The AAFP has reviewed Practice Enhancement Through Clinically
Correct Coding and deemed it acceptable for Prescribed credit.
Term of Approval is from 01/01/2023 through 12/31/2023.*
*Individual courses must be completed prior to January 1, 2024 to receive CME credit for that course.
Practice Enhancement Through Clinically Correct Coding
The purpose of this educational platform is to assist in allowing providers to remain current and compliant in the ever-changing world of documentation, coding, and billing. There were sweeping changes in office coding in 2021 and a similar overhaul unfolded for the hospital, emergency department, and post-acute settings in January 2023. This platform will allow access to help empower providers with knowledge to master these changes. The creator of the content is a practicing family medicine physician with over 30 years in practice – 17 years of which were in a blended ambulatory/inpatient medicine setting – who has been a Certified Professional Coder (CPC) since 2000. The educational curriculum is focused on practical applications of these concepts to align with the needs faced in primary care.
You will receive up to 20 CME Prescribed credits upon successful completion of these courses.
There are 3 purchasing options:
-
Combined Track $400Purchase complete access to all 40 sessions and receive the full 20 Hours of CME Credit upon successful completion.
- Ambulatory Track $360
Purchase 30 sessions, #'s 1 - 30 and receive 15 Hours of CME Credit upon successful completion.
- Hospital Track $300
Purchase 25 sessions, #'s 1, 2, 8, 17-21 and 24-40 and receive 12.5 Hours of CME Credit upon successful completion.
2023 Practice Enhancement Tracks
2023 Practice Enhancement Through Clinically Correct Coding Sessions – Combined Track (40 Sessions)
Total CME: 20.0
Key
C: Combined Track 20.0 Prescribed AAFP/AMA PRA Cat I CME credits
A: Ambulatory Track 15.0 Prescribed AAFP/AMA PRA Cat I CME credits
H: Hospital Track 12.5 Prescribed AAFP/AMA PRA Cat I CME credits
SESSIONS (each 0.5h)
(C/A/H) Session #1:
The Billing Classification of Patients: Defining New and Established
- Be able to define new and established patients in the ambulatory space
- Know how patients are classified in the hospital/facility setting
- State how new and established encounters are correctly billed
(C/A/H) Session #2:
Compliant Use of Nurse Practitioners (NPs) and Physician Assistants (PAs)
- Define the various Non-Physician Providers (NPPs) commonly seen in primary care
- Differentiate between “shared” and “incident to” services and how NPPs can be an integral part this type of care delivery given AMA/CMS updates
- Know the appropriate billing and understand the correct documentation needed to be
compliant in overseeing NPP care delivery
(C/A) Session #3:
The Basic Evaluation and Management Guidelines for the Office Setting
- Apply time-based coding in the ambulatory office practice setting
- Define the Medical Decision-Making components and correctly apply them clinically
- Understand how to use prolonged services
(C/A) Session #4:
The Chronic Disease Primer for Primary Care: Hypertension
- Know the clinical manifestations of hypertension in America today
- Be able to state the Stars quality measure associated with hypertension and strategies to succeed in this measure
- Know basic medication classes used and laboratory studies pertinent in management
(C/A) Session #5:
The Chronic Disease Primer for Primary Care: Diabetes Mellitus
- Know the Stars quality measures associated with Diabetes
- Be able to state the basic medication management options in DM
- Know a best practice way to optimize quality measure outcomes for DM
(C/A) Session #6:
The Chronic Disease Primer for Primary Care: Heart Failure
- Be able to state the various stages of Heart Failure (HF)
- Define the types of heart failure, appropriate diagnosis codes, and HCC risk assignment
- Understand the pharmacological basic medications used to manage HF
(C/A) Session #7:
The Chronic Disease Primer for Primary Care: COPD
- Know the clinical impact COPD has on populations
- Be able to state the basic medication management options in COPD
- Understand the correct documentation to support the clinical definition of COPD
(C/A/H) Session #8:
Care Management in Primary Care: Performing Transitional Care Management to Manage the Hospital
to Home Journey
- 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 Transitional Care Management codes and know when to bill each
- Know processes needed to successfully implement this in your practice
(C/A) Session #9:
Care Management in Primary Care: Offering Chronic Care and Principal Care Management Services
- Outline reasons for care management service delivery in primary care
