Campus Catalog

Below are the offerings in our Campus, at this time. Members can access the Lecture Hall pages to watch any course, by scheduling a webinar broadcast, which allows the student to ask questions at any time. To register for a webinar, choose a course below, go to the Lecture Hall link shown, and choose the tab “Watch The Webinar” to choose your day and time. Each Lecture Hall page includes instructions for downloading Handouts, asking questions and getting your CEU Certificates.

CEU Availability
All courses listed below are available for viewing. CEUs are available as listed on each Lecture Hall page. Some CEUs are not yet approved when the course is posted, but this usually occurs within 30 days of being posted here. If you watch a course before it is approved, we will automatically send you the CE Certificate by email as soon as it becomes available.

  Click Here for Course Catalog “Quick Views”


Courses in Alphabetical Order

OP Surgery During our anatomy lesson of surgical coding, we will be discussing the global surgical package; documentation of surgical services; use of surgical modifiers; dissection of some operative reports, and finally we will end with some surgical coding tips.

This course authored by [modal id=”2786″ style=plain color=default size=default]Stephanie Albright[/modal].

Course Topics:

  • Understanding the global surgical package
  • Components of global surgery, including what is and what is not included
  • Components of operative notes
  • Surgical modifiers
EnterTheLectureHall

HA121-Drugs In this course the student will focus on proper reporting and reimbursement of drugs and biologicals provided in the outpatient hospital and physician setting under the Medicare program.We will look into how physicians and hospitals should report as well as process considerations for reporting drugs and biologicals.

This course authored by [modal id=”2794″ style=plain color=default size=default]Paula Digby[/modal].

Course Objectives:

  • Coding & billing under OPPS
  • Coding & billing for physician claims
  • Discuss how errors occur and how to prevent these errors
  • Review each of the RACs focus areas
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RRSD312-AssessRisk In this course the student learns to use PEPPER reports and data analysis techniques to enhance compliance efforts.

This course authored by [modal id=”2803″ style=plain color=default size=default]Dr. Ralph Wuebker[/modal].

Course Objectives:

  • PEPPER Report usage and recent updates
  • How to use data analysis and benchmarking
  • How to calculate Reserves based on risk
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HG607-ICD9-1 In this course the student will gain an understanding of volumes 1 and 2 of the ICD-9-CM classification system in order to appropriately assign diagnosis codes in the outpatient setting. Diagnosis coding process including coding conventions, coding guidelines and specific examples will be discussed.

This course authored by [modal id=”2861″ style=plain color=default size=default]Paula Digby[/modal].

Course Objectives:

  • Structure of ICD-9-CM, including organization and contents of volumes 1 and 2.
  • Coding conventions, definitions, symbols, punctuation, cross references and notes.
  • A discussion of general coding.
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HG608-ICD9-2 In this course the student will gain an understanding of volumes 1 and 2 of the ICD-9-CM classification system in order to appropriately assign diagnosis codes in the outpatient setting. Diagnosis coding process including coding conventions, coding guidelines and specific examples will be discussed.

This course authored by [modal id=”2862″ style=plain color=default size=default]Paula Digby[/modal].

Course Objectives:

  • Understand chapter specific guidelines, including appropriate use of tables, definitions, sequencing.
  • Understand coding guidelines for diagnosis selection in an outpatient setting, including ambulatory surgery, observation stay, diagnositic and therapeutic service encounters.
  • Understand relationship to medical necessity, documentation and reimbursement.
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RRSA312-SwatTeam In this course the student will gain a high-level overview of what kind of audits and auditors are out there, making trouble for providers. They will also learn to use various methods to quickly respond to these audits, and how to prepare for them with a competent, prepared team of key personnel, equipped to handle whatever comes at them.

This course authored by [modal id=”2853″ style=plain color=default size=default]Dr. Ralph Wuebker[/modal].

Course Topics:

  • Review the types of audits/reviews in the industry today
  • Overview of the different types of auditors and how they work
  • Best practices to handle each audit type
  • How to setup your own team to best handle it all
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HA128-Appeals The guidebook on how to appeal RAC determinations. Includes timelines, responsibilities, recommendations and a Q&A session..

This course authored by [modal id=”2863″ style=plain color=default size=default]Paula Digby[/modal].

