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)
capture
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