- Know how to perform, document, and bill for Principal Care Management services
- Know how to perform, document, and bill for Chronic Care Management services
(C/A) Session #10:
Care Management in Primary Care: Home Health and Care Plan Oversight Authorizations
- Understand the clinical criteria for home bound status
- Understand the clinical medical necessity for home health service delivery
- Know how to document and bill correctly for home health certification, recertification, and care plan oversight
(C/A) Session #11:
Behavioral Health Integration (BHI) in Primary Care: The Psychiatric Collaborative Care Model
- Define how to effectively integrate behavioral health into primary care
- Be able to construct the psychiatric collaborative care delivery model and how to correctly document, code, and bill for these services
- Know the correct behavioral health diagnoses for optimal Hierarchical Condition Code (HCC)
capture
(C/A) Session #12:
Performing the Medicare Wellness Visits in Primary Care
- Define the three types of Medicare Wellness Visits
- Know 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
(C/A) Session #13:
Understanding 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 breast, colon, and lung cancer screening
- Discuss the preventive services offered through Medicare related to intensive behavioral therapy
(C/A) Session #14:
Dermatology Integration in Primary Care
- Understand the economic benefit to adding dermatology procedures as a service line
- Know which procedures most easily fit in the primary care workflow
- Understand an operational workflow to integrate this service line
(C/A) Session #15:
Correct Documentation, Coding and Billing 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
(C/A) Session #16:
Telehealth and Remote Patient Monitoring (RPM): Clinical Applications
- Be able to describe how Telehealth looks in 2023 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 documentation, coding, and billing needs for RPM
(C/A/H) Session #17:
Advance Care Planning: Helping Our Patients Transition
- State why 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
(C/A/H) Session #18:
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
(C/A/H) Session #19:
Understanding Healthcare Disparities
- Define healthcare disparities
- Know where disparities have greatest clinical impact
- Outline some best practice steps to address healthcare disparities
(C/A/H) Session #20:
Defining Hierarchical Condition Categories (HCCs) in Primary Care
- Be able to define optimal clinical documentation, redocumentation, and “risk” scores
- Know clinical conditions that are a focus of opportunity to optimize HCCs
- Be able to show the economics associated with excellence in this area
(C/A/H) Session #21:
Clinical Applications of Key HCCs in Primary Care
- Understand the details associated with HCC code capture with cancer diagnoses
- Understand the details associated with HCC code capture with diabetes and obesity
- Understand the details associated with HCC code capture with chronic kidney disease
- Understand the details associated with HCC code capture with neurologic (stroke) syndromes
(C/A) Session #22:
Documentation, Coding and Billing for the Nursing Facility E&M Services
- Define clinical states that merit acute inpatient, skilled, and long-term care delivery
- Describe the documentation, coding, and billing in the nursing facility setting
- Explain the care delivery rule application for NPPs
(C/A) Session #23:
Documentation, Coding and Billing for Home/Residence Places of Care Delivery
- Define various “home” settings
- Understand how time and medical decision making applies to these places of service
- Explain documentation and billing applications of NPPs for these settings
(C/A/H) Session #24:
A Strategic Path to Documentation, Coding and Billing Compliance
- Outline reasons why a compliance plan related to coding and billing is important in primary care
- Define areas of focus for providers based on current governmental guidance
- Understand the process of assessment and performance improvement through encounter audits to aid in success of a compliance plan
(C/A/H) Session #25:
The Preoperative Assessment: Step One in Effective Care Transitions
- Understand the roles primary care and other providers play in the surgical patient’s care
- Know the areas of focus for preoperative assessment of the older adult
- State the importance of the coordinated transition care management (TCM) interaction post-operatively and strategies in delivery
(C/A/H) Session #26:
The Role of the Physician Advisor (PA): Expanding Beyond Status Determination
- Be able to define a “Physician Advisor” and what types of physicians can fit this role
- Know how PAs can support of case management with respect to resource utilization and quality