Course Topics:

  • Overview of the RACs and the process of appeals
  • Discussion of each level of appeals
  • Time frames for provider and RAC
  • Excluded claims and self – reporting
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RRSD312-ABRebill This course offers a methodology on how to determine the value of rebilling an Inpatient claim as Outpatient. Originally, it was created to help providers decide how to judge their continued participation in the CMS AB Rebill Demonstration. Now, however, it serves as a good primer on how to judge the value of either appealing a Part A claim or rebilling it as Part B Inpatient.

This course authored by [modal id=”2808″ style=plain color=default size=default]Mike Frith[/modal].

Course Topics:

  • Overview of the concept – the Carrot & the Catch
  • Discussion of results in the project
  • How to evaluate the difference in payments and costs
  • Examples from four hospitals in the project
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HG602-CPT In this course the student will gain an understanding of the CPT procedure coding classification system in order to appropriately assign codes for physician and hospital outpatient services. Procedure coding process including classification structure, coding conventions and specific examples will be discussed.

This course authored by [modal id=”2864″ style=plain color=default size=default]Paula Digby[/modal].

Course Topics:

  • Structure of CPT, including organization, content of the classification system, terminology and code format.
  • CPT Coding Conventions, including guidelines, notes, symbols, unlisted codes and modifiers.
  • Relationship to documentation.
  • Relationship to reimbursement, including payment systems for physicians and hospitals for outpatient services.
  • Relationship to documenting medical necessity and its effect on billing and reimbursement
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RRSA312-DenialProc This course offers a complete overview of a successful, working, comprehensive denial processing system in an above average size hospital, presented by one of the key architects of the system, a Physician Advisor with a very successful (97%) win rate for Medicare appeals of medical necessity denials.

This course authored by [modal id=”2811″ style=plain color=default size=default]Dr. Jeffrey Epstein[/modal].

Course Topics:

  • Medicare, Medicaid and Commercial Payer denial management processes
  • Complete Process Diagrams
  • Multiple department interactions
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HA126-SOW In this course the student will learn about all the topics covered in the RAC Statement of Work, as posted by CMS. Included are the important areas, such as what kinds of improper payments RACs and will not pursue, how they will make Records Requests, what kinds of time frames are involved, who is watching the RACs, and how the RACs will work with CMS during the appeals process.

This course authored by [modal id=”2865″ style=plain color=default size=default]Paula Digby[/modal].

Course Objectives:

  • Explain what the RACs will and will not review.
  • Identify the limits that have been placed on the RACs by the SoW.
  • Describe how RACs will handle underpayments, overpayments, payment adjustments and appeals.
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RRSC312-CDI_helps This course presents a real example of a working CDI program in an average size hospital, and is presented by the program manager. She explains how to create a team, who is in it, and how it is effecting their complete denial management system.

This course authored by [modal id=”2815″ style=plain color=default size=default]Carol Murphy[/modal].

Course Objectives:

  • Identify the team members needed
  • How to maintain a RAC-Ready CDI team
  • Discussion of CDI’s role in helping develop denial prevention tools
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HA119-OPRehab2 As more and more of our healthcare services are scrutinized, what are the appropriate options to consider when documenting, coding and billing outpatient rehab services? In this session the student will hear of the conditions of coverage, a discussion on timed and untimed services and more.

This course authored by [modal id=”2866″ style=plain color=default size=default]Paula Digby[/modal].

Course Topics:

  • General  coverage policies
  • Appropriate Capture of Services including coding, modifier use, and billing of services
  • Takeaways from an auditor’s perspective
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RRSD312-MedPAR MedPAR data is greatly underused, but can be highly effective for reducing RAC denials and takebacks. In this course, the student will learn to PROactively use the data already available via MedPAR, to analyze your own hospital’s peer groups date, CC/MCC rates, ALOS and Case Mix.

This course authored by [modal id=”2819″ style=plain color=default size=default]Gene Krantz[/modal].

Course Topics:

  • Narrow down peer groups
  • Analyze CC/MCC capture rates
  • Compare ALOS, Case Mix and payment data
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HG616-Ready Every provider of healthcare services will be required to utilize the ICD-10 coding system in only three short years. What should your organization be doing NOW to make this transition happen more smoothly and with less difficulty and greater revenue integrity?.

