2025 Practice Enhancement Through Clinically Correct Coding

GME Specific Core Tracks:

GME Specific Core Tracks:

The vast needs surrounding graduate medical coding education has been present since before I started Protime in 2000 – and the need is even greater today. 

 Built from the base Practice Enhancement education, our GME offering covers two, eight-session tracks – one for the ambulatory space and one for the hospital space. These come with the complete education and reporting that other Tracks offer to provide key feedback to promote learning to both physicians and NP/PAs in training. 

The physician-level GME curriculum is expanded to also provide education for upper-level residents in both the 2nd and 3rd years of training. Pricing is based on the type of training and number of participants):

GME Year 1

GME Ambulatory Sessions

  • Know how to apply time-based coding in the ambulatory office setting
  • Define the clinical application of the Medical Decision-Making (MDM) components
  • Understand how to use prolonged services
  • 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 (tie to ED f/u and HF f/u)
  • Know processes needed to compliantly implement and bill for this in your practice
  • 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
  • State why physicians should engage their patients in end-of-life care discussions
  • Know the specific documents used for end-of-life decision making
  • Be able to perform, document, and correctly bill for ACP services
  • Be able to define optimal clinical “documentation”, “redocumentation”, and “risk” scores
  • Explain the 2024 HCC transition from Version 24 to Version 28
  • State the financial possibilities associated with optimal performance in this area
  • 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 and the concept of co-insurance across the spectrum of healthcare
  • Be able to state the basic link between documentation integrity and coding, 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
  • 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

GME Hospital Sessions

  • 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 how the E&M Services Guide released 08/2024 defines the hospital encounter
  • Understand how to document/perform care related to both the time-based coding and Medical Decision-Making components in the hospital 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
  • Apply the “Two Midnight Rule” based on the 2024 Medicare Advantage Final Rule
  • 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

Contact us to learn more!

Individualized Pricing:

$750

Non-physician (NP and PA) programs

$1,200

Resident physician program (18 or less participants)

$1,500

Resident physician program (>18 participants)
GME Year 1: Approx. 8 hours to complete

There are 2 - 8 Session tracks.

GME Year 2: Approx. 3 hours to complete

There are 6 Session tracks.

GME Year 3: Approx. 3 hours to complete

There are 6 Session tracks.

Full access

Until December 31st, 2025.

CME Credits are not available

The Practice Enhancement GME
Business of Medicine Tracks
(2nd and 3rd yr)

GME Year 2

  • Be able to define new and established patients in the ambulatory space
  • Know how new/established patients are classified in the hospital/facility
  • Apply this concept in specially designated sites (provider-based, Rural and Federally Qualified Health Centers)
  • 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 find the central source of updated information on Medicare Preventive Services, codes, co-insurance, and coverage intervals
  • 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
  • Understand the details associated with HCC code capture with cardiovascular conditions
  • Understand the details associated with HCC code capture with hematology/oncology conditions
  • Understand the details associated with HCC code capture with metabolic and endocrine conditions
  • 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

GME Year 3

  • Define the various Non-Physician Providers (NPPs) commonly seen in primary care
  • Differentiate between “split/shared” and “incident to” services given the latest updates
  • Know the appropriate documentation and billing for overseeing NPP care delivery
  • 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
  • Outline reasons why a compliance plan related to coding and billing is important
  • Define areas of focus for providers based on current governmental guidance
  • Understand the process of using encounter audits to assess and develop a performance improvement plan
  • Know the prevalence and progression of burnout in the medical professional community
  • 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
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