- State how PAs can support CDI, medical necessity, and denials management
(C/A/H) Session #27:
Understanding the Basics of the Business of Medicine
- Know the history of the Medicare program and understand the parts that make it up
- Know the out-of-pocket costs associated with the Medicare Beneficiary in and the concept of co-insurance across the spectrum of healthcare
- Be able to state the basic components of coding and the concepts of documentation integrity and its application to how we get paid
- Define relative value units, the conversion factor, shared savings, and cost of care and how these play into payment for providers
(C/A/H) Session #28:
Dousing the Flames of Burnout
- 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
(C/A/H) Session #29:
Today’s Physician: Stakeholder and Leader for Sustainable Change
- 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
(C/A/H) Session #30:
Population Health Management: It’s more than just seeing patients
- Define “Population Health Management”
- Understand key data points needed to succeed in population health management
- Restate strategies needed to keep aligned with this aspect of medicine
(C/H) Session #31
The Hospital Quality Journey: Where is our Focus?
- Know the quality metrics tied to value-based care
- Understand the conditions tied to the readmission reduction program
- Know the conditions linked to the hospital acquired infections measure
(C/H) Session #32:
The E&M Guidelines for the Hospital Setting: Current Updates
- Explain the 2023 documentation and billing rules for time-based coding and Medical Decision-Making components in the hospital setting
- Describe split/shared billing in the hospital facility setting
- Understand how to use prolonged services in the hospital setting
(C/H) Session #33:
Hospital Clinical Documentation Improvement (CDI): Stating the Correct Clinical Picture
- Define the Diagnosis Related Group (DRG) concept
- Know how DRGs impact the Case Mix Index (CMI) and how these economically impact a hospital facility
- State top Diagnosis Related Groups (DRGs) and how to best document to capture the optimal clinical picture
(C/H) Session #34:
The Two Midnight Rule and Medical Necessity in the Hospital Setting
- Define the “Two Midnight Rule” and the inpatient vs observation determination
- State the importance of “D-Day” documentation with respect to patient status
- Understand what the “Inpatient Only List” is and a management option for correct use
(C/H) Session #35:
The Medical Necessity Series, Part I
- State documentation pearls associated with documentation of medical necessity of key cardiac conditions in the hospital setting to include:
- Chest Pain/ Myocardial Infarction
- Heart Failure
- Atrial Fibrillation
- State documentation pearls associated with documentation of medical necessity of key cardiac conditions in the hospital setting to include:
(C/H) Session #36:
The Medical Necessity Series, Part II
- State documentation pearls associated with documentation of medical necessity of key respiratory conditions in the hospital setting to include:
- COPD
- Pneumonia
(C/H) Session #37:
The Medical Necessity Series, Part III
- State documentation pearls associated with documentation of medical necessity of key neurological conditions in the hospital setting to include:
- Encephalopathy
- TIA
- Stroke
(C/H) Session #38:
The Medical Necessity Series, Part IV
- State documentation pearls associated with documentation of medical necessity of key infectious conditions in the hospital setting to include:
- Sepsis
- Cellulitis
- Urinary Tract Infections
(C/H) Session #39:
Compliant Time-based Coding and Documentation in the Hospital Setting
- Define the documentation needed for time-based services in the hospital setting
- Explain critical care services policy and know how to document, code and bill for these services
- Know how to document discharge services as well as prolonged services hospital care
(C/H) Session #40:
Current Evaluation & Management (E&M) Guidelines in the Emergency Department (ED)
- Know current ED E&M documentation, coding, and billing guidelines regarding Medical Decision Making
- Describe split/shared billing in the ED setting
- Apply clinical examples to the appropriate levels of ED care delivery
Total Prescribed AAFP/AMA PRA Cat I CME: 20.0
2023 Practice Enhancement Through Clinically Correct Coding Sessions – Ambulatory Track (30 Sessions)
Total CME: Ambulatory Track – 15.0 Prescribed AAFP/AMA PRA Cat I CME credits
SESSIONS (each 0.5h)
Session #1:
The Billing Classification of Patients: Defining New and Established
- Be able to define new and established patients in the ambulatory space
- Know how patients are classified in the hospital/facility setting
- State how new and established encounters are correctly billed
