About this Course
This course introduces the student to health insurance and reimbursement in the home health industry. In this course, the student will become familiar with the home health insurance industry, legal and regulatory issues, and differences in reimbursement methodologies. The student will learn principles of medical billing related to proper claim form preparation, submission and payment processing, and the follow-up process.
HH01: History of Home Health
This module provides an overview of the home health benefit and understanding what is Medicare. You will learn about Medicare Administrative Contractors (MAC’s) and their purpose. In addition to exploring MACs, you will explore Medicare.gov and look at Home Health Compare List as a resource.
HH02: Structure of Home Health
You will learn the terminology and many many acronyms associated with Home Health along with the original structure and the different Home Health disciplines. Explore the various Medicare Administrative Contractors and learn about their portals and how they’re used to access Medicare information. You will gain a better understanding of what Part A of Medicare is and the services it covers and learn about the Prospective Payment System versus Patient Driven Grouping Model. We will also talk and explore some of the different Federal and State associations.
HH03: Healthcare Law
Examine some of the different laws and programs governing Medicare to protect patient’s information and prevent against fraud and abuse.
HH04: Medicare Billing Overview
This module will go over the process of billing including defining the role of the biller, provider enrollment, and using the UB04 claim form. Students will learn about timely filing and using Medicare Administrative Contractors to process claims and the use of clearinghouses. In addition, this course will cover National Provider Identifier (NPI) and the Provider Transaction Access Number (PTAN) and the differences between the two.
HH05: Home Health Claims
In this module students will learn about the life cycle of the claim from the time its submitted to the time its paid. Learn the differences between electronic and paper claims submission. Explore the various billing software including the Direct Data Entry (DDE) and MAC portals. Will look at the eligibility requirements and different OASIS’s types. Students will get an understanding of the 60 day episode life cycle, 30 day periods, form CMS-485, Face to Face requirements, the free software Haven provided by Centers for Medicare, Pro-32 and Medical Services (CMS), and the Home Health Care Survey (HHCAPS). Students will learn which documents and clinical documentation are needed before billing can be submitted. Discuss how clinical and billing interact and take a look at verbal orders. Students will explore the diagnosis codes, revenue codes, HCPCS codes, G codes, Q codes and other billing codes as well as the billing process.
HH06: RAP Claim Type
This module will discuss what is a Request for Anticipated Payment otherwise known as RAP, its purpose, what information is included on the RAP including the use of the Health Insurance Prospective Payment System (HIPPS) codes and the Home Health Resource Group (HHRG) codes. Students will learn about how a RAP can be autocanceled and the use of the 47 Code. Students will study the various billing codes including revenue codes. Throughout the course students will study different RAP UB04 examples.
HH07: Final Claim Types
Students will learn about submitting final claims for full episode and cover what’s a Partial Payment Adjustment (PPA), Low Utilization Payment Adjustment (LUPA) and Outlier payments. We will look at how supplies bundled, as well as, other billing codes like Nursing codes, Therapy codes, Revenue Codes, HCPC codes and other codes. This course will also discuss prebilling audits, how to calculate Health Insurance Prospective Payment System (HIPPS) codes using final UB04 examples.
HH08: Direct Data Entry & Eligibility
Students will gain an understanding of the Direct Data Entry (DDE) system as well as other MAC portals. Will learn how to view eligibility through the HIPPA Eligibility Transaction System (HETS) and learn the various status codes. Students will learn about how to make an entry of a claim as well as cancel, correct or make an adjustment on a claim.
HH09: Follow-Up & Post Claims Submission
In this module you will learn about the common problems, issues and challenges that arise when dealing with rejected claims and as well as the five levels of the appeal process. Students will also learn about credit balance reports and cost reports. There will be a discussion regarding payments in relation to Remittance Advice (RA’s), Electronic Funds Transfer (EFT), and PC print. You will explore the issue of revenue recovery and collections.
HH10: Things to Know
This module will be an overview of useful information and resources that students will need to know when billing for home health. Information regarding Med Pac, proposed & final rules, the federal register, Medicare Learning Network (MLN), and Centers for Medicare and Medicaid Services (CMS) will be reviewed. There will be a discussion of the various programs such as the Program for Evaluating Payment Patterns Electronic Report (PEPPER), Comparative Billing Reports, Home Health Care Survey (HHCAPS) and Provider Enrollment, Chain and Ownership System (PECOS). Information regarding list serves/MACs, Value Based Purchasing, Care Plan Oversight, compliance, and the new Medicare cards will also be covered.
General Course Details
Registered students are to log into PMBI’s education portal online with their unique credentials that will be given to them once they have completed registration and payment requirements.
Students must watch each online recorded session, in its entirety, in sequential order. There are 10 online modules for this course. Students must pass the required quiz with a score of 70% at the end of each module to be able to go to the next module.
- Self-paced learning
- Become familiar with Traditional Medicare Home Health Insurance
- Legal and Regulatory Issues
- Understand Differences in Reimbursement Methodologies
- Learn Principles of Medical Billing Related Claim Form Preparation, Submission and Payment Processing
- Best Practices of the Follow-up Process
- PMBi Online Education Portal
- 10 Online Module Courses in Sequential Order
- Weekly Quiz at the End of Each Module
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