Medicare Compliance for Healthcare Personnel (Online CE Course)

(based on 393 customer ratings)

Author: Christopher Young
Reviewer: Laurie Bjerklie, MA, MLS(ASCP)^CM

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This course covers all elements of a successful Medicare compliance program. LMRPs, ABNs, coding, and requisitions are given full treatment. Special sections for billing departments, managers, and sales / marketing departments emphasize requirements specific for these areas. Ten case studies allow employees to practice their knowledge and get feedback. This course is ideal for front line healthcare workers, sales, and clerical staff.

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Objectives

Define voluntary compliance program and discuss the elements that should be included.
Identify the Medicare laws and regulations.
Identify compliance problems and issues.
Explain each of these terms or processes that are related to Medicare reimbursements: medical necessity, International Classification of Diseases (ICD) coding, Current Procedural Terminology (CPT) coding, and Advance Beneficiary Notice.
State the responsibilities of administration, management, employees, and the billing department that are related to Medicare compliance.

Customer Ratings

(based on 393 customer ratings)

Course Outline

Click on the links below to preview selected pages from this course.

Voluntary Compliance Program

Introduction

What is a Voluntary Compliance Program?

Seven Elements of a Compliance Program

Seven Fundamental Elements of a Voluntary Compliance Program
Element 1
Element 2
Element 3
Element 4
Element 5
Element 6
Element 7
Your health care facility has a compliance officer (CO) and a Compliance Committee. Which of the following statements is true regarding the individual...

Laws and Regulations

Laws and Regulations Applicable to Medicare
The law that prohibits healthcare providers and payers from improperly or inappropriately using a patient's confidential health information, requires ...

Compliance Issues

Confidentiality

Confidentiality
Case Study

Billing

Inducements

Kickbacks and Inducements

Documentation

Documentation

Whistleblowers

Whistleblowers

Processes and Issues Related to Medicare Reimbursement

Medical Necessity

Medical Necessity

Advance Beneficiary Notices

Advance Beneficiary Notice
Advance Beneficiary Notice, continued
ABN Form CMS-R-131

Coding

International Classification of Diseases Coding
ICD-10 Clinical Modification/Procedure Coding System Coding
HCPCS and CPT Coding

Responsibilities for Medicare Compliance

Administration's Responsibilities
Management Personnel Responsibilities
Billing Department
Case Study
Employees' Responsibilities

References

References

Additional Information

Level of Instruction: Basic

Intended Audience: All healthcare personnel.

Author Information: Christopher Young, of Laboratory Management Support Services, Phoenix, AZ, is an independent consultant and nationally recognized speaker and expert currently specializing in compliance, sales and marketing, and customer service, as they pertain to clinical laboratories. He has extensive first-hand laboratory experience, in positions ranging from phlebotomist to decision support coordinator, and in his consulting practice.

The author has no conflict of interest to disclose.

Reviewer Information: Laurie Bjerklie, MA, MLS(ASCP)^CM, is a Lead Education Developer. She earned a B.S. in Medical Laboratory Science from the University of North Dakota and an M.A. in Curriculum and Instruction from Saint Xavier University. She has over 15 years of experience in higher education and has held program director and faculty positions in both MLT and MLS programs.