Medicare Compliance for Healthcare Personnel (Online CE Course)

(based on 465 customer ratings)

Author: Christopher Young
Reviewers: Barbara Cebulski, MS, MLS(ASCP) and Alexandru Casapu, MBA, MLS(ASCP)^CM, PBT^CM

How to Subscribe

Individual course

$25

Add to cart

Need multiple seats for your university or lab? Get a quote

Users Also Bought

MLS & MLT Comprehensive CE Package

Exam Simulator (MLS, MT, MLT)

Histology CE Package

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.

See all available courses

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; Advance Beneficiary Notice.
State the responsibilities of administration, management, employees, and the billing department that are related to Medicare compliance.

Customer Ratings

(based on 465 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 healthcare facility has a compliance officer (CO) and a Compliance Committee. Which of the following statements is true regarding the individuals...

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

Kick-Backs and Inducements

Documentation

Documentation

Whistleblowers

Whistleblowers

Processes and issues related to Medicare Reimbursement

Medical Necessity

Medical Necessity

ABNs

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

Coding

International Classification of Disease (ICD) Coding
International Classification of Diseases, 10th Edition, Clinical Modification /Procedure Coding System (ICD-10-CM/PCS) 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

Intended Audience: All healthcare personnel.

Level of Instruction: Basic

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.

Reviewer information: Barbara Cebulski, MS, MLS(ASCP) has over 40 years of experience in the medical laboratory profession as a technologist, section supervisor, and laboratory manager. She was an Inspection and Technical Specialist for nine years with the College of American Pathologists in the Laboratory Accreditation Program and, until her retirement in 2015, was Program Director for MediaLab, Inc. Barbara holds a Masters in Instructional Technology from Georgia State University.

Reviewer Information: Alexandru Casapu, MBA, MLS(ASCP)^CM, PBT^CM has over 20 years of experience as a medical laboratory scientist, section supervisor, and laboratory manager. He is currently a Program Director at MediaLab, Inc. Alexandru holds BS degrees in Biology and Medical Technology from Clark Atlanta University and an MBA from the University of Georgia.