Medicare Fundamentals: A Ten-Session On-Demand Workshop

Medicare Fundamentals, a ten-part on-demand workshop, is designed to provide the new nurse assessment coordinator (NAC) or interdisciplinary team (IDT) member with a strong foundation of knowledge of the basics of Medicare coverage in the skilled nursing facility (SNF). AAPACN nurse expert, Jennifer LaBay, will guide you through understanding the Medicare benefit period, the key technical and skilled care requirements of Medicare Part A coverage, consolidated billing practices, and the requirements of beneficiary notices to ensure compliance and avoid potential penalty. Gain an understanding of the medical review process, including responding to medical reviews and appeals. 

 

Following this workshop, you will be able to:

  • Understand the technical requirements of Medicare Part A coverage in the SNF including the qualifying hospital stay, 30-day transfer rule, benefit period, and the physician certification and recertification process
  • Recognize the clinical requirements of Medicare Part A coverage in the SNF including direct skilled nursing, indirect skilled nursing, direct skilled rehabilitation, and the administrative presumption of coverage
  • Explain the documentation requirements of Medicare Part A services
  • Understand the implications of noncompliance with Medicare regulations and how to avoid noncompliance
  • Apply the basics of consolidated billing
  • Identify the key components of Medicare meetings
  • Recognize the required beneficiary notices for Medicare Part A and when and how to fill out the notices and administer them Describe the medical review process, including types of review, possible outcomes, and the appeals process
  • Medicare Fundamentals Part 1: Medicare Basics for the New NAC and IDT Members - Avoiding Penalty On-Demand Workshop

    Contains 3 Component(s), Includes Credits

    Part 1 of Medicare Fundamentals

    Why Medicare basics? Failure to comply with Medicare requirements results in penalty to the facility that may impact reimbursement or the ability to participate in the Medicare program. Following Medicare Fundamentals Part 1: Medicare Basics, you will have a broad overview of the Medicare program’s technical and clinical requirements as well as links to multiple resources to ensure you can locate and follow the required regulations.

    Jennifer LaBay RN, RAC-MT, RAC-MTA, CRC

    Curriculum Development Specialist

    AAPACN

    Jennifer LaBay, RN, RAC-MT, RAC-MTA, CRC, is a curriculum development specialist with AAPACN. She has been involved in the RAI process since 1997 and has been in the long-term care industry since 1991 serving in a variety of capacities including laundry aid, certified nursing assistant, charge nurse, nurse assessment coordinator, regional corporate clinical reimbursement specialist, and independent clinical reimbursement consultant. Jennifer has been a Master Teacher for AAPACN’s RAC-CT program since July 2011 and AAPACN's RAC-CTA advanced certification since 2019. She has been a Certified Risk Coder (CRC) through the American Academy of Professional Coders (AAPC) since 2020. Jennifer has considerable expertise in the MDS 3.0 and RAI process, the prospective payment system (PPS), and ICD-10 coding including the clinical and financial aspects. She has a knack for making her seminars an enjoyable learning experience and readily makes herself available to all attendees of her programs for any follow-up questions that may arise long after the seminar is complete.

  • Medicare Fundamentals Part 2: Medical Appropriateness Exception and Administrative Presumption of Care On-Demand Workshop

    Contains 3 Component(s), Includes Credits

    Part 2 of Medicare Fundamentals

    Does the facility have a resident who is non-weight bearing on admission and will not need skilled therapy until the 30-day transfer rule has passed? Or perhaps there is a new admission coming in that the team is not quite sure will meet daily skilled clinical requirements. Can these cases be covered under Medicare Part A? During Medicare Fundamentals Part 2: Medical Appropriateness Exception and Administrative Presumption, you will take a deeper dive into two frequently misunderstood exceptions to the Medicare program requirements: the Medicare appropriateness exception, which allows skilled Medicare coverage to begin more than 30 days after the qualifying hospital stay; and the administrative presumption of coverage, which is the only guaranteed Medicare Part A coverage available in the SNF. This session will also help you understand when and how these exceptions can be used.

