Medicare Review – Fall 2025

Program Description

This comprehensive training program offers a detailed review of Medicare, Medicare Advantage, and supplemental insurance coverage. Participants will gain an in-depth understanding of nursing facility benefits, payment methods, and strategies to improve care coordination and service quality for eligible individuals in both fee-for-service and managed care systems.

Key topics covered will include:

• Skilled Nursing Facility (SNF) level of care requirements and preadmission screening
• Facility expenses, billing requirements, and Medicare reimbursement processes—including deductibles and co-insurance
• Navigating the complexities of Medicare Advantage plans and overcoming payment obstacles

In addition, this training will focus on practical strategies to optimize reimbursement and ensure compliance. Participants will also learn to identify and address common challenges in long-term care facilities, ensuring that patients receive the highest level of care.

By the end of this training, participants will be able to:

• Identify facility challenges involving Medicare skilled inpatient and outpatient services
• Determine proper PDPM MDS filing requirements
• Address Medicare Advantage plan hurdles and methods to overcome payment obstacles
• Appropriately apply consolidated billing principles
• Identify and issue the appropriate discharge notices, including SNF ABN and NOMNC forms
• Review and implement recently updated rules and forms, including SNF ABN form instructions and NOMNC guidelines

This course provides the knowledge and tools necessary for health care workers to navigate the complexities of Medicare and enhance their ability to manage billing and reimbursement efficiently.

Continuing Education Credit

This course is approved for 3.5 contact hours for:

• NF Administrators
• Nurses
• Social Services

Registration Fees

Members:     $75 per person
Non-Members:         $225 per person

Speaker Bio

Jim Wilkes leads the Data Processing Services team for the Brighton Consulting Group. His expertise is providing consulting and technical reporting services to a large number of Iowa’s providers of skilled nursing and other long-term care services. Throughout his 30+ years in the long-term care sector, he has helped countless facilities establish and maintain Medicare and Medicaid certification. Jim also prepares and consults on Medicare and Medicaid cost reports. Jim is a graduate of Central College in Pella and makes his home in Iowa City.

• Training Hours: 3.50