Practice Enhancement Through Clinically Correct Coding – Hospital Track Included Modules (12)
12 CME Credits
MODULE #9:
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
MODULE #10:
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
MODULE #12:
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
MODULE #13:
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
MODULE #14:
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
MODULE #15:
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
MODULE #16:
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.
MODULE #17:
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
MODULE #18:
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
MODULE #20:
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