This course authored by [modal id=”2858″ style=plain color=default size=default]Stephanie Albright[/modal].

Course Objectives:

Stephanie Albright brings a checklist with timelines to assist as you go forward.

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RRSB312-IPvOBS The student will learn to readily distinguish between and proactively analyze the documentation of IP and OP procedures and surgeries performed, which has become a major focus of RAC Audits. They will also learn to use Observation correctly, in coding and billing, as taught by a practicing Physician Advisor.

This course authored by [modal id=”2822″ style=plain color=default size=default]Dr. Steven Meyerson[/modal].

Course Topics:

  • Understanding the distinction between IP vs OP surgery & procedures
  • Analyzing how the RACs and other auditors view the “medical necessity” for these claims
  • Documentation necessary for compliant claims of this type
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RRSA312-Interest This course takes the student through the process of calculating interest payments due, related to RAC takebacks. The process is explained for interest in both directions – for the payer and for the provider, when appropriate.

This course authored by [modal id=”2825″ style=plain color=default size=default]David Dessen[/modal].

Course Topics:

  • How to know who owes what to whom
  • How to calculate anhy interest due, based on the laws & regulations
  • How to know when it is due, one way or the other
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RRSC312-CDI_Prepay The course explains areas that are being audited by RACs and MACs in prepayment audits, highlighting the most common deficiencies in medical documentation. Based on that, plans are discussed for avoiding these problems, both via internal prebill audits and in retrospective audits and processes that assist in supporting proper compliance with audit requests coming from both RACs and MACs.

This course authored by [modal id=”2829″ style=plain color=default size=default]Barbara Flynn[/modal].

Course Objectives:

  • Identify common deficiencies leading to prepayment denials
  • Plans to insure clinical documentation supports appropriate level of care and services provided
  • Plans for supporting prebill audits and audit requests from RACs and MACs
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RRSC312-MedicaidRACs This course helps you get your organization ready for the State Medicaid RACs, looking at the most recent developments in the reimbursement environment. It also offers practical considerations needed to survive in the current system.

This course authored by [modal id=”2832″ style=plain color=default size=default]Sara Kay Wheeler[/modal].

Course Objectives:

  • Discussion of recent trends in Medicaid reimbursement
  • A look at all the different contractors auditing for Medicaid, and their differing roles
  • Plans for compliance to successfully navige the Medicaid audit & dispute landscape
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RRSA312-RecoupStrat Medicare reimbursements are hard enough to get in the first place, but even more difficult to get when payment adjustments are made by Medicare contractors. Plus, the Periodic Payment system (PIP) adds even more issues. This course goes over several important topics about getting recouped, the way Medicare communicates it all, and what happens when IP claims are denied due to inappropriate medical setting.

This course authored by [modal id=”2834″ style=plain color=default size=default]Stewart Presser[/modal].

Course Objectives:

  • Navigating RAC reimbursement adjustments
  • PIP Payment system issues
  • Medicare Demand Letters
  • How Medicare issues refunds to providers
  • ALJ decisions changing IP to OP
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HF313-HotSpots2 The course gives an overview and case examples of key areas of concern found throughout the RACs pilot project. Suggestions and ideas regarding specificity and clarity in documentation are discussed.

This course authored by [modal id=”2867″ style=plain color=default size=default]Paula Digby[/modal].

Course Objectives:

  • Overview of RACs program
  • Discussion of RACS potential focus areas such as Medical Necessity, documentation and coding
  • Determining how to assess your current coding & documentation to be prepared for the RAC Audits and
  • Ideas on implementing strategic changes to comply & defend going forward.
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RRSB312-Keys In this course, a Nurse Auditor/Attorney reviews her experience at winning 99% of their appeals of Medicare RAC denials for medical necessity. Good strategies are given for filing level 1 & level 2 appeals, in an easy way, getting ready to file the 3rd level of appeal and going to the Administrative Law Judge level, where you have the best chance to win your appeals.

This course authored by [modal id=”2837″ style=plain color=default size=default]Julie Brown[/modal].

Course Objectives:

  • Overview of AHA RACTrac statistics
  • Discussion of barriers to filing appeals
  • How to overcome the barriers and provide a comfort level for filing appeals
  • Strategy for appeal letter templates and getting to the ALJ/3rd level of appeal
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AA311-2Dx The correct secondary diagnoses can impact reimbursement for your facility. Add it inappropriately and cause a myriad of difficulties. Omit it inadvertently and cost your facility much needed revenue. What are the RACs looking for in the secondary diagnoses fields? This course is retained as a valuable source of historical information.