    Jennifer LaBay RN, RAC-MT, RAC-MTA, CRC

    Curriculum Development Specialist

    AAPACN

    Jennifer LaBay, RN, RAC-MT, RAC-MTA, CRC, is a curriculum development specialist with AAPACN. She has been involved in the RAI process since 1997 and has been in the long-term care industry since 1991 serving in a variety of capacities including laundry aid, certified nursing assistant, charge nurse, nurse assessment coordinator, regional corporate clinical reimbursement specialist, and independent clinical reimbursement consultant. Jennifer has been a Master Teacher for AAPACN’s RAC-CT program since July 2011 and AAPACN's RAC-CTA advanced certification since 2019. She has been a Certified Risk Coder (CRC) through the American Academy of Professional Coders (AAPC) since 2020. Jennifer has considerable expertise in the MDS 3.0 and RAI process, the prospective payment system (PPS), and ICD-10 coding including the clinical and financial aspects. She has a knack for making her seminars an enjoyable learning experience and readily makes herself available to all attendees of her programs for any follow-up questions that may arise long after the seminar is complete.

  • Medicare Fundamentals Part 3: Benefit Period On-Demand Workshop

    Contains 3 Component(s), Includes Credits

    Part 3 of Medicare Fundamentals

    Medicare Part A coverage in the SNF is not unlimited. Beneficiaries are allowed a limited number of days of coverage under the extended care benefit. Following Medicare Fundamentals Part 3: Benefit Period, you will understand the number of days available in a benefit period, what starts a benefit period, and what ends a benefit period. This session also includes several examples and popular myths and facts surrounding the benefit period.

    Jennifer LaBay RN, RAC-MT, RAC-MTA, CRC

    Curriculum Development Specialist

    AAPACN

    Jennifer LaBay, RN, RAC-MT, RAC-MTA, CRC, is a curriculum development specialist with AAPACN. She has been involved in the RAI process since 1997 and has been in the long-term care industry since 1991 serving in a variety of capacities including laundry aid, certified nursing assistant, charge nurse, nurse assessment coordinator, regional corporate clinical reimbursement specialist, and independent clinical reimbursement consultant. Jennifer has been a Master Teacher for AAPACN’s RAC-CT program since July 2011 and AAPACN's RAC-CTA advanced certification since 2019. She has been a Certified Risk Coder (CRC) through the American Academy of Professional Coders (AAPC) since 2020. Jennifer has considerable expertise in the MDS 3.0 and RAI process, the prospective payment system (PPS), and ICD-10 coding including the clinical and financial aspects. She has a knack for making her seminars an enjoyable learning experience and readily makes herself available to all attendees of her programs for any follow-up questions that may arise long after the seminar is complete.

  • Medicare Fundamentals Part 4: Physician Certification and Recertification On-Demand Workshop

    Contains 3 Component(s), Includes Credits

    Part 4 of Medicare Fundamentals

    The physician certification is a written statement certifying the need for skilled care in the nursing facility. Failure to complete this technical requirement of Medicare Part A coverage per regulations may result in financial penalty. Following Medicare Fundamentals Part 4: Physician Certification, you will be able to explain the requirements and timing of physician certifications including who can sign the certifications. This session also includes examples and popular myths and facts surrounding the physician certifications.

