COSEHQ Practice Enhancement Through Clinically Correct Coding – Hospital Track



Practice Enhancement Through Clinically Correct Coding – Hospital Track Included Modules (12)

12 CME Credits


The 2021 Basic Evaluation and Management Guidelines for the Hospital Setting

  • State differences in the 2021 Evaluation and Management Guidelines in the office and the hospital facility
  • Know the concepts that make up the History, Exam, and Medical Decision Making Key Component of the Guidelines
  • State ways to practically apply the three Key Components in clinical practice examples


The Two Midnight Rule and Medical Necessity in the Hospital Setting

  • Define the “Two Midnight Rule” clinically
  • Understand the CMS changes associated with the “Inpatient Only List” and how clinical documentation can support the appropriate status of patients
  • State documentation pearls associated with cardio-pulmonary conditions to support medical necessity of a hospital stay and appeal a denial if one occurs 

MODULE #11: 

Compliant Time-based Coding and Documentation in the Hospital Setting

  • Define the documentation needed for time-based services in the hospital setting
  • Know how to document discharge care and other evaluation and management services in the inpatient site of service
  • Explain critical care services, where this can be delivered and how to document and correctly bill for this care 


The Expanding Role of the Physician Advisor in the Hospital Space

  • Be able to define a “Physician Advisor” and why family physicians with hospital experience ideally fit this role
  • Explain the roles performed in support of case management with respect to resource utilization and quality
  • Know how the physician advisor can support CDI, medical necessity, and denials management processes for healthcare systems

Advance Care Planning: Helping Our Patients Transition

  • State why family physicians should engage their patients in discussions relating to end of life care
  • Know the specific documents used for health care decision making
  • Be able to perform, document, and correctly bill the Advance Care Planning service


Understanding the Basics of the Business of Medicine

  • Know the global history of the Medicare program and understand the parts (A, B, C, and D) that make it up
  • Know the out of pocket costs associated with the Medicare Beneficiary in 2021 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 support of how we get paid
  • Define relative value units, conversion factor, shared savings, and cost of care and how these play into how providers get paid 


Burnout 101:  Addressing the Issue with Strategies for Success

  • Know the prevalence and progression of burnout in the medical professional community
  • 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 


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. 


Population Health:  Understanding Quality, Incentives, and Value

  • Define “Population Health Management”
  • Discuss how quality is aligned across the healthcare spectrum
  • State how incentives, penalties and value are defined across the healthcare spectrum 


A Strategic Path to Documentation, Coding and Billing Compliance in Primary Care

  • Outline reasons why a compliance plan related to coding and billing is important in primary care
  • Define key areas of focus for primary care practices in 2021
  • Understand the process of assessment and performance improvement through encounter audits to aid in success of a primary care compliance plan 

MODULE #19: 

Clinical Documentation Improvement: Capturing Risk Across the Healthcare Space

  • Be able to explain optimal clinical documentation, redocumentation, “risk” scores and the economics associated with excellence in this area
  • Know clinical conditions in the outpatient office practice that are a focus of opportunity with regards to Hierarchical Condition Categories (HCCs)
  • State several Diagnosis Related Groups (DRGs) and how clinical documentation assists in capturing the correct picture of a patient’s disease state 


Compliant Use of the Advance Practice Professionals (APPs) in Primary Care

  • Define the various Advanced Practice Professionals commonly seen in primary care
  • Differentiate between “shared” and “incident to” services and how APPs can be an integral part this type of care delivery
  • Know the appropriate billing and understand the correct documentation needed to be compliant in overseeing APP care delivery