Combined Track

• 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

• 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

• 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

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• 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

• 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

• 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

• 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

• 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

• 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

• 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

• 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

• 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

• 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

• 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

• 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

• 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

• 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

• 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

• 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 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