Master Medicare Parts A-D, Medical Billing, Medical Coding, Denial Management, Appeal, Audit & Revenue Cycle Management
What you will learn
Healthcare Administrators looking to enhance their knowledge of Medicare billing processes
Medical Billers and Coders aiming to specialize in Medicare-specific codes and compliance
Practice Managers seeking to improve revenue cycle outcomes through effective Medicare claim strategies
Billing and RCM Professionals wanting to understand Medicareβs unique requirements, audits, and payment integrity
Healthcare Students or career changers interested in a deep dive into Medicare and revenue cycle management fundamentals
Why take this course?
Ready to Uncover the Secrets of Medicare and Supercharge Your Revenue Cycle Management?
This course breaks down Medicare in simple terms. You will learn the foundations of medical billing, medical coding, and RCM (Revenue Cycle Management). We will show you how to handle prior authorizations, referrals, and specialist provider billing. You will also learn how to avoid claim denials, manage compliance, and respond to audits. By the end, you will feel confident using Medicare-specific codes (ICD-10, CPT, HCPCS) and applying best practices in any health care setting.
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Key Topics Covered:
- Medicare Basics: Understand the different parts of Medicare (A, B, C, and D), who is eligible, and when to enroll.
- Billing and Coding Essentials: Learn how to submit accurate claims, reduce errors, and follow correct medical coding guidelines.
- Prior Authorizations & Referrals: Discover techniques to simplify these steps for both patients and providers.
- Compliance & Audits: Explore methods to prevent fraud and respond effectively to Medicare audits.
- Revenue Cycle Management: Master strategies to improve cash flow, reduce denials, and optimize overall billing processes.
After completing this course, you will be ready to handle Medicare billing challenges in health care organizations. You will know how to manage coordination of benefits, use data analytics for better outcomes, and adapt to policy changes. If you want a clear, step-by-step guide to Medicare and Revenue Cycle Management, this course is designed for you. Enroll now and take control of your medical billing future!
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Add-On Information:
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Course Overview
- This comprehensive masterclass provides an in-depth exploration of the intricate world of Medicare insurance billing, coding, and compliance.
- Delve into the nuances of Medicare’s complex structure, encompassing all its parts (A, B, C, and D) and their specific billing and coding regulations.
- Gain a strategic advantage by mastering the entire revenue cycle, from initial patient registration and documentation to final payment and reconciliation under Medicare guidelines.
- Understand the critical role of compliance in preventing fraud, waste, and abuse, ensuring adherence to all federal regulations and payer policies.
- Develop proficiency in navigating the challenges of claim submission, denial management, and effective appeal strategies specific to Medicare.
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Requirements / Prerequisites
- A foundational understanding of general medical terminology is recommended.
- Familiarity with basic healthcare administrative processes is beneficial.
- Access to a computer with internet connectivity for digital resources and potential simulations.
- An eagerness to learn and apply complex regulatory information.
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Skills Covered / Tools Used
- Medicare Part A & B Specifics: Inpatient, outpatient, and physician billing intricacies.
- Medicare Part C (Advantage Plans): Understanding plan structures, benefit coordination, and coding requirements.
- Medicare Part D (Prescription Drugs): Navigating the formulary, patient eligibility, and claim processing for medications.
- CPT, HCPCS, and ICD-10-CM Coding for Medicare: Precise coding to support medical necessity and compliance.
- Documentation Best Practices: Ensuring accurate and complete medical records to substantiate claims.
- Claim Submission & Scrubbing: Utilizing tools and techniques for error-free electronic claim submissions.
- Denial Analysis & Resolution: Identifying root causes of denials and implementing effective correction strategies.
- Medicare Appeal Processes: Mastering the steps for appealing denied claims at various levels.
- Auditing & Compliance Monitoring: Proactive measures to ensure adherence to Medicare regulations.
- Revenue Cycle Optimization: Strategies to accelerate payment and reduce claim delinquencies.
- Fraud, Waste, and Abuse Prevention: Identifying and mitigating compliance risks.
- Government Payer Software & Portals (General Understanding): Navigating common interfaces used by Medicare.
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Benefits / Outcomes
- Become a highly sought-after professional with specialized expertise in Medicare billing and coding.
- Significantly reduce claim rejections and denials, leading to improved cash flow for healthcare organizations.
- Enhance your ability to interpret and apply complex Medicare regulations to real-world billing scenarios.
- Develop confidence in managing audits and ensuring a compliant billing operation.
- Gain a competitive edge in career advancement within the healthcare revenue cycle management field.
- Contribute to the financial health and operational efficiency of healthcare providers.
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PROS
- Specialized Expertise: Focuses on one of the most critical and complex payer systems in healthcare.
- Revenue Enhancement: Directly impacts a provider’s financial performance through optimized billing.
- Compliance Assurance: Equips learners with the knowledge to avoid costly penalties.
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CONS
- Requires continuous learning due to frequent updates in Medicare regulations.
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