This course authored by [modal id=”2868″ style=plain color=default size=default]Paula Digby[/modal].

Course Objectives:

  • Brief discussion of OP secondary diagnoses.
  • Discussion of diagnosis selection relevance to RACs.
  • Focus on inpatient coding of secondary diagnoses.
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HA115-EGDs This is one area expected to receive RAC focus as the program spreads throughout the country. Be prepared.

This course authored by [modal id=”2869″ style=plain color=default size=default]Paula Digby[/modal].

Course Objectives:

  • A description of Colonoscopies and EGDs
  • Review of Coding and Medicare Coverage Guidelines for Colonoscopies and EGDs
  • Clarification of RACS demonstration focus regarding these procedures.
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HA113-MUEs This session will explain Medically Unlikely Edits, a part of Medicare’s prepayment review process. These unit of service edits can be a puzzle if you are not prepared. Note: CMS has published MUEs on October 1, 2008.

This course authored by [modal id=”2870″ style=plain color=default size=default]Paula Digby[/modal].
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RRSB312-PrepayReviews MACs have been doing prepayment reviews forever, but now the RACs have been authorized for this type of audit, albeit for a limited number of audit “areas” and states.

This course authored by [modal id=”2720″ style=plain color=default size=default]Brian Annulis[/modal].

Course Topics:

  • Expansion of the RACs to prepayment reviews
  • Preparing for and managing these reviews
  • States impacted and what it means about CMS’s thought process
  • Resources for further study
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RRSC312-HotStuff HOT STUFF was very popular back in the days of disco, but now it’s not so popular. Unless you’re a RAC. Students learn in this course how to go after both automated and complex denials – for some of the most “popular” RAC denials. They also learn the significant connection between medical necessity and medical coding.

This course authored by [modal id=”2839″ style=plain color=default size=default]Sharon Easterling[/modal].

Course Topics:

  • RAC Automated denials, impact and source
  • Inpatient-Only procedure denials – Why and How this happens
  • The Key Relationship between Coding and Medical Necessity
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HA145-Respiratory Whether you are a hospital or a physician office, reporting certain respiratory tests and treatments proves to be a challenge and now in certain parts of the country has been identified as a RAC focus area.

This course authored by [modal id=”2873″ style=plain color=default size=default]Stephanie Albright[/modal].

Course Topics:

  • Rules for reporting common respiratory tests and treatments in the Outpatient setting.
  • Coding or charge capture No-No’s
  • Ways to avoid recoupment for these services
  • Identification of RAC Respiratory “issues”
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HA125-Insider This session focuses on medical chart to bill auditing. As audits are discussed, including reviews and auditors,the focus is on medical coding and billing audits and those individuals who perform the task of auditing the services for appropriateness.

This course authored by [modal id=”2871″ style=plain color=default size=default]Paula Digby[/modal] and [modal id=”2874″ style=plain color=default size=default]Stephanie Albright[/modal].

Course Topics:

  • Auditing rules of the game”
  • Determining the scope of an audit
  • Preparation for and selection of an auditor
  • Strategies for successful auditing
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RRSB312-Advocacy This session focuses on how providers can interact with their US Congressmen to let them know about all the problems with the RACs and MACs, and perhaps feed ideas to Congress on how to reduce the providers’ burden.

This course authored by [modal id=”2841″ style=plain color=default size=default]Jenny Boese[/modal].

Course Topics:

  • How to read and use AHA’s RACTrac statistics
  • How to analyze your own state’s statistics
  • Effective ways to talk to your Congressmen
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RRSD312-Discussion The RAC Discussion Period is little used and greatly underestimated, but there are some hospitals getting as much as a 75% success rate for certain types of cases, when pursued properly, thereby greatly reducing the cost of denials and subsequent appeals. In this course, you get to hear about the great success of one such hospital.

This course authored by [modal id=”2844″ style=plain color=default size=default]Dr. Jeannine Engle[/modal].

Course Topics:

  • Post-Discharge Care: of Charts!
  • Timelines – with or without Discussion Period
  • Success Strategies
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