Session #2:
Compliant Use of Nurse Practitioners (NPs) and Physician Assistants (PAs)
- Define the various Non-Physician Providers (NPPs) commonly seen in primary care
- Differentiate between “shared” and “incident to” services and how NPPs can be an integral part this type of care delivery given AMA/CMS updates
- Know the appropriate billing and understand the correct documentation needed to be
compliant in overseeing NPP care delivery
Session #3:
The Basic Evaluation and Management Guidelines for the Office Setting
- Apply time-based coding in the ambulatory office practice setting
- Define the Medical Decision-Making components and correctly apply them clinically
- Understand how to use prolonged services
Session #4:
The Chronic Disease Primer for Primary Care: Hypertension
- Know the clinical manifestations of hypertension in America today
- Be able to state the Stars quality measure associated with hypertension and strategies to succeed in this measure
- Know basic medication classes used and laboratory studies pertinent in management
Session #5:
The Chronic Disease Primer for Primary Care: Diabetes Mellitus
- Know the Stars quality measures associated with Diabetes
- Be able to state the basic medication management options in DM
- Know a best practice way to optimize quality measure outcomes for DM
Session #6:
The Chronic Disease Primer for Primary Care: Heart Failure
- Be able to state the various stages of Heart Failure (HF)
- Define the types of heart failure, appropriate diagnosis codes, and HCC risk assignment
- Understand the pharmacological basic medications used to manage HF
Session #7:
The Chronic Disease Primer for Primary Care: COPD
- Know the clinical impact COPD has on populations
- Be able to state the basic medication management options in COPD
- Understand the correct documentation to support the clinical definition of COPD
Session #8:
Care Management in Primary Care: Performing Transitional Care Management to Manage the Hospital
to Home Journey
- State the importance of care coordination and understand how to transition patients fromhospital to home, from home to office, and then office to home
- Differentiate between the two Transitional Care Management codes and know when to bill each
- Know processes needed to successfully implement this in your practice
Session #9:
Care Management in Primary Care: Offering Chronic Care and Principal Care Management Services
- Outline reasons for care management service delivery in primary care
- Know how to perform, document, and bill for Principal Care Management services
- Know how to perform, document, and bill for Chronic Care Management services
Session #10:
Care Management in Primary Care: Home Health and Care Plan Oversight Authorizations
- Understand the clinical criteria for home bound status
- Understand the clinical medical necessity for home health service delivery
- Know how to document and bill correctly for home health certification, recertification, and care plan oversight
Session #11:
Behavioral Health Integration (BHI) in Primary Care: The Psychiatric Collaborative Care Model
- Define how to effectively integrate behavioral health into primary care
- Be able to construct the psychiatric collaborative care delivery model and how to correctly document, code, and bill for these services
- Know the correct behavioral health diagnoses for optimal Hierarchical Condition Code (HCC)
capture
Session #12:
Performing the Medicare Wellness Visits in Primary Care
- Define the three types of Medicare Wellness Visits
- Know 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 #13:
Understanding 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 breast, colon, and lung cancer screening
- Discuss the preventive services offered through Medicare related to intensive behavioral therapy
Session #14:
Dermatology Integration in Primary Care
- Understand the economic benefit to adding dermatology procedures as a service line
- Know which procedures most easily fit in the primary care workflow
- Understand an operational workflow to integrate this service line
Session #15:
Correct Documentation, Coding and Billing 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 #16:
Telehealth and Remote Patient Monitoring (RPM): Clinical Applications
- Be able to describe how Telehealth looks in 2023 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 documentation, coding, and billing needs for RPM
Session #17:
Advance Care Planning: Helping Our Patients Transition
- State why 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 #18:
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 #19:
Understanding Healthcare Disparities
- Define healthcare disparities
- Know where disparities have greatest clinical impact
