Reimbursement Boot Camp - Critical Access Hospitals

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Critical Access Hospitals receive cost-based reimbursement for services rendered to Medicare beneficiaries. CAHs benefit immensely under the cost-based reimbursement system but only if you know how to appropriately operate under this unique system. This Boot Camp is designed to provide Critical Access Hospital (CAH) leaders with a fundamental understanding of the Medicare program’s cost-based reimbursement system and strategies for obtaining all the Medicare reimbursement the CAH is entitled to under the Medicare cost reporting regulations and cost report instructions. A comprehensive understanding of cost-based reimbursement will allow hospital executives, Board members, and finance staff to develop effective, comprehensive financial and operations strategies for Critical Access Hospitals. The Advanced Session is more oriented to the financial executives, accounting personal and others within the revenue cycle function needing comprehensive knowledge on the cost report forms, data reported within the Medicare cost report, as well as reporting tactics that improve cost-based reimbursement.

Where and When

Brentwood, TN

October 15th        tbd


October 16th        tbd


October 17th        tbd


October 18th        tbd

*Please note that this event was previously scheduled for September 24 – 26, 2019

Who Should Attend

If you are one of the following healthcare leaders at your Critical Access Hospital or a system that owns or operates a Critical Access Hospital, you should attend this boot camp:

  • CFO
  • Revenue cycle and reimbursement professional
  • Controller or member of the accounting staff (and others involved in the cost report compilation process)
  • Financial Analyst
  • CEO, COO, Hospital Board member

Topics Covered

Core Sessions – October 15 & 16

During the Core Sessions, we also discuss physician fee for schedule reimbursement methodology, Medicare Rural Health Clinics and provider based clinic designations due to their importance to health care delivery in rural America. The Core Sessions are completed with a discussion of reimbursement issues specific to CAHs and that require C Suite attention to effectuate cost reimbursement strategies.

In the Core Sessions boot camp participants will learn how to:

  • Understand the Medicare cost-based reimbursement system
  • Recognize cost-based reimbursement improvements available to CAHs
  • Identify how Medicare cost-based reimbursement affects their hospital’s financial decision-making and financial results
  • Recognize the importance of each major component of the Medicare cost report
  • Introduction to the Medicare Critical Access Hospital program, its history, and CAH Medicare Conditions of Participation
  • Basic principles of cost-based reimbursement. This session summarizes the Medicare cost apportionment formulary, overview of allowable and non-allowable costs, uniform pricing rule and Medicare utilization that drives Medicare cost-based reimbursement.
  • How Medicare cost-based reimbursement affects your hospital’s financial decision-making and financial results
  • How Medicare cost reimbursements increase or decrease with changing volumes, costs, payor mix, and product mix
  • How Medicare cost reimbursements change when service lines are added or deleted and how to utilize this knowledge to make sound product line decisions
  • Overview of physician practice settings and reimbursement methodologies under the physician fee schedule reimbursement system, provider-based physician practices, and Medicare certified Rural Health Clinics and Federally Qualified Health Centers.
    • Highlights the RHC Medicare conditions of participation requirements, covered services, and basic RHC billing.
    • Explain the Medicare regulatory requirements for establishing provider-based physician practices, provider based RHCs and other provider-based type services such as Diagnostic Centers, therapy centers, urgent care centers, etc.
    • Understand the reimbursement benefits and pitfalls of establishing either a Medicare certified Rural Health Clinic or a Provider Based Clinic.
    • Identify compliance issues associated with provider-based clinics and other provider-based settings
  • The relationship between report settlements, patient volume, and hospital Medicare contractual allowances and adjustments.
  • Handful of issues specific to CAHs that require whole CAH awareness such as CAH pricing pitfalls and strategies, importance of Medical Utilization Review function in the CAH, billing issues specific to CAHs that require non accountant understanding and other developments within the CAH and rural health care in America. Some of these sessions change as CAH payment issues evolve.
  • We will finish this part of the program with general highlights of the cost report compilation and filing process as well as the overall flow of the cost report for the non-accountant.

Advanced Sessions (Attending Core Sessions is a prerequisite) – October 17 & 18

  • Review Medicare cost report forms and Medicare cost apportionment formulas within the forms. Major cost report worksheets will be discussed in detail, including compilation requirements and cost report worksheets specific to Medicare Rural Health Clinics. Attendees will comprehend the purpose of each worksheet within the cost report forms, data required to be compiled for each worksheet, and how the cost report “flows” to determine a hospitals Medicare program settlement amounts.
  • Underlying cost reporting issues that affect reimbursements and final settlement, cost reporting strategies and reporting practices that yield appropriate Medicare reimbursements will be discussed and highlighted.
  • Detailed cost reporting issues such as:
    • Cost Report Questionnaire (now incorporated into cost report, previously a separate report CMS-339)
    • Reporting requirement for patient statistics such as patient days and observation days
    • Medicare allowable cost principles, Medicare cost allocation methodology, and the Medicare cost apportionment process
    • How to review the Medicare Cost Report for overall accuracy including the cost report settlement estimates
    • Compilation and work paper compilation practices that will result in accurate and complete Medicare cost reimbursements
  • Discussions on cost-based reimbursement issues such as:
    • Physician compensation costs and allowable emergency department physician staffing costs
    • Interest costs and other capital cost issues
    • Other Medicare defined non-allowable costs
    • Cost allocation strategies that yield appropriate hospital reimbursements by minimizing cost allocation to non-reimbursable cost centers and non-cost-based reimbursed services
    • How hospital revenue reporting, charge structure, and Medicare revenues affect cost reimbursement and potential pricing strategies to minimize adverse Medicare reimbursement effects
    • Hospital facility replacement and or major renovations: estimating amount of capital costs Medicare will reimburse and methods to increase capital costs reimbursement levels
    • Proper matching of costs revenues and Medicare program revenues
    • Reviewing the Medicare cost report and key data points to always verify before filing a Medicare cost report.
  • Note: Participants will receive a copy of QHR’s cost report review checklist and other relevant handouts to assist with annual cost report compilation process.

