Welcome to the Ability Education Platform

Practice Enhancement Through Clinically Correct Coding

There are four purchasing options available for these courses.

This is a 23-session course designed  to assist in successful navigation of the business of medicine. The sessions have been chosen to not only promote quality in care delivery, but also to assist in the economic side of practice enhancement.  Because Family Medicine physicians are so broadly used in healthcare, we’ve chosen sessions that speak to both the inpatient and ambulatory practices of medicine.

You will receive up to 20 CME Prescribed credits upon successful completion of these courses.

The AAFP has reviewed Practice Enhancement Through Clinically
Correct Coding and deemed it acceptable for Prescribed credit.
Term of Approval is from 01/01/2022 to 12/31/2022.

2022 Practice Enhancement Through Clinically Correct Coding Sessions

Total CME:       20.0

Session #1:         1.0

The Basic Evaluation and Management Guidelines for the Office Setting

  • Know the definitions of the types of conditions that we use in our evaluation and management services as well as how to determine whether a patient is new or established in a practice
  • Be able to correctly apply time-based coding in the ambulatory office practice setting
  • Describe the Medical Decision-Making components as redefined in 2021 and be able to clinically apply them in 2022

Session #2:         0.5

Practical Applications of the Office Evaluation and Management Guidelines

  • Know the two ways that office-based encounters can be billed in 2022
  • Be able to define the 2021 prolonged service code and correct applications of such
  • State ways to clinically apply appropriate levels of service from various clinical scenarios

Session #3:         1.0

Performing the Medicare Wellness Visits in Primary Care:  2022 Insights

  • Understand the reasons behind the Comparative Billing Report of 2021 and its implications in 2022 for the Medicare Wellness Visit
  • Define the three types of Medicare Wellness Visits and how to correctly perform, document, and bill for each of these services
  • Understand how to correctly apply chronic disease care delivery in the context of the Medicare Wellness Visit with the addition of the -25 modifier

Session #4:         1.0

Understanding the Preventive Services in Medicare

  • Define how to find the central source of updated information on Medicare Preventive Services, codes, co-insurance, and coverage intervals
  • Describe the covered services offered through Medicare in cancer prevention
  • Discuss the preventive services offered through Medicare related to intensive behavioral therapy, diabetes, and diabetes prevention

Session #5:         1.0

Care Management in Primary Care:  CCM, PCM, Home Health, and Care Plan Oversight Services

  • Know how to perform, document, and bill for Chronic Care Management (CCM) services
  • Know how to perform, document, and bill for Principle Care Management (PCM) services
  • Know how to document and bill correctly for home health certification, recertification, and care plan oversight

Session #6:         1.0

Documentation and Coding of Dermatology Procedures in Primary Care

  • Outline documentation strategies to support dermatology procedures
  • Know how to document and bill for biopsy procedures based on latest guidelines
  • Describe how to document and bill for multiple procedures as well as procedures done in the context of a problem-based encounter using the -25 modifier

Session #7:         0.5

Behavioral Health Integration (BHI) and The Psychiatric Collaborative Care Model

  • Define how to effectively integrate behavioral health into primary care
  • Be able to outline the psychiatric collaborative care delivery model and how to correctly document, code, and bill for these services

 Session #8:         1.0

Transition Care Management (TCM):  The Keystone of Care Transitions

  • State the importance of care coordination and understand how to transition patients from hospital to home, from home to office, and then office to home
  • Differentiate between the two Transition Care Management codes (99495 and 99496) for 2022 and how and when to bill each
  • Know processes needed to successfully implement TCM in your practice

Session #9:         0.5

Advance Care Planning:  Helping Our Patients Transition

  • State why family physicians should engage their patients in discussions relating to end-of-life care.
  • Know the specific documents used for end-of-life decision making in health care
  • Be able to perform, document, and correctly bill for Advance Care Planning services

Session #10:      1.0

Compliant Use of the Nurse Practitioners (NPs) and Physician Assistants (PAs) in 2022

  • Define the various Advanced Practice Professionals (APPs) commonly seen in primary care
  • Differentiate between “split/shared” and “incident to” services and how APPs can be an integral part this type of care delivery given the 2022 CMS updates
  • Know the appropriate billing and understand the correct documentation needed to be compliant in overseeing APP care delivery

Session #11:      0.5

Social Determinants of Health (SDoH):  Uncovering a Key Player in Healthcare Outcomes

