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


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 


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 


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


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


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


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


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


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