2024 Practice Enhancement Through Clinically Correct Coding Sessions – Hospital Track (25 Sessions)
Total CME:
12.5 Prescribed AAFP/AMA PRA Cat I CME credits
SESSIONS (each 0.5h)
Session #1:
The Billing Classification of Patients: Defining New and Established
- 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
Session #2:
Compliant Use of Nurse Practitioners (NPs) and Physician Assistants (PAs)
- 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
Session #8:
Care Management in Primary Care: Performing Transitional Care Management to Manage the Hospital
to Home Journey
- 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
Session #17:
Advance Care Planning: Helping Our Patients Transition
- 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
Session #18:
Social Determinants of Health (SDoH): Uncovering a Key Player in Healthcare Outcomes
- 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
Session #19:
Understanding Healthcare Disparities
- Define healthcare disparities
- Know where disparities have greatest clinical impact
- Outline some best practice steps to address healthcare disparities
Session #20:
Defining Hierarchical Condition Categories (HCCs) in Primary Care
- 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
Session #21:
Clinical Applications of Key HCCs in Primary Care
- 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
Session #24:
A Strategic Path to Documentation, Coding and Billing Compliance
- 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
Session #25:
The Preoperative Assessment: Step One in Effective Care Transitions
- 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
Session #26:
The Role of the Physician Advisor (PA): Expanding Beyond Status Determination
- 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
Session #27:
Understanding the Basics of the Business of Medicine
- 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
Session #28:
Dousing the Flames of Burnout
- 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
Session #29:
Today’s Physician: Stakeholder and Leader for Sustainable Change
- 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
Session #30:
Population Health Management: It’s more than just seeing patients
- 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
Session #31
The Hospital Quality Journey: Where is our Focus?
- 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
Session #32:
The E&M Guidelines for the Hospital Setting: Current Updates
- 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
Session #33:
Hospital Clinical Documentation Improvement (CDI): Stating the Correct Clinical Picture
- 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
Session #34:
The Two Midnight Rule and Medical Necessity in the Hospital Setting
- 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
Session #35:
The Medical Necessity Series, Part I
- 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
Session #36:
The Medical Necessity Series, Part II
- State documentation pearls associated with documentation of medical necessity of key respiratory conditions in the hospital setting to include:
- COPD
- Pneumonia
Session #37:
The Medical Necessity Series, Part III
- State documentation pearls associated with documentation of medical necessity of key neurological conditions in the hospital setting to include:
- Encephalopathy
- TIA
- Stroke
Session #38:
The Medical Necessity Series, Part IV- State documentation pearls associated with documentation of medical necessity of key infectious conditions in the hospital setting to include:
- Sepsis
- Cellulitis
- Urinary Tract Infections
Session #39:
Compliant Time-based Coding and Documentation in the Hospital Setting- 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
Session #40:
Current Evaluation & Management (E&M) Guidelines in the Emergency Department (ED)- 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
Total Prescribed AAFP/AMA PRA Cat I CME: 12.5
