Medicare Boot Camp: Understanding Coverage Criteria for Skilled Nursing Services
1.5 CE for Ohio NHA, Ohio Nurses, Ohio CPA
SNF
Understanding Medicare coverage criteria is essential for the clinical, financial, and regulatory success of skilled nursing facilities. This Medicare Boot Camp webinar provides a clear, structured walk through of Medicare Part A coverage requirements, from admission through continued stay.
Designed for members of the interdisciplinary team, this session breaks down complex regulations into practical guidance. Participants will explore technical eligibility rules, including qualifying hospital stays, benefit periods, and physician certification requirements, as well as the skilled level of care standards that determine daily coverage.
Through real-world examples and regulatory guidance, the webinar will clarify direct vs. indirect skilled services, observation and assessment, teaching and training activities, and management and evaluation of care plans. Emphasis is placed on documentation expectations and common “questionable situations” that often lead to denials.
Whether you support admissions, clinical care, billing, or compliance, this session equips attendees with the foundational knowledge needed to support appropriate Medicare coverage and reduce financial risk.
Learning Objectives
At the conclusion of this 90-minute session, participants will be able to:
1. Identify Medicare Part A technical eligibility requirements, including enrollment, qualifying hospital stay, benefit periods, and timely transfer rules.
2. Explain physician certification and recertification requirements and recognize common compliance pitfalls that place coverage at risk.
3. Differentiate between skilled and non-skilled services, including direct and indirect skilled nursing and rehabilitation services.
4. Apply the “skilled level of care” and “practical matter” criteria to real-world admission and continued stay scenarios.
Who Should Attend:
• Skilled Nursing Facility Administrators
• Directors of Nursing and Clinical Leaders
• MDS Coordinators
• Therapy Managers
• Social Services and Admissions Staff
• Billing, Compliance, and Revenue Cycle Teams
Presented by:
Robin L. Hillier, CPA, LNHA, RAC-CTA, RAC-MT
Robin L. Hillier is a healthcare executive dedicated to post-acute and long-term care. She is a Certified Public Accountant, a Licensed Nursing Home Administrator, and is Resident Assessment Coordinator Certified Advanced and a Master Teacher through the American Association of Post-Acute Care Nursing (AAPACN). Throughout her career she has been involved in all aspects of facility operations, including ownership roles. She is currently the President of RLH Consulting, which provides operational and reimbursement consulting to providers of skilled nursing, assisted living and intellectual or developmental disabilities. She is a nationally recognized expert on payment system design, quality measurement and the Resident Assessment Instrument, and was actively involved in the design of the Patient Driven Payment Model implemented October 1, 2019.
Ms. Hillier is Past Chair of both the Ohio Health Care Association (OHCA) and its’ Educational Foundation (EFOHCA), and has served on the OHCA Board of Directors since 1998. She served on the Board of Governors and Executive Committee of the American Health Care Association (AHCA) from 2010 through 2017, and continues to serve on the Reimbursement Cabinet. She serves on the AAPACN Board of Director and is vice chair of its’ Expert Advisory Panel. Ms. Hillier was a recipient of the 2018 AANAC Contributor of the Year award, the 2015 AHCA Joe Warner Patient Advocacy award, and the 2004 OHCA President’s award. She is a graduate of both the AHCA Future Leader and Political Ambassador programs, and represented AHCA at the 2014 White House Summit on Working Families.
Registration Fees:
Members: $55
Non-Members: $110