCI is a powerful tool used to identify improbable coding occurrences submitted by different types of providers.  In this audioconference, George Alex takes you inside NCCI using BRS and real-life examples to explain clearly, the specific types of edits used and how modifiers bypass these edits when special circumstances exist. Join us as we explore in detail what NCCI is, where it is used and how different types of edits are developed for specific types of coding errors.

Time: 2:00PM Eastern Time

Who Should Attend: Claims Processors – Quality Improvement – Claim Supervisors – Contract Management – Educators – BRS Trainers

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02/24/2009: Value Codes and Why We Need Them

Time: 2:00PM Eastern Time

Value codes… Who needs them??  You do.  Inclusion of value codes on specific types of claims submitted on the CMS-1450 form provides CMS the flexibility it needs to acquire the unique information needed to administer its programs.  In this audioconference, your presenter, George Alex will carefully detail how certain value codes can significantly influence the reimbursement of a wide variety of medical providers. Leaving no doubt, after completing this session, you too will understand the “value” of value codes.

Who Should Attend: Claims Processors – Quality Improvement – Claim Supervisors – Contract Management – Educators – BRS Trainers

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03/17/2009: The 2008 and 2009 Composite APC Groups

Time: 2:00PM Eastern Time

Join us to learn how BRS follows CMS guidelines in calculating the APC Composite rates.  We will explain which codes are converted into the different Composite APCs in both 2008 and 2009. We will also describe how the codes with Status Indicators Q1,Q2, and Q3 are priced. This Knowledge Break will increase you understanding of APC Composite pricing, which CMS has indicated will be significantly increased in future OPPS updates.

Who Should Attend: Claims Processors – Quality Improvement – Claim Supervisors – Contract Management – Educators – BRS Trainers

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 04/07/2009: How to Bill Partial Hospitalization and Mental Health Services

Time: 2:00PM Eastern Time

Join us to learn about APC pricing for mental health services, both in Partial Hospitalization Programs and in a general NonPartial  hospital outpatient settings. Learn which codes are considered mental health services and how these codes are priced with or without Condition Code 41. We will also discuss in detail the numerous OCE edits for mental health services.

Who Should Attend: Claims Processors – Quality Improvement – Claim Supervisors – Contract Management – Educators – BRS Trainers

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04/28/2009: ICD-10: Positioning Your Organization for Success

Time: 2:00PM Eastern Time

After years of delays, the final rule has been published for ICD-10 with October 2013 being the final date by which all organizations must be compliant.  While many have ignored or minimized the impact of the change to ICD-10 until a final date was set, the future is here and industry leading organizations have already begun assessments of what will be needed for compliance.  In this audioconference, Charlie Nostrand will explain the differences between ICD-9 and ICD-10,  what they mean to your organization, and how the change can actually add value to your healthcare delivery activities. He will also help you understand the impact to each of your organizations constituents, internal and external, and steps you need to take now to assure that each of them will be ready for the 2013 date.

Who Should Attend: Claims Processors - Quality Improvement - Claim Supervisors - Contract Management - Educators - BRS Trainers

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05/19/2009: Outpatient Code Editor

Time: 2:00PM Eastern Time

Join us to learn about the Outpatient Code Editor (OCE). Learn the history of OCE.  Increase your knowledge regarding the number and types of edits. How many edits are currently active? What are the edit dispositions?  Which edits do we receive the most questions about? These and other questions will be addressed by Frank Camozzi during this informative session.

Who Should Attend: Claims Processors - Quality Improvement - Claim Supervisors - Contract Management - Educators - BRS Trainers

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06/9/2009: The Ever-Changing Provider Specific File

Time: 2:00PM Eastern Time

At the core of BRS software is a dynamic set of data developed by CMS called the Provider-Specific File (PSF).  Rich in content, this information is used in payment calculation in a variety of ways. In this program lead by George Alex, you'll discover how the information is organized, which columns are used for what purpose.  You'll gain a better understanding of how CMS uses the provider specific file for everything from assigning the wage index to determining whether special payment adjustments apply.  Also, you'll see how this information can change on a daily basis, ultimately affecting payment.

Who Should Attend: Claims Processors - Quality Improvement - Claim Supervisors - Contract Management - Educators - BRS Trainers

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06/30/2009: Dynamics of Medically Unlikely Edits

Time: 2:00PM Eastern Time

Unit billing is commonly used in conjunction with certain HCPCS codes.  However, depending upon the associated HCPCS description involved, exceeding a certain number of units for a given code is highly unlikely or even impossible.  That's where medically unlikely edits come in.  Medically Unlikely Edits (aka MUEs) are commonly used to identify the inappropriate allocation of units for a specific HCPCS codes.  In this program, George Alex will explore how MUEs are used based upon how the code is identified.  This includes time designation, laterality designation and other anatomic considerations, as well as, identification of "each additional" in the code description.  Upon completion, of this program, you will have a better understanding of not only how the MUEs are applied, but why the MUE was applied, as well.

Who Should Attend: Claims Processors - Quality Improvement - Claim Supervisors - Contract Management - Educators - BRS Trainers

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07/21/2009: Idiosyncrasies of Ambulance Payment

Time: 2:00PM Eastern Time

Although simple in its methodology, the payment of ambulance services includes unique characteristics that are not encountered with other provider types.  In this program, George Alex will review the specific methodology used to determine base rates and mileage including differences in how ground ambulance and air ambulance are calculated.  Additionally, we'll define terms unique to ambulance such as point of pick-up, and differentiate other terms used in the ambulance setting such as the difference between ambulance services and patient transportation.  Finally, we will explore some of the more confusing areas of ambulance billing including billing for a point of pick up outside of the United States, pricing in cases where the patient expired prior to the arrival of the ambulance, or pricing in circumstances where more than one trip was involved on the same day.