    Jennifer LaBay RN, RAC-MT, RAC-MTA, CRC

    Curriculum Development Specialist

    AAPACN

    Jennifer LaBay, RN, RAC-MT, RAC-MTA, CRC, is a curriculum development specialist with AAPACN. She has been involved in the RAI process since 1997 and has been in the long-term care industry since 1991 serving in a variety of capacities including laundry aid, certified nursing assistant, charge nurse, nurse assessment coordinator, regional corporate clinical reimbursement specialist, and independent clinical reimbursement consultant. Jennifer has been a Master Teacher for AAPACN’s RAC-CT program since July 2011 and AAPACN's RAC-CTA advanced certification since 2019. She has been a Certified Risk Coder (CRC) through the American Academy of Professional Coders (AAPC) since 2020. Jennifer has considerable expertise in the MDS 3.0 and RAI process, the prospective payment system (PPS), and ICD-10 coding including the clinical and financial aspects. She has a knack for making her seminars an enjoyable learning experience and readily makes herself available to all attendees of her programs for any follow-up questions that may arise long after the seminar is complete.

  • Medicare Fundamentals Part 5: Skilled Nursing Requirements On-Demand Workshop

    Contains 3 Component(s), Includes Credits

    Part 5 of Medicare Fundamentals

    SNF staff have the ultimate responsibility of determining skilled Medicare Part A coverage at the time of the delivery of care. No outside entity reviews the records and makes this decision during a beneficiary’s stay. SNF staff must understand what the Medicare Administrative Contractor will be looking for in the documentation to support why those skilled services were provided. Following Medicare Fundamentals Part 5: Skilled Nursing Requirements, you will be able to recognize the requirements that qualify as skilled nursing care under Medicare Part A, as well as to recognize the difference between direct and indirect skilled nursing services.

    Jennifer LaBay RN, RAC-MT, RAC-MTA, CRC

    Curriculum Development Specialist

    AAPACN

    Jennifer LaBay, RN, RAC-MT, RAC-MTA, CRC, is a curriculum development specialist with AAPACN. She has been involved in the RAI process since 1997 and has been in the long-term care industry since 1991 serving in a variety of capacities including laundry aid, certified nursing assistant, charge nurse, nurse assessment coordinator, regional corporate clinical reimbursement specialist, and independent clinical reimbursement consultant. Jennifer has been a Master Teacher for AAPACN’s RAC-CT program since July 2011 and AAPACN's RAC-CTA advanced certification since 2019. She has been a Certified Risk Coder (CRC) through the American Academy of Professional Coders (AAPC) since 2020. Jennifer has considerable expertise in the MDS 3.0 and RAI process, the prospective payment system (PPS), and ICD-10 coding including the clinical and financial aspects. She has a knack for making her seminars an enjoyable learning experience and readily makes herself available to all attendees of her programs for any follow-up questions that may arise long after the seminar is complete.

  • Medicare Fundamentals Part 6: Skilled Rehabilitation On-Demand Workshop

    Contains 3 Component(s), Includes Credits

    Part 6 of Medicare Fundamentals

    SNF staff have the ultimate responsibility of determining skilled coverage at the time of the delivery of care. No outside entity reviews the records and makes this decision during a beneficiary’s stay. SNF staff must understand what the Medicare Administrative Contractor will be looking for in the documentation to support those skilled services were provided. Following Medicare Fundamentals Part 6: Skilled Rehabilitation Requirements, you will be able to recognize the requirements that qualify as skilled rehabilitation care under Medicare Part A, as well as the documentation requirements of therapy under Medicare Part A in the SNF.

    Jennifer LaBay RN, RAC-MT, RAC-MTA, CRC

    Curriculum Development Specialist

    AAPACN

    Jennifer LaBay, RN, RAC-MT, RAC-MTA, CRC, is a curriculum development specialist with AAPACN. She has been involved in the RAI process since 1997 and has been in the long-term care industry since 1991 serving in a variety of capacities including laundry aid, certified nursing assistant, charge nurse, nurse assessment coordinator, regional corporate clinical reimbursement specialist, and independent clinical reimbursement consultant. Jennifer has been a Master Teacher for AAPACN’s RAC-CT program since July 2011 and AAPACN's RAC-CTA advanced certification since 2019. She has been a Certified Risk Coder (CRC) through the American Academy of Professional Coders (AAPC) since 2020. Jennifer has considerable expertise in the MDS 3.0 and RAI process, the prospective payment system (PPS), and ICD-10 coding including the clinical and financial aspects. She has a knack for making her seminars an enjoyable learning experience and readily makes herself available to all attendees of her programs for any follow-up questions that may arise long after the seminar is complete.

  • Medicare Fundamentals Part 7: Skilled Medicare Documentation On-Demand Workshop

    Contains 3 Component(s), Includes Credits

    Part 7 of Medicare Fundamentals

    The goal of SNF documentation is to ensure that residents receive proper care to promote the highest practicable level of well-being through clear written communication, to validate a facility’s decisions for or against care and treatment, to prove the need for daily skilled care to support claims and to comply with federal regulatory requirements. Following Medicare Fundamentals Part 7: Skilled Medicare Documentation, you will understand both basic and skilled documentation requirements. This session also includes examples of notes that reflect skilled care versus task completion, as well as the supportive documentation of other members of the IDT.

    Jennifer LaBay RN, RAC-MT, RAC-MTA, CRC

    Curriculum Development Specialist

    AAPACN

    Jennifer LaBay, RN, RAC-MT, RAC-MTA, CRC, is a curriculum development specialist with AAPACN. She has been involved in the RAI process since 1997 and has been in the long-term care industry since 1991 serving in a variety of capacities including laundry aid, certified nursing assistant, charge nurse, nurse assessment coordinator, regional corporate clinical reimbursement specialist, and independent clinical reimbursement consultant. Jennifer has been a Master Teacher for AAPACN’s RAC-CT program since July 2011 and AAPACN's RAC-CTA advanced certification since 2019. She has been a Certified Risk Coder (CRC) through the American Academy of Professional Coders (AAPC) since 2020. Jennifer has considerable expertise in the MDS 3.0 and RAI process, the prospective payment system (PPS), and ICD-10 coding including the clinical and financial aspects. She has a knack for making her seminars an enjoyable learning experience and readily makes herself available to all attendees of her programs for any follow-up questions that may arise long after the seminar is complete.

  • Medicare Fundamentals Part 8: Consolidated Billing and Essential Medicare Meetings On-Demand Workshop

    Contains 3 Component(s), Includes Credits

    Part 8 of Medicare Fundamentals

    Is the facility paying for services that they are not responsible for? Is it unclear why the facility is getting a bill for certain services from the physician? Under Medicare Part A, facilities are paid a daily rate calculated from the MDS. Out of this daily rate, the SNF is required to pay for all the goods and services provided to the beneficiary while they are a resident in the SNF under a Medicare Part A paid stay, a consolidated bill. There are some items that are excluded from this consolidated bill, meaning these are services that are typically outside the scope of services provided in a SNF and are not the responsibility of the SNF. Following Medicare Fundamentals Part 8: Consolidated Billing and Essential Medicare Meetings, you will be able to apply the basics of consolidated billing including how to determine if a service is not the responsibility of the facility. In addition, this session will provide examples of several beneficial facility meetings that could be conducted to ensure Medicare coverage guidelines are met including the daily PPS meeting, the weekly Medicare meeting, and the monthly triple check meeting.

    Jennifer LaBay RN, RAC-MT, RAC-MTA, CRC

    Curriculum Development Specialist

    AAPACN

    Jennifer LaBay, RN, RAC-MT, RAC-MTA, CRC, is a curriculum development specialist with AAPACN. She has been involved in the RAI process since 1997 and has been in the long-term care industry since 1991 serving in a variety of capacities including laundry aid, certified nursing assistant, charge nurse, nurse assessment coordinator, regional corporate clinical reimbursement specialist, and independent clinical reimbursement consultant. Jennifer has been a Master Teacher for AAPACN’s RAC-CT program since July 2011 and AAPACN's RAC-CTA advanced certification since 2019. She has been a Certified Risk Coder (CRC) through the American Academy of Professional Coders (AAPC) since 2020. Jennifer has considerable expertise in the MDS 3.0 and RAI process, the prospective payment system (PPS), and ICD-10 coding including the clinical and financial aspects. She has a knack for making her seminars an enjoyable learning experience and readily makes herself available to all attendees of her programs for any follow-up questions that may arise long after the seminar is complete.

