2024 Protime Practice Enhancement Through Clinically Correct Coding in Family Medicine – Ambulatory Track (31 Sessions)



2024 Practice Enhancement Through Clinically Correct Coding Sessions – Ambulatory Track (31 Sessions)

Total CME: Ambulatory Track 15.5 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 #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

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

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

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

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

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 #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

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

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)

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

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

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

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

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

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 #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

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

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 #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:                       15.5

Scroll to Top