- Outline some best practice steps to address healthcare disparities
Session #20:
Defining Hierarchical Condition Categories (HCCs) in Primary Care
- Be able to define optimal clinical documentation, redocumentation, and “risk” scores
- Know clinical conditions that are a focus of opportunity to optimize HCCs
- Be able to show the economics associated with excellence in this area
Session #21:
Clinical Applications of Key HCCs in Primary Care
- Understand the details associated with HCC code capture with cancer diagnoses
- Understand the details associated with HCC code capture with diabetes and obesity
- Understand the details associated with HCC code capture with chronic kidney disease
- Understand the details associated with HCC code capture with neurologic (stroke) syndromes
Session #22:
Documentation, Coding and Billing for the Nursing Facility E&M Services
- Define clinical states that merit acute inpatient, skilled, and long-term care delivery
- Describe the documentation, coding, and billing in the nursing facility setting
- Explain the care delivery rule application for NPPs
Session #23:
Documentation, Coding and Billing for Home/Residence Places of Care Delivery
- Define various “home” settings
- Understand how time and medical decision making applies to these places of service
- Explain documentation and billing applications of NPPs for these settings
Session #24:
A Strategic Path to Documentation, Coding and Billing Compliance
- Outline reasons why a compliance plan related to coding and billing is important in primary care
- Define areas of focus for providers based on current governmental guidance
- Understand the process of assessment and performance improvement through encounter audits to aid in success of a compliance plan
Session #25:
The Preoperative Assessment: Step One in Effective Care Transitions
- Understand the roles primary care and other providers play in the surgical patient’s care
- Know the areas of focus for preoperative assessment of the older adult
- State the importance of the coordinated transition care management (TCM) interaction post-operatively and strategies in delivery
Session #26:
The Role of the Physician Advisor (PA): Expanding Beyond Status Determination
- Be able to define a “Physician Advisor” and what types of physicians can fit this role
- Know how PAs can support of case management with respect to resource utilization and quality
- State how PAs can support CDI, medical necessity, and denials management
Session #27:
Understanding the Basics of the Business of Medicine
- Know the history of the Medicare program and understand the parts that make it up
- Know the out-of-pocket costs associated with the Medicare Beneficiary in and the concept of co-insurance across the spectrum of healthcare
- Be able to state the basic components of coding and the concepts of documentation integrity and its application to how we get paid
- Define relative value units, the conversion factor, shared savings, and cost of care and how these play into payment for providers
Session #28:
Dousing the Flames of Burnout
- 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 #29:
Today’s Physician: Stakeholder and Leader for Sustainable Change
- 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 #30:
Population Health Management: It’s more than just seeing patients
- Define “Population Health Management”
- Understand key data points needed to succeed in population health management
- Restate strategies needed to keep aligned with this aspect of medicine
Total Prescribed AAFP/AMA PRA Cat I CME: 15.0
2023 Practice Enhancement Through Clinically Correct Coding Sessions – Hospital Track (25 Sessions)
Total CME: 12.5 Prescribed AAFP/AMA PRA Cat I CME credits
SESSIONS (each 0.5h)
Session #1: The Billing Classification of Patients: Defining New and Established- Be able to define new and established patients in the ambulatory space
- Know how patients are classified in the hospital/facility setting
- State how new and established encounters are correctly billed
- Define the various Non-Physician Providers (NPPs) commonly seen in primary care
- Differentiate between “shared” and “incident to” services and how NPPs can be an integral part this type of care delivery given AMA/CMS updates
- Know the appropriate billing and understand the correct documentation needed to be compliant in overseeing NPP care delivery
- State the importance of care coordination and understand how to transition patients fromhospital to home, from home to office, and then office to home
- Differentiate between the two Transitional Care Management codes and know when to bill each
- Know processes needed to successfully implement this in your practice
- State why 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
