2023 Practice Enhancement Through Clinically Correct Coding – Combined Track (40 Sessions)

$400.00

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2023 Practice Enhancement Through Clinically Correct Coding Sessions – Combined Track (40 Sessions)

Total CME:                       20.0

Key
C: Combined Track 20.0 Prescribed AAFP/AMA PRA Cat I CME credits
A: Ambulatory Track 15.0 Prescribed AAFP/AMA PRA Cat I CME credits
H: Hospital Track 12.5 Prescribed AAFP/AMA PRA Cat I CME credits

SESSIONS (each 0.5h)

(C/A/H) 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

(C/A/H) 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

(C/A) Session #3:
The Basic Evaluation and Management Guidelines for the Office Setting

  • Apply time-based coding in the ambulatory office practice setting
  • Define the Medical Decision-Making components and correctly apply them clinically
  • Understand how to use prolonged services

(C/A) Session #4:
The Chronic Disease Primer for Primary Care: Hypertension

  • Know the clinical manifestations of hypertension in America today
  • Be able to state the Stars quality measure associated with hypertension and strategies to succeed in this measure
  • Know basic medication classes used and laboratory studies pertinent in management

(C/A) Session #5:
The Chronic Disease Primer for Primary Care: Diabetes Mellitus

  • Know the Stars quality measures associated with Diabetes
  • Be able to state the basic medication management options in DM
  • Know a best practice way to optimize quality measure outcomes for DM

(C/A) Session #6:
The Chronic Disease Primer for Primary Care: Heart Failure

  • Be able to state the various stages of Heart Failure (HF)
  • Define the types of heart failure, appropriate diagnosis codes, and HCC risk assignment
  • Understand the pharmacological basic medications used to manage HF

(C/A) Session #7:
The Chronic Disease Primer for Primary Care: COPD

  • Know the clinical impact COPD has on populations
  • Be able to state the basic medication management options in COPD
  • Understand the correct documentation to support the clinical definition of COPD

(C/A/H) 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

(C/A) Session #9:
Care Management in Primary Care: Offering Chronic Care and Principal Care Management Services

  • Outline reasons for care management service delivery in primary care
  • Know how to perform, document, and bill for Principal Care Management services
  • Know how to perform, document, and bill for Chronic Care Management services

(C/A) Session #10:
Care Management in Primary Care: Home Health and Care Plan Oversight Authorizations

  • Understand the clinical criteria for home bound status
  • Understand the clinical medical necessity for home health service delivery
  • Know how to document and bill correctly for home health certification, recertification, and care plan oversight

(C/A) Session #11:
Behavioral Health Integration (BHI) in Primary Care: The Psychiatric Collaborative Care Model

  • Define how to effectively integrate behavioral health into primary care
  • Be able to construct the psychiatric collaborative care delivery model and how to correctly document, code, and bill for these services
  • Know the correct behavioral health diagnoses for optimal Hierarchical Condition Code (HCC)
    capture

(C/A) Session #12:
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

(C/A) Session #13:
Understanding Preventive Services in Medicare

  • Define how to find the central source of updated information on Medicare Preventive Services, codes, co-insurance, and coverage intervals
  • Describe the covered services offered through Medicare in breast, colon, and lung cancer screening
  • Discuss the preventive services offered through Medicare related to intensive behavioral therapy

(C/A) Session #14:
Dermatology Integration in Primary Care

  • Understand the economic benefit to adding dermatology procedures as a service line
  • Know which procedures most easily fit in the primary care workflow
  • Understand an operational workflow to integrate this service line

(C/A) Session #15:
Correct Documentation, Coding and Billing of Dermatology Procedures in Primary Care

  • Outline documentation strategies to support dermatology procedures
  • Know how to document and bill for biopsy procedures based on latest guidelines
  • Describe how to document and bill for multiple procedures as well as procedures done in the context of a problem-based encounter using the -25 modifier

(C/A) Session #16:
Telehealth and Remote Patient Monitoring (RPM): Clinical Applications

  • Be able to describe how Telehealth looks in 2023 and how to apply it to your primary care practice
  • Be able to define what remote patient monitoring is and what clinical disease states can be most easily addressed as a first step outreach
  • Understand the documentation, coding, and billing needs for RPM

(C/A/H) 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

(C/A/H) 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

(C/A/H) Session #19:
Understanding Healthcare Disparities

  • Define healthcare disparities
  • Know where disparities have greatest clinical impact
  • Outline some best practice steps to address healthcare disparities

(C/A/H) 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

(C/A/H) 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

(C/A) Session #22:
Documentation, Coding and Billing for the Nursing Facility E&M Services

  • Define clinical states that merit acute inpatient, skilled, and long-term care delivery
  • Describe the documentation, coding, and billing in the nursing facility setting
  • Explain the care delivery rule application for NPPs

(C/A) Session #23:
Documentation, Coding and Billing for Home/Residence Places of Care Delivery

  • Define various “home” settings
  • Understand how time and medical decision making applies to these places of service
  • Explain documentation and billing applications of NPPs for these settings

(C/A/H) 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

(C/A/H) 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

(C/A/H) 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

(C/A/H) 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

(C/A/H) 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

(C/A/H) 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

(C/A/H) 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

(C/H) 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

(C/H) 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

(C/H) 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

(C/H) 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

(C/H) 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

(C/H) 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

(C/H) 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

(C/H) 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

(C/H) 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

(C/H) 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:                       20.0

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