Medicare Training

The 21 hour (2.1 credit hour) training for nursing facilities is on the management of the Medicare program. The focus is on Medicare Part A; however, an introduction to the opportunities under Medicare Part B is included. This program includes the process of Skilled Nursing Facility Medicare Participation, elements that impact reimbursement, and admission requirements for compliance with the program. This program discusses critical issues such as recertification, expedited review, HIPAA, and coverage determinations. Discussion covers qualifying services and nursing care and services that support Medicare supplied services. Team communication and data documentation relative to Medicare are explored. Medicare therapy caps and billing including covered services and supplies are described. Program Integrity/Medical Review and the implementation process from CMS are introduced.

Program Objectives

Upon completion of the program, the participant will be able to:

  1. Describe the applications process for SNF Medicare participation;
  2. Identify MDS elements that impact Medicare reimbursement;
  3. Identify admissions requirements for Medicare compliance;
  4. Provide Medicare qualifying services to residents in a SNF;
  5. Describe current critical issues and compliance including expedited review, ABNs, coverage determinations, physician certs/recerts, Medicare Advantage Plans, and HIPAA;
  6. Facilitate communication among departments relative to Medicare;
  7. Describe nursing care and services that support Medicare supplied services;
  8. Identify data needed to support the therapy program;
  9. Describe the current therapy caps, exception process, and CCI edits;
  10. Complete the UB-04 billing form including additional billing responsibilities;
  11. Describe covered supplies and services under Medicare Part B; and
  12. Explain Program Integrity/Medical Review and the implementation process from CMS.

Audience

This education program is appropriate for nursing home administrators, owners, directors of nursing, Medicare nurses, social service, MDS coordinators, and office/billing personnel in nursing facilities.

Continuing Education Credit

This education program meets the continuing competency requirements of 20.5 hours for the renewal/reinstatement of a Nebraska Nursing Home Administrator’s license as granted by the Nebraska Board of Nursing Home Administrators. This program meets the criteria of a peer approved continuing education program of 20.5 hours for nurses. This program meets the criteria of an approved continuing education program for social work.

College Credit

Training may be taken as credit or non-credit. The Nebraska Health Care Learning Center will award 2.1 hours of college credit upon successful completion of 20.5 hours of classroom instruction.