2024 Practice Enhancement Through Clinically Correct Coding – Hospital Track (25 Sessions)

$300.00

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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

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