Stay Ahead of the Claim Game by
Attending a Workshop

Coding, Claim Types, Billing, and Reimbursement Presentation

Navigating the world of healthcare billing, coding, and reimbursement can be difficult. You may be someone who understands CPT codes but want to know how they are used for reimbursement, or you may understand the billing process but not know what payors do with the codes on a claim.

To assist you in learning more about these topics, we are pleased to share with you our guide to Healthcare Billing, Coding, and Reimbursement. This document describes the major coding systems, including CPT, HCPCS, ICD-9 and ICD-10, DRGs, and APCs; the process by which a claim is generated and adjudicated; and common reimbursement methods including RBRVS, capitation, carve outs, and risk sharing. You may download it here.

We invite you to share this document within your organization and with your colleagues. If you are interested in scheduling an on-site training session, please contact us at info@nokomishealth.com

This most recent workshop was a major success!

If you are interested in attending a claim review workshop or having our expert staff provide a custom session designed for your team please contact us at info@nokomishealth.com

 


MEDICAL CLAIMS BOOT CAMP
Cracking the Code to Healthcare Billing, Coding, and Reimbursement

June 2, 2016 | 7:30AM – 4:30PM

 

COURSE OVERVIEW

This course covers the fundamentals of medical billing, coding, and reimbursement by explaining how all of these components work together. Emphasis will be placed on the practical application of the latest industry knowledge and standards, with the goal of helping those who work with medical claims and claims data stay ahead of the game.

Participants will learn about the following:

  • The claim flow process from registration through adjudication and payment
  • How physicians and hospitals set and manage charges
  • Critical data elements on the two major claim forms and what they mean
  • How and why the major coding systems are utilized
  • How various reimbursement methods are used by payors


AAPC Continuing Education Units Available

This program meets AAPC guidelines for 6.0 Core A continuing education units.

 

TOPICS

SECTION 1: Clinic and Hospital Billing and Claim Adjudication

  • Setting charges – the hospital chargemaster and clinic fee schedule
  • Process by which a claim is generated, from registration through discharge, and the role that each department plays in that process
  • Important data elements on the UB04 and CMS-1500 and what they mean
  • Role of the claims clearinghouse
  • How payors adjudicate and pay claims
  • How providers receive and post payments
  • Common electronic data (EDI) files: 270, 272, 835, 837, and others
  • The back end: appeals, denials, adjustments, subrogation, etc.

SECTION 2: Major Healthcare Coding Systems

  • How they work
  • When and why they’re used
  • How they affect charges and reimbursement
  • CPT, HCPCS codes
  • Revenue codes
  • Diagnosis Related Groups (DRGs) and Major Diagnostic Categories (MDCs)
  • Diagnosis Related Groups (DRGs) and Major Diagnostic Categories (MDCs)
  • Ambulatory Patient Classifications (APCs)
  • ICD-9 and ICD-10 diagnosis and procedure codes
  • National Drug Codes (NDCs)

SECTION 3: Common Hospital and Physician Reimbursement Methods

  • Prospective Payment Systems: DRG and APC based reimbursement
  • Typical hospital contracting structures: per diem, per stay, carve outs, case rates, minimum/maximums, etc.
  • Physician fee schedules and fee maximums, RBRVS and RVUs, capitation, value-based purchasing, risk sharing
  • Major payor types (Medicare, Medicaid, HMO, PPO, ACO, etc.) and how they reimburse providers

 Who Should Attend

  • Financial Analysts
  • Provider Contracting Staff
  • Chief Financial Officers & Finance Directors
  • Directors of Managed Care
  • Claim Analysts
  • SAS Programmers
  • Actuaries
  • Underwriters
  • Billing Department Staff
  • Medical Coders
  • Anyone Who Works with Medical Claims Data
Nokomish Health | Rich Henriksen

Rich Henriksen
President and Founder of Nokomis Health, Inc.

About the Instructor

Rich Henriksen is the Chief Executive Officer and founder of Nokomis Health. Rich has 28 years of experience in healthcare systems, coding, billing, and reimbursement. He has led managed care departments and provider contracting units at a variety of organizations, including hospitals, clinics, and health plans. Rich has worked with over 70 different organizations, ranging from hospitals and clinics to third-party administrators, law firms, and internet-based companies. As a respected industry expert he is well known for his unparalleled depth of knowledge in all aspects of healthcare coding, billing and reimbursement.

CREDENTIALS
Rich received his Bachelor of Arts in biology from Luther College in Decorah, Iowa, and his Master of Arts in Healthcare Administration from The University of Iowa. He resides in Minneapolis, Minnesota where he leads the Nokomis Health team on their mission to set a new standard for medical claim review. Rich has previously trained staff at Optum, Prime Therapeutics, Definity Health, UCare Minnesota, TC Health, Essential Health, the American Association of Acupuncture and Oriental Medicine, and others. He has presented several times at SAS user conferences and other regional conferences.

METHODOLOGY
An engaging instructor with an informal teaching style – making sessions enjoyable and easy to follow. Rich has taught this course to many professionals within the medical industry and incorporates feedback and suggestions from previous participants to evolve this incredibly insightful program. Rich allows time in the schedule for participants to ask questions.