- 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
- Define healthcare disparities
- Know where disparities have greatest clinical impact
- Outline some best practice steps to address healthcare disparities
- Be able to define optimal clinical documentation, redocumentation, and “risk” scores
- Know clinical conditions that are a focus of opportunity to optimize HCCs
- Be able to show the economics associated with excellence in this area
- Understand the details associated with HCC code capture with cancer diagnoses
- Understand the details associated with HCC code capture with diabetes and obesity
- Understand the details associated with HCC code capture with chronic kidney disease
- Understand the details associated with HCC code capture with neurologic (stroke) syndromes
- Outline reasons why a compliance plan related to coding and billing is important in primary care
- Define areas of focus for providers based on current governmental guidance
- Understand the process of assessment and performance improvement through encounter audits to aid in success of a compliance plan
- Understand the roles primary care and other providers play in the surgical patient’s care
- Know the areas of focus for preoperative assessment of the older adult
- State the importance of the coordinated transition care management (TCM) interaction post-operatively and strategies in delivery
- Be able to define a “Physician Advisor” and what types of physicians can fit this role
- Know how PAs can support of case management with respect to resource utilization and quality
- State how PAs can support CDI, medical necessity, and denials management
- Know the history of the Medicare program and understand the parts that make it up
- Know the out-of-pocket costs associated with the Medicare Beneficiary in and the concept of co-insurance across the spectrum of healthcare
- Be able to state the basic components of coding and the concepts of documentation integrity and its application to how we get paid
- Define relative value units, the conversion factor, shared savings, and cost of care and how these play into payment for providers
- 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
- 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
- Define “Population Health Management”
- Understand key data points needed to succeed in population health management
- Restate strategies needed to keep aligned with this aspect of medicine
- Know the quality metrics tied to value-based care
- Understand the conditions tied to the readmission reduction program
- Know the conditions linked to the hospital acquired infections measure
- Explain the 2023 documentation and billing rules for time-based coding and Medical Decision-Making components in the hospital setting
- Describe split/shared billing in the hospital facility setting
- Understand how to use prolonged services in the hospital setting
- Define the Diagnosis Related Group (DRG) concept
- Know how DRGs impact the Case Mix Index (CMI) and how these economically impact a hospital facility
- State top Diagnosis Related Groups (DRGs) and how to best document to capture the optimal clinical picture
- Define the “Two Midnight Rule” and the inpatient vs observation determination
- State the importance of “D-Day” documentation with respect to patient status
- Understand what the “Inpatient Only List” is and a management option for correct use
-
- State documentation pearls associated with documentation of medical necessity of key cardiac conditions in the hospital setting to include:
- Chest Pain/ Myocardial Infarction
- Heart Failure
- Atrial Fibrillation
- State documentation pearls associated with documentation of medical necessity of key cardiac conditions in the hospital setting to include:
- State documentation pearls associated with documentation of medical necessity of key respiratory conditions in the hospital setting to include:
- COPD
- Pneumonia
- State documentation pearls associated with documentation of medical necessity of key neurological conditions in the hospital setting to include:
- Encephalopathy
- TIA
- Stroke
- State documentation pearls associated with documentation of medical necessity of key infectious conditions in the hospital setting to include:
- Sepsis
- Cellulitis
- Urinary Tract Infections
- Define the documentation needed for time-based services in the hospital setting
- Explain critical care services policy and know how to document, code and bill for these services
- Know how to document discharge services as well as prolonged services hospital care
- Know current ED E&M documentation, coding, and billing guidelines regarding Medical Decision Making
- Describe split/shared billing in the ED setting
- Apply clinical examples to the appropriate levels of ED care delivery