Accreditation

Core Sessions:

Participants will earn xx.x CPE credits (TBD)

Field of Study: Specialized Knowledge
Prerequisites: Interest in understanding Medicare reimbursement methodology for Critical Access Hospitals
Who Should Attend: CFO, Revenue cycle and reimbursement professional, Controller or member of the accounting staff (and others involved in the cost report compilation process), CEO, COO, Hospital Board member
Advanced Preparation: None
Program Level: Basic to Intermediate
Delivery Method: Group Live

Learning Objectives:

  • Develop a general knowledge of reimbursement methodologies
  • Gain an understanding of Medicare Cost Reports
  • Physician Practice Settings in Rural America
  • Rural Health Clinic Certification requirements
  • Medicare Provider Based Regulatory Requirements
  • Physician Fee Schedule Reimbursement
  • Other issues specific to CAH reimbursement from the Medicare program

Advanced Sessions:

Participants will earn xx.x CPE credits (TBD)

Field of Study: Specialized Knowledge
Prerequisites: CAH Reimbursement & Medicare Cost Reporting Boot Camp Core Sessions
Who Should Attend: CFO, Revenue cycle and reimbursement professional, Controller or member of the accounting staff (and others involved in the cost report compilation process), CEO, COO
Advanced Preparation:  None
Program Level: Basic to Intermediate
Delivery Method: Group Live

Learning Objectives:

  • Develop and enhance technical knowledge of reimbursement methodologies, cost reporting requirements, underlying reporting of costs, revenues, statistics and Medicare settlement data
  • Learn all major worksheets included in the Medicare Cost Report, CMS Form 2552
  • Understand how the Medicare Costs are calculated within the cost report forms and how the various worksheets are completed and flow within the cost report
  • Technical understanding of multiple types of allowable versus non allowable costs
  • Technical understanding of the Medicare cost report forms allocate general service cost center costs to patient care and non-reimbursable cost centers within the cost report
  • Reporting of hospital patient care revenues and Medicare program patient revenues
  • How combining and reporting hospital departments into cost centers on the cost report effects Medicare cost reimbursement to the CAH
  • Reporting of Medicare program revenues, patient statistics and payment data on the appropriate worksheets and lines within the cost report forms
  • Appropriate and accepted cost allocation statistics and methodologies within the cost report

Quorum Learning Institute (QLI) is registered with the National Association of State Boards of Accountancy (NASBA) as a sponsor of continuing professional education on the National Registry of CPE Sponsors. State boards of accountancy have final authority on the acceptance of individual courses for CPE credit. Complaints regarding registered sponsors may be submitted to the National Registry of CPE Sponsors through its website: www.nasbaregistry.org.

Refunds and Cancellations:

QLI may cancel or reschedule a classroom program at its discretion due to unforeseen circumstances. We will use reasonable efforts to notify registrants of the cancellation or rescheduled date at least thirty (30) days in advance of the original classroom program. If QLI cancels or reschedules a classroom program, the registrant is entitled to:

  • a full refund of the registration fee, or
  • the right to transfer the registration fee to the rescheduled classroom program date

- You must notify customer service immediately should you be unable to attend a classroom program in which you are registered.
- Customer service may be reached at (615) 371-7979 or learning_institute@qhr.com from 8:30am – 4:30pm CST, Monday through Friday.
- Due to the nature of live events, refunds of registration fees are not covered.
- QLI will not be responsible for refunding any travel related expenses in the event of a classroom program cancellation or rescheduling.
We do offer the following:

NON-QUORUM AFFILIATED ATTENDEES

  • If your cancellation is received fifteen (15) business days or more prior to the start of the event, we will provide a credit to your account to be used on any future eligible classroom event. This credit will be good for up to one (1) year from the date of cancellation.
  • Participant(s) who cancel less than fifteen (15) business days prior to the event start date will be considered “no shows” and will not be eligible for a registration fee credit.

QUORUM AFFILIATED ATTENDEES

  • Select QLI classroom programs are included in Quorum affiliate contracts and may not have up-front registration fees. However, Quorum affiliates will be assessed a fee of $150.00 for cancellation within fifteen (15) business days of the event. This fee is charged to offset the hard costs incurred by QLI for meals and course materials.
  • For classroom programs which incur paid registration fees for affiliated attendees, the same non-affiliated attendee cancellation policy applies.

For more information regarding refunds, program cancellation policies and/or grievances please contact our client support team at (615) 371-7979 or learning_institute@qhr.com.

Presenters for this event:

This event will feature some of the best and brightest we have to offer. Click on a presenter’s name to view their bio:

VP, Regulatory & Financial Reporting
Manager, Healthcare Finance & Reimbursement