Who Should Attend: Claims Processors - Quality Improvement - Claim Supervisors - Contract Management - Educators - BRS Trainers

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08/11/2009: Rural Health Centers and Federally Qualified Health Centers... What Are They and How Are They Paid

Time: 2:00PM Eastern Time

Health care rendered in the rural setting can often involve two different programs with unique billing requirements.  Established in 1977 to address an inadequate supply of physicians who serve CMS beneficiaries in rural areas, the Rural Health Center program provides qualifying Clinics located in rural and medically underserved communities. Newer to the CMS system, the Federally Qualified Health Center (FQHC) program was designed to enhance the provision of primary care services in underserved urban and rural communities. Join George Alex as we gain a better understanding of these two programs including insight into the specific policies used to pay for services rendered.

Who Should Attend: Claims Processors - Quality Improvement - Claim Supervisors - Contract Management - Educators - BRS Trainers

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09/01/2009: The APC and ASC Payment Methodologies - Differences and Similarities

Time: 2:00PM Eastern Time

Similarities between the services paid in an ambulatory surgical center (ASC payment methodology) and those paid in the outpatient hospital setting (APC payment methodology) has resulted in confusion and conflation of the policies and procedures that apply to both.  However, stark differences between these provider-types exist.  Join your speaker, George Alex as he explores both the similarities and differences between the ASC and APC payment systems.  At the completion of this session, you’ll have a clear understanding the payment methodologies used in both the ASC and outpatient hospital settings.

Who Should Attend: Claims Processors – Quality Improvement – Claim Supervisors – Contract Management – Educators – BRS Trainers

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09/22/2009: Multiple Procedure Reductions in Professional, ASC, and Hospital Outpatient

Time: 2:00PM Eastern Time

Double the number of services performed at the same encounter does not always mean twice as much cost.  For example, many of the services that are integral to the first procedure do not need to be duplicated when an additional procedure is performed.  To account for this reduction in value, Medicare applies a multiple-procedure reduction to secondary procedures for some provider types.  Join your speaker, George Alex as he examines these policies in detail, identifying when and how these reductions are applied, as well as, any exceptions that may exist.

Who Should Attend: Claims Processors - Quality Improvement - Claim Supervisors - Contract Management - Educators - BRS Trainers

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10/13/2009: Changes to the Inpatient Rehabilition Facility and Skilled Nursing Facility Prospective Payment Systems in Fiscal Year 2010

Time: 2:00PM Eastern Time

Are you ready for the changes to the IRF and SNF programs in fiscal year 2010?  Final rules published in the Federal Register identify significant changes to both programs effective for discharges on or after October 1, 2009.  The final rule for IRF published in the Federal Register on August 7, 2009, includes big changes to the factors, exponents and other amounts used to calculate IRF payment.   This includes some values  that rarely changed and even includes one that had not changed since the program's inception.  The rule also clarifies and modifies existing regulations, including new provider requirements when Medicare Advantage plans are involved.  In the SNF Final Rule published on August 11, 2009, recalibration of the case mix indexes will result in a reduction in Medicare payments to skilled nursing facilities of over $360 million for the new fiscal year. Other changes for SNF include a revised case-mix classification methodology (RUG-IV) with an implementation schedule for FY 2011.  Join your presenter, George Alex, as he guides you through the morass of changes in these two decidedly complex Medicare payment systems.

Who Should Attend: Claims Processors - Quality Improvement - Claim Supervisors - Contract Management - Educators - BRS Trainers

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11/03/2009: Changes to the Inpatient and Long-Term Care Hospital Prospective Payment System in Fiscal Year 2010 (Including Changes to DRG Grouping)

Time: 2:00PM Eastern Time

11/24/2009: Out of the Frying Pan (and into the fire): Payment for Interfacility Transfers

Time: 2:00PM Eastern Time

In today’s medical environment it is essential that the most effective care is delivered in the most efficient way.  This often involves transferring a patient from one institution to another and this can have special relevance when determining the associated payment. Whether it is through assignment of a special DRG or the recalculation of payment based upon average length of stay, in this program we’ll clearly demonstrate how interfacility transfer can ultimately affect payment for each of the different provider types.

Who Should Attend: Claims Processors - Quality Improvement - Claim Supervisors - Contract Management - Educators - BRS Trainers

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12/15/2009: Coding and Billing of Observation Status for the Facility and the Professional

Time: 2:00PM Eastern Time

Often mistakenly viewed as a physical location within the hospital, observation status denotes a unique designation that includes special billing requirements for the hospital, as well as, the professional who provides services within the hospital.  Occurring over a course of one or more days, a patient who originates in the clinic or emergency department may transfer into observation status and may ultimately be admitted to inpatient status.  Depending upon how and when these circumstances occur, the associated billing can vary widely.  Join us as we follow several cases through the observation status process with an emphasis on the specific coding and billing issues more commonly encountered in both the facility and professional provider setting.

Who Should Attend: Claims Processors - Quality Improvement - Claim Supervisors - Contract Management - Educators - BRS Trainers

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