This course zeroes in on compliance topics relevant to the revenue cycle. It would be appropriate for revenue cycle staff with some experience, supervisors, managers, and executives. Medicare coding requirements and HCPCS Level I and Level II codes are presented. The course discusses the National Correct Coding Initiative and illustrates common coding risks, such as upcoding, DRG creep, and unbundling. In addition, Medicare requirements for electronic claims submission, determining when Medicare is the secondary payer, and credit balances are described. The concepts of medical necessity, Advance Beneficiary Notices, and the three-day bundling rule are explained. The course also provides overviews of EMTALA and HIPAA requirements. 

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  • Explain the purpose and function of coding.
  • Explain the required use of certain code sets under HIPAA.
  • Explain Medicare’s requirement for electronic claims submission.
  • Discuss the history and purpose of ICD-9-CM coding.
  • Explain the required use of the HIPAA transaction standards.
  • Describe when and how EMTALA would apply in specific situations.
  • Identify general protections afforded to patients under the Privacy Rule.
  • Define protected and non-protected health information.
  • Explain the American Recovery and Reinvestment Act and its impact on HIPAA.

HFMA members: $249
Non-members: $299

Course information:

  • Approximate time to complete: 12 hours
  • Preliminary CPE credit: 10.5
  • Designed for: Revenue cycle and compliance professionals
  • Level: Intermediate
  • Instructional method: Self-study
  • Format: Online
  • NASBA Field of Study: Specialized Knowledge and Applications
  • Program prerequisite: None
  • Advance preparation: None
  • Course availability: One year from start date
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HFMA stands behind the quality of our programming. If you are not satisfied, we will gladly refund your money or provide you with a credit certificate toward any future HFMA National educational programs or select products. Contact HFMA directly at 3 Westbrook Corporate Center, Suite 600, Westchester, IL 60154, Attn: Professional Development, or call (800) 252-4362, ext. 2. Please provide HFMA with your comments within two weeks of beginning the program.

CPElittleHealthcare Financial Management Association Educational Foundation is registered with the National Association of State Boards of Accountancy (NASBA) as a sponsor of continuing professional education on the National Registry of CPE Sponsors. State boards of accountancy have final authority on the acceptance of individual courses for CPE credit. Complaints regarding registered sponsors may be submitted to the National Registry of CPE Sponsors through its website: