MACtoberfest®

Published 12/07/2022

Thank you for joining us in the virtual world for MACtoberfest

MACtoberfest® 2022 has concluded! We want to thank you all for taking part in our largest provider education event of the year. If you were unable to attend, all of our sessions are now available on-demand, giving you the opportunity to delve back into our virtual world. Please visit the links in the table below to view these informative sessions on demand. 

Review the workshop descriptions below. Each course may be viewed seperately. 

Medicare Part A

Medicare Part B

Day One

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Palmetto GBA Medical Affairs Wavetops

The 2022 Virtual MACtoberfest kicks off with a Part A and Part B combined session offered by Dr. Shane Mull, M.D., Senior Medical Director for Palmetto GBA. As the new Senior Medical Director, Dr. Mull will share insight into his role at Palmetto GBA, discuss current hot topics, initiatives, and share other area of focus within Palmetto GBA.

View here. 

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 Audit and Reimbursement

This session is intended for Part A providers as we Enter the Virtual World of Audit and Reimbursement. The Palmetto GBA Provider Audit and Reimbursement team will highlight common issues and helpful tips related to the filing and review of the Medicare Cost Report. Topics will include hospice CAPs and postpay adjustments, review of nursing and allied health costs, S-10 Audits, MCREF, and more. Facilities billing and coding staff, medical review departments, nurse reviewers, finance, and compliance officers would benefit from this session.

View here.
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Phishing Around the Medicare Grid of Appeals

Join us as we go Phishing Around the Medicare Grid of Appeals. This session we will enter the world of appeals and discuss our top three denial reasons in appeals for Medicare Part A Erythropoietin stimulating agents (ESA), Hyperbaric Oxygen Therapy (HBO), and PET Scans.

Facilities billing and coding staff, medical review departments, nurse reviewers, finance, and compliance officers would benefit from this session.

View here. 
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Updating the Drivers of Medicare in A/B Rebilling

Join us in Updating the Drivers of Medicare in A/B rebilling. This session will help Part A providers cruise through the requirements when it comes to A/B Rebilling. This session will include background information about the CMS 1455-R, CMS 1599-F, billing scenarios, knowledge checks, and tips and reminders that will assist with successful claims processing. We'll provide instruction on A/B rebilling for denied hospital inpatient claims to assist providers when a hospital inpatient payment cannot be made under Medicare Part A.

Facilities billing and coding staff, medical review departments, nurse reviewers, finance, and compliance officers would benefit from this session.

View here.
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Day Two

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Breaking Down the Firewalls of Finance

Join us as we Break Down the Firewalls of Finance. Learn how to manage Medicare overpayments — we will review overpayment recovery options and tools available to assist providers in the daily handling of their overpayment management including:

  • Voluntary Refunds
  • Credit Balance Reports
  • Utilizing online overpayment recovery tools: Overpayment Lookup, Green Mail demand letters, eCheck and eOffset

Billing and coding staff, medical review, nurse reviewers, finance, and compliance officers will benefit from this session.

View here.
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Entering the Cyber World of the Provider Contact Center

Enter the Cyber World of the Provider Contact Center as we address some of the most common Part A PCC claim issues. This session will provide generalized information that will assist you with lowering the claim error rates for MSP, timely filing and claim overlap. The presentation will provide insight on how to avoid these issues. 

Target Audience: Part A facilities billing and coding staff, medical review departments, nurse reviewers, and compliance officers.

View here.
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RAC COTIVITI

Palmetto GBA is pleased to have representatives from the CMS Recovery Audit Contractor (RAC), Cotiviti, as part of this year’s MACtoberfest. Part A and Part B providers will have the opportunity to hear directly from RAC representatives as they share insight into Cotiviti’s roles, responsibilities and general RAC overview as the RAC for Palmetto GBA providers in Jurisdictions J and M.

View here.

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The Right Touchpoints of Medicare Part A with ESRD

Join us for The Right Touchpoints of Medicare Part A with End Stage Renal Disease and requirements when it comes to submission of Medicare Part A ESRD claims. This session will include CMS updates with ESRD, frequent ESRD denials, and ways to help prevent them. Part A facilities billing and coding staff, medical review departments, nurse reviewers, compliance officers should attend.

View here.

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Understanding the Motherboards of Inpatient vs. Ambulatory Surgical Procedures with MCG Health

Join Palmetto GBA and MCG Health as Dr. Rifkin takes us through Understanding the Motherboards of Inpatient vs. Ambulatory Surgical Procedures. The objectives for this session include: 

  • Define and describe what is meant by an ambulatory procedure
  • Learn about and recognize patterns within the variation in the proportion of patients undergoing a given procedure on an ambulatory basis
  • Understand the point and purpose of the Medicare Inpatient Only List and the Ambulatory Surgical Center-Covered Procedure List
  • Learn about recent trends in total hip arthroplasty/total knew arthroplasty (THA/TKA) including racial disparities and the impact of the COVID 19 pandemic

Target Audience: This session is intended for Part A facilities, physicians, nurses, medical reviewers, compliance officers, billing and coding staff and medical records/review staff.

View here.

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Day Three

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NCDs/LCDs: What’s The Difference? Why Do They Matter?

Join Dr. Lisa Banker, Chief Medical Officer/Contractor Medical Director, Palmetto GBA, as she shares valuable insight regarding Palmetto GBA’s Part A and B local coverage determinations (LCDs) and CMS national coverage determinations (NCDs). 