  • Medicare Fundamentals Part 9: Beneficiary Notices Initiative On-Demand Workshop

    Contains 3 Component(s), Includes Credits

    Part 9 of Medicare Fundamentals

    Medicare beneficiaries have protections related to financial liability and appeal rights. A beneficiary notice is a required CMS form that notifies the beneficiary or their representative that the facility believes Medicare will no longer pay for the services and that financial liability will be transferred to beneficiary and provides details on how to appeal this decision. Following Medicare Fundamentals Part 9: Beneficiary Notices Initiative, you will be able to explain the reasons to end Medicare coverage and to identify what required documents must be delivered to the resident and when. This session includes step-by-step instruction on completion of the required forms, as well as examples and popular myths and facts surrounding the beneficiary notices initiative.

    Jennifer LaBay RN, RAC-MT, RAC-MTA, CRC

    Curriculum Development Specialist

    AAPACN

    Jennifer LaBay, RN, RAC-MT, RAC-MTA, CRC, is a curriculum development specialist with AAPACN. She has been involved in the RAI process since 1997 and has been in the long-term care industry since 1991 serving in a variety of capacities including laundry aid, certified nursing assistant, charge nurse, nurse assessment coordinator, regional corporate clinical reimbursement specialist, and independent clinical reimbursement consultant. Jennifer has been a Master Teacher for AAPACN’s RAC-CT program since July 2011 and AAPACN's RAC-CTA advanced certification since 2019. She has been a Certified Risk Coder (CRC) through the American Academy of Professional Coders (AAPC) since 2020. Jennifer has considerable expertise in the MDS 3.0 and RAI process, the prospective payment system (PPS), and ICD-10 coding including the clinical and financial aspects. She has a knack for making her seminars an enjoyable learning experience and readily makes herself available to all attendees of her programs for any follow-up questions that may arise long after the seminar is complete.

  • Medicare Fundamentals Part 10: Medical Review and Appeals On-Demand Workshop

    Contains 3 Component(s), Includes Credits

    Part 10 of Medicare Fundamentals

    The SNF Medicare claims processing system is based largely on the honor system. A claim is submitted to the Medicare Administrative Contractor and is paid without the SNF first being asked for evidence that items on the bill occurred or met Medicare requirements for billing. Medical review is the process of reviewing a portion of claims to determine whether services provided were medically reasonable and necessary, as well as to follow up on the effectiveness of previous corrective actions. Following Medicare Fundamentals Part 10: Medical Review and Appeals, you will be able to describe the medical review process including what to do when a request for medical records comes in and how to proceed if the decision is not in the facility’s favor.

    Jennifer LaBay RN, RAC-MT, RAC-MTA, CRC

    Curriculum Development Specialist

    AAPACN

    Jennifer LaBay, RN, RAC-MT, RAC-MTA, CRC, is a curriculum development specialist with AAPACN. She has been involved in the RAI process since 1997 and has been in the long-term care industry since 1991 serving in a variety of capacities including laundry aid, certified nursing assistant, charge nurse, nurse assessment coordinator, regional corporate clinical reimbursement specialist, and independent clinical reimbursement consultant. Jennifer has been a Master Teacher for AAPACN’s RAC-CT program since July 2011 and AAPACN's RAC-CTA advanced certification since 2019. She has been a Certified Risk Coder (CRC) through the American Academy of Professional Coders (AAPC) since 2020. Jennifer has considerable expertise in the MDS 3.0 and RAI process, the prospective payment system (PPS), and ICD-10 coding including the clinical and financial aspects. She has a knack for making her seminars an enjoyable learning experience and readily makes herself available to all attendees of her programs for any follow-up questions that may arise long after the seminar is complete.