2025 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 new/established patients are classified in the hospital/facility
- Apply this concept in specially designated sites (provider-based, Rural and Federally Qualified Health Centers)
- Define the various Non-Physician Providers (NPPs) commonly seen
- Differentiate between “split/shared” and “incident to” services given the latest updates
- Know the appropriate documentation and billing for overseeing NPP care delivery
- Understand the importance of care coordination and understand the need to transition patients from hospital to home, home to office, and then office to home
- Differentiate between the two Transitional Care Management service codes and know when to bill each
- Know processes needed to compliantly implement and bill for this in your practice
- 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
- 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 factor assessment and correct coding for these conditions
- Define healthcare disparities
- Know some healthcare provider initiatives with greatest impact
- Summarize some data driven approaches to addressing disparities
- 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
- Understand the details associated with HCC code capture of cardiovascular conditions
- Understand the details associated with HCC code capture with hematology/oncology conditions
- Know details associated with HCC code capture with metabolic and endocrine conditions
- 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 how to develop a performance improvement plan using encounter audits
- Understand the roles non-surgical providers play in the surgical patient’s care
- Know the areas of focus for preoperative assessment of the older adult
- State strategies for the coordinated transition care management (TCM) interaction post-operatively
- Be able to define a “Physician Advisor” (PA) and what types of physicians can fit that 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 various “parts” of the Medicare program and understand the parts that make it up
- Define relative value units, the conversion factor, shared savings, and cost of care and how these play into the payments for providers
- Understand how to supply clinical business of medicine strategies across the outpatient and inpatient sites of service
- 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
- State practical applications of physician leadership skills across the scope of healthcare
- Define “Population Health Management” through hospital and ambulatory views of care
- Understand ambulatory quality measures needed to succeed in managing a population
- Be able to state strategies needed to keep aligned with this evolving 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 how the E&M Services Guide released 08/2024 defines the hospital encounter
- Understand how to document/perform both the time-based and Medical Decision Making-based options in the hospital setting
- Define how to use prolonged services in the hospital setting
Session #33: Hospital Clinical Documentation Improvement (CDI): Stating the Correct Clinical Picture
- Define the Diagnosis Related Group (DRG) concept and know how to document the most frequently seen
- Define and Differentiate between an MCC and a CC
- Know how DRGs impact the Case Mix Index (CMI) and how these impact hospital facility revenues
- Correctly apply the “Two Midnight Rule” clinically
- State the importance of “D-Day” documentation to capture medical necessity.
- 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:
- Transient Ischemic Attack
- Stroke
- Encephalopathy
- 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 how to document time-based services in the hospital setting
- Explain how to document, code and bill for critical care services
- Know how to document time-based discharge and prolonged hospital care services
- Know the current Emergency Department (ED) E&M documentation, coding, and billing guidelines regarding Medical Decision Making
- Describe split/shared billing in the ED
- 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, 2025.
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 01/01/2025 to 12/31/2025. 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 12.5 CEUs.
Note: You will receive a downloadable Certificate of Completion upon finishing each session