  • Definitions of local and national coverage determinations.
  • How the policies impact your everyday world
  • Tips for finding and navigating the LCDs and NCDs
  • Uutilizing these policies to help guide valuable utilization review and clinical documentation efforts in our organization 

This session will be of interest to Part A facilities and Part B providers that bill for services on the CMS 1500 claim form or electronic equivalent.

View here.

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Meeting Medicare Requirements for Hyperbaric Oxygen Therapy

This session is intended for Part A providers, please join us as we enter JJ/JM Part A Meeting Medicare Requirements for Hyperbaric Oxygen Therapy (HBO). This webcast is designed to provide an overview of HBO Therapy, billing, documentation and medical necessity requirements, CERT and valuable tips to prevent errors. 

Facilities billing and coding staff, medical review departments, nurse reviewers, finance, and compliance officers would benefit from this session.

View here.

Day One

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Palmetto GBA Medical Affairs Wavetops

The 2022 Virtual MACtoberfest kicks off with a Part A and Part B combined session offered by Dr. Shane Mull, M.D., Senior Medical Director for Palmetto GBA. As the new Senior Medical Director, Dr. Mull will share insight into his role at Palmetto GBA, discuss current hot topics, initiatives, and share other area of focus within Palmetto GBA.

View here. 

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Navigating the Web of Electronic Data Interchange (EDI) 

This session will provide general information, updates, tips, and reminders to help providers navigate their way through EDI. Palmetto GBA will also discuss electronic methods to obtain information in the eServices portal to include claims, patient eligibility and remittance notices, along with other self-service tools. We encourage billers, managers, administrative and compliance staff to attend this session together. 

 

View here.

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Home Health and Hospice Referral, Documentation and Collaboration for Part B Providers 

 

This session will instruct physicians and other providers on what is required to make a referral to a home health or hospice agency. We will discuss eligibility, certification and how physicians can bill for certification, care plan oversight and hospice supervision.
 

View here.

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Decoding the Railroad Medicare Program

 

Have questions about Railroad Medicare? Whether you are a new provider and need to know who to get started with Railroad Medicare, or a current provider who would like more information on the Railroad Medicare program, then this event is for you!

During this session we will address frequently asked questions about Railroad Medicare topics including:

  • Who we are and what we do
  • How to get started billing Railroad Medicare
  • Registering for and using the eServices portal
  • Medical review of Railroad Medicare claims
  • Submitting Appeals and Reopenings requests
  • Resources and contacts 

We will also give you a chance to ask your questions about the topics covered. So don’t delay, register today!

View here.
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Day Two

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Accessing the Appeals U-verse

Part B Appeals invites providers to control +Alt +delete and access the world of appeals. This session will guide you through:

  • When a Medicare claim can (and cannot) be appealed
  • How to request an appeal 
  • What information to include on (and with) your appeal request
  • How to appeal an overpayment notice
  • Most common errors found on appeals and how to avoid them
  • Why some appeal requests are not completed as appeals 
  • When to request a reopening instead of an appeal

View here.
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MolDX® Program and Drugs of Abuse Testing

This session combines two diagnostic testing topics. Join Gabriel Bien-Willner, MD, MolDX® Chief Medical Director for Palmetto GBA as he discusses the Molecular Diagnostic Testing, MolDX® Program and the role Palmetto GBA plays in this program. 

Miguel Brito, Jr., MD, Chief Medical Officer and Contract Medical Director for Palmetto GBA, will discuss drugs of abuse testing. This session will include information regarding coverage, documentation requirements and associated common errors for these tests.

View here.
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RAC COTIVITI

Palmetto GBA is pleased to have representatives from the CMS Recovery Audit Contractor (RAC), Cotiviti, as part of this year’s MACtoberfest. Part A and Part B providers will have the opportunity to hear directly from RAC representatives as they share insight into Cotiviti’s roles, responsibilities and general RAC overview as the RAC for Palmetto GBA providers in Jurisdictions J and M.

View here.

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Discovering the Drives in Medical Review

In this session, medical review will show you how to discover the different drives in medical review and will discuss: 

  • Targeted Probe and Educate
  • Identify how to respond to an Additional Documentation Requests (ADR)
  • Updating the Provider Point of Contact and how this is beneficial to success
  • Comprehensive Error Rate Testing (CERT)
  • How to avoid a denial

View here

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Day Three

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NCDs/LCDs: What’s The Difference? Why Do They Matter?

Join Lisa Dr. Banker, Chief Medical Officer/Contractor Medical Director, Palmetto GBA, as she shares valuable insight regarding Palmetto GBA’s Part A and B local coverage determinations (LCDs) and CMS national coverage determinations (NCDs). This session will include:

  • Definitions of local and national coverage determinations
  • How the policies impact your everyday worlds
  • Tips for finding and navigating the LCDs and NCDs
  • Utilizing these policies to help guide valuable utilization review and clinical documentation efforts in our organization. 

This session will be of interest to Part A facilities and Part B providers that bill for services on the CMS 1500 claim form or electronic equivalent.

View here.

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Provider Enrollment

All providers who serve Medicare Part B patients are required to enroll with Medicare. During this presentation, we will discuss an overview of the Medicare Part B Provider Enrollment process. This will include the application submission options, the available CMS systems, as well as when to make changes and revalidate.

View here.

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