Billing & Coding Workshop

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. 

Workshops are capped at 75 participants to allow for group discussion. Back by popular demand, In 2024, AACVPR will host two Pulmonary Rehabilitation Workshops and two Cardiac Workshops.

Pulmonary Rehabilitation Workshops

Date Offerings:

  • 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

Register for June Pulmonary Workshop

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.


Cardiac Rehabilitation Workshop

Date Offerings:

  • April 9, 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 5-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)

Module Learning Objectives Presenter
Module One: Review of Coverage Rules and Regulations 1.Attendees will demonstrate competence in their interpretation and application of current Medicare rules for delivery of cardiac rehabilitation services.
2. Attendees will recognize the relationship between federal regulations, local governmental regulations, and private insurers.
3. Attendees will formulate solutions for given clinical situations in practice.
4. Attendees will explain strategies for avoiding CMS audits and the process of navigating inappropriate audit denials.
Lorri Lee, MHA, BS, CCRP, CEP, FAACVPR
Module Two: Referral-to-Enrollment Key Considerations 1.Attendees will be prepared to establish their own screening process for incoming patients including pre-certification, diagnosis review, review of clinical data for appropriateness of rehab, billing codes, and tracking visits. Review the prior authorization (PA) process.
2. Attendees will be able to describe how to handle patients with non-Medicare payers such as private plans, including recommendations on best practices for determining co-payments and deductibles.
3. Attendees will be able to identify the steps necessary for obtaining authorization for non-Medicare patients (Commercial, Workers Compensation, VA), determining and tracking approved number of sessions and period of validity.
4. Attendees will demonstrate their understanding of how to create a smooth referral to enrollment process within their individual department during a breakout group discussion
Stacey Greenway, CCRP, FAACVPR
Module Three: ITPs 1.Attendees will be able to describe the mandatory elements of the Individualized Treatment Plan (ITP) as required by CMS.
2. Attendees will learn best practices for completing Individualized Treatment Plans (ITPs) including how to handle unusual circumstances, e.g., extended absence.
3. Attendees will understand how to use the ITP to improve patient care and outcomes by treating it as a “living document” that is continuously updated as opposed to being an onerous chore completed every 30 days.
4. Attendees will understand the role of each staff member in completing the ITP.
5. Attendees will be able to describe the flexibility given in the ITP physician signature process
Robert Berry, MS, RCEP, FAACVPR
Module Four: Effeciencies/Business Practices 1. Attendees will understand the prevailing billing and reimbursement pathway for Cardiac Rehab departments.
2. Attendees will recognize key concepts of fiscal accountability as it applies to department revenue and organizational cost savings.
3. Attendees will be introduced to fundamental operational leadership concepts including strategic planning, benchmarking and SWOT analysis to strengthen program delivery.
4. Attendees will recognize internal and external resources for compensation inquiries and support.
Matthew Thomas, MS, MBA
Registration Pricing
AACVPR Members: $250
Non-members: $350
Register for April Cardiac Workshop

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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