  • State several health impacts associated with SDoH.
  • Know the key SDoH risk factors and why regular screening for such is important in healthcare
  • Understand the codes associated with SDoH risk factors and the importance of correct coding for these conditions

Session #12:      1.0

Know How Hierarchical Condition Categories (HCCs) and Diagnosis Related Groups (DRGs) Shape Clinical Documentation Improvement in 2022:

  • Be able to explain optimal clinical documentation, redocumentation, “risk” scores and the economics associated with excellence in this area
  • Know clinical conditions in the outpatient office practice that are a focus of opportunity with regards to Hierarchical Condition Categories (HCCs)
  • State several Diagnosis Related Groups (DRGs) and how clinical documentation assists in capturing the correct picture of a patient’s disease state in the hospital setting

Session #13:      1.0

The Why and How to Develop Documentation, Coding and Billing Compliance in Primary Care

  • Outline reasons why a compliance plan related to coding and billing is important in primary care
  • Know the key focus areas of compliance audits in 2022
  • Understand the process of assessment and performance improvement through encounter audits to aid in success of a primary care compliance plan

Session #14:      0.5

The Preoperative Assessment:  Step 1 in Effective Care Transitions

  • Understand the roles primary care plays in the surgical patient’s care
  • Know areas of focus for preoperative assessment of the older adult
  • State the importance of a coordinated transition care management (TCM) interaction post-operatively and strategies in delivery

Session #15:      1.0

The Many Hats of the Physician Advisor in 2022

  • Be able to define a “Physician Advisor” and why primary care physicians with hospital experience ideally fit this role
  • Explain the roles performed in support of case management with respect to resource utilization and quality
  • Know how the physician advisor can support CDI, medical necessity, and denials management processes for healthcare systems

Session 16:         0.5 

2022 Telehealth and Remote Patient Monitoring (RPM):  Clinical Applications Across the Spectrum

  • Be able to describe how Telehealth looks in 2022 and how to apply it to your primary care practice
  • Be able to define what remote patient monitoring is and what clinical disease states can be most easily addressed as a first step outreach
  • Understand the coding and billing associated with RPM services

Session #17:      1.0

The Business of Medicine:  Foundational Information Not Taught in Residency

  • Know the global history of the Medicare program and understand the parts (A, B, C, and D) that make it up
  • Define and understand the 2022 changes to relative value units (RVUs) and the conversion factor
  • Know the out-of-pocket costs associated with the Medicare Beneficiary in 2022 and how shared savings and cost of care play into payments
  • Know the basic components of coding and the concept of documentation integrity and its application to how we get paid

Session #18:      0.5

Dousing the Flames of Burnout in 2022

  • Know the prevalence and progression of burnout in the medical professional community and the effects of the COVID pandemic
  • List the clinical manifestations of burnout and triggers that lead to this clinical state
  • Discuss strategies to deploy to help reduce personal and occupational stress

Session #19:      1.0

Leadership Challenges for Today’s Physician

  • Know reasons behind having physicians as leaders.
  • Understand essential elements needed for effective physician leadership.
  • Be able to outline practical applications of physician leadership skills across the scope of healthcare needs.

Session #20:      1.0

Population Health Management:  Understanding Quality, Incentives, and Value

  • Define “Population Health Management”
  • Discuss how quality is aligned across the healthcare spectrum
  • State how incentives, penalties and value are defined in healthcare

 Session #21:      1.0

The 2022 Basic Evaluation and Management Guidelines for the Hospital Setting

  • State differences in the 2021 Evaluation and Management Guidelines in the office and the hospital facility
  • Know the concepts that make up the History, Exam, and Medical Decision-Making Key Components of the Hospital E&M Guidelines
  • State ways to practically apply the three Key Components in clinical practice examples

 Session #22:      1.5

The Two Midnight Rule and Medical Necessity in the Hospital Setting

  • Define the “Two Midnight Rule” clinically and correct applications given the 2022 “Inpatient Only List” changes
  • State pearls associated with documentation of medical necessity of key conditions in the hospital setting to include heart failure, myocardial infarction, pulmonary conditions, stroke, and sepsis

Session #23:      1.0

Compliant Time-based Coding and Documentation in the Hospital Setting

  • Define the documentation needed for time-based services in the hospital setting
  • Explain 2022 revised critical care services policy and how to document, code and bill for these services
  • Explain 2022 revised split and shared services policy and how to document, code and bill for these services
  • Know how to document discharge care in the inpatient site of service

Total CME:                       20.0