Practice Enhancement Through Clinically Correct Coding in Family Medicine Sessions
MODULE #1
The Basic Evaluation and Management Guidelines for the Office Setting: 2021 Update
- Know the definitions of the types of conditions that we use in our evaluation and management services as well as how to determine whether a patient is new or established in a practice
- Be able to correctly apply time-based coding in the ambulatory office practice setting
- Define the 2021 Medical Decision-Making components and be able to correctly apply them clinically
MODULE #2:
Practical Applications to the 2021 Office Evaluation and Management Guidelines
- Know the two ways that office-based encounters can be billed in 2021
- Be able to define the prolonged service (G2212) and the complexity add-on (G2211) codes for 2021
- State ways to clinically apply appropriate levels of service from various clinical scenarios
MODULE #3:
Transition Care Management: Hospital to Home, Home to Office, and Office to Home Primary Care
- State the importance of care coordination and understand how to transition patients from hospital to home, from home to office, and then office to home
- Differentiate between the two Transition Care Management codes (99495 and 99496) for 2021 and how and when to bill each
- Know processes needed to successfully implement this in your practice
MODULE #4:
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
MODULE #5:
Understanding the 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 cancer prevention
- Discuss the preventive services offered through Medicare related to diabetes and diabetes prevention
- Outline the Intensive Behavioral Therapy services offered to Medicare Beneficiaries
MODULE #6:
Care Management: Patient Engagement and Quality Gap Closure
- Outline reasons for care management service delivery in primary care and understand how to use add-on codes for visit complexity offered in 2021
- Know how to document and bill correctly for home health certification, recertification, and care plan oversight
- Know how to perform, document, and bill for Principal Care Management and Chronic Care Management services
MODULE #7:
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 #8:
Documentation and Coding 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
MODULE #9:
The Behavioral Health Tsunami: COVID’s “Second Wave”
- Restate the effects of how the COVID-19 pandemic has impacted the mental health status of our patients
- Explain ways that primary care practices can step up to help meet the needs of our patients in this space and how to implement, document, and bill for these services
MODULE #10:
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 #11:
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 #12:
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 #13:
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 #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
