Presbyterian College Provider Pause

A time to stop and understand something new that's occurred
that impacts our role as healthcare providers.

Recorded 5/12/21

Practice Enhancement Through Clinically Correct Coding in Family Medicine Presbyterian College Pilot Sessions

MODULE #1:

Understanding the Basics of the Business of Medicine

  • Know the global history of the Medicare program and understand the parts (A, B, C, and D) that make it up
  • Know the out of pocket costs associated with the Medicare Beneficiary in 2021 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 support of how we get paid
  • Define relative value units, conversion factor, shared savings, and cost of care and how these play into how providers get paid 

MODULE #2

The Basic Evaluation and Management Guidelines for the Office Setting: 2021 Update

  • Know the definitions of the types of conditions that we use in our evaluation and management services as well as how to determine whether a patient is new or established in a practice
  • Be able to correctly apply time-based coding in the ambulatory office practice setting
  • Define the 2021 Medical Decision-Making components and be able to correctly apply them clinically 

MODULE #3:

Practical Applications to the 2021 Office Evaluation and Management Guidelines

  • Know the two ways that office-based encounters can be billed in 2021
  • Be able to define the prolonged service (G2212) and the complexity add-on (G2211) codes for 2021
  • State ways to clinically apply appropriate levels of service from various clinical scenarios

MODULE #4:

The 2021 Basic Evaluation and Management Guidelines for the Hospital Setting

  • State differences in the 2021 Evaluation and Management Guidelines in the office and the hospital facility
  • Know the concepts that make up the History, Exam, and Medical Decision Making Key Component of the Guidelines
  • State ways to practically apply the three Key Components in clinical practice examples

MODULE #5:

The Two Midnight Rule and Medical Necessity in the Hospital Setting

  • Define the “Two Midnight Rule” clinically
  • Understand the CMS changes associated with the “Inpatient Only List” and how clinical documentation can support the appropriate status of patients
  • State documentation pearls associated with cardio-pulmonary conditions to support medical necessity of a hospital stay and appeal a denial if one occurs

MODULE #6:

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

MODULE #7:

Transition Care Management:  Hospital to Home, Home to Office, and Office to Home Primary Care

  • 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 Transition Care Management codes (99495 and 99496) for 2021 and how and when to bill each
  • Know processes needed to successfully implement this in your practice

MODULE #8:

Care Management:  Patient Engagement and Quality Gap Closure

  • Outline reasons for care management service delivery in primary care and understand how to use add-on codes for visit complexity offered in 2021
  • Know how to document and bill correctly for home health certification, recertification, and care plan oversight
  • Know how to perform, document, and bill for Principal Care Management and Chronic Care Management services 
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