Demystifying CR and PR Billing and Coding
AACVPR members are often responsible for coding cardiac and pulmonary rehabilitation services for insurance reimbursement or sharing the coded information with their hospital's billing department. To help aid this process, we are launching a brand-new, virtual, educational offering that'll give our community the opportunity to connect with experts, ask questions and stay up to date on changes in Medicare payment.
Pulmonary Rehabilitation Workshop
Date Offering:
- June 5, 2024 | 10:00 AM - 3:00 PM CT
What's Included? (click to expand)
The following items are included in the cost of registration:
- Access to the live, virtual five-hour workshop, including didactic lectures and interactive breakout discussion with peers and experts.
- A digital course workbook, including presenter slides and supplemental course resources.
- Exclusive access to the lecture recordings.
- 4.0 AACVPR CEU’s upon completion of the live virtual workshop.
Program Overview (click to expand)
| Time |
Topic |
Presenter |
| 10:00 a.m. - 10:05 a.m. CT |
Introduction |
| 10:00 a.m. - 10:05 a.m. CT |
Review of Coverage Rules and Regulations
1. Discuss importance of using correct terminology (pulmonary rehabilitation vs. outpatient respiratory services).
2. Provide an overview of CMS coverage rules (CFR 410.49) for pulmonary rehabilitation and ORS services, highlighting the appropriate diagnostic codes.
3. Review MAC jurisdiction, how to access MAC website for a specific region and LCDs.
4. Provide billing case examples for pulmonary rehabilitation and ORS services.
|
Susan Flack, MS, BSN, RN, FAACVPR |
| 11:05 a.m. - 11:15 a.m. CT |
10-Minute Break |
| 11:15 a.m. - 12:15 p.m. CT |
Referral-to-Charge Key Considerations
1. Provide a step-by-step review of the screening process including benefits verification, diagnosis review, review of clinical data for appropriateness of rehab, billing codes and tracking visits.
2. Provide an overview of non-Medicare payors such as private plans and workers compensation cases, including recommendations on best practices for determining co-payments and deductibles.
3. Provide three examples for submitting a charge to enhance learning to provoke breakout group discussions, including an example of virtual rehabilitation.
4. Describe steps for obtaining authorization for non-Medicare patients (commercial, workers compensation, VA), determining and tracking approved number of sessions and period of validity. |
Aimee Kizziar, MHAL, BA, RRT-NPS, RCP, CES; and Lisa Smith, PT, CLT |
| 12:15 p.m. - 12:45 p.m. CT |
30-Minute Break |
| 12:45 p.m. - 2:00 p.m. CT |
ITP and Audits
1. Review the purpose and importance of the ITP as a living document to establish and develop therapeutic goals and guide care.
2. Discuss the importance of the daily progress note especially with respect to use of timed codes such as G0237 and G0238.
3. Provide and review and ITP example(s).
4. Describe the audit process, how ITP is used in the process, and potential triggers.
5. Develop as an additional resource an audit checklist and describe the appeal process and resources from AACVPR, MACs and CMS. |
Connie Paladenech, RRT, RCP |
| 2:00 p.m. - 2:15 p.m. CT |
15-Minute Break |
| 2:15 p.m. - 3:00 p.m. CT |
Real-Life Application of Tools/Resources
1. Provide a brief overview of the scientific basis for PR, including the most recent studies/data on improving mortality and cost savings, as well as newer data on novel models of PR.
2. Review the updated PR Reimbursement Toolkit, highlighting the urgency to update charges to gain improved reimbursement and providing examples for real-life application.
3. Discuss some possible barriers to implementing the toolkit and some possible solutions to gain executive support. |
Chris Garvey, FNP, MSN, MPA, MAACVPR; and Debbie K, MS,RRT-NPS, AE-C, FAARC |
|
Registration Pricing
AACVPR Members: $250
Non-members: $350
Note: An on-demand course will not be available; the lecture recording will be exclusively-offered to live workshop registrants. Additionally, these CE credits are not transferrable and will only be available to those who purchase the course.
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