2023 Practice Enhancement Through Clinically Correct Coding

Hospital Track

Hospital Track:

The hospital-based provider has many demands placed upon them. The knowledge gap in areas of documentation, quality, non-physician provider use, critical care billing, and others can be an obstruction to an efficient day on the floors.

  • 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 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



Approx. 12.5 hours to complete

There are 25 Sessions in this track.

Full access

Until December 31st, 2023.

Certificate of completion

Available for download upon successful completion of each session.

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 to 12/31/2023. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Each Session has been assigned 0.5 CEU credits, for a total of 20 CEUs.

Note: You will receive a downloadable Certificate of Completion upon finishing each session

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