This training will be provided from the perspective of a provider documenting in a medical record and will provide valuable perspective on how facility leaders, professional coders, and billing staff use the information in the medical record to extract data related to what services are documented (CPT and HCPCS-II codes) and why they were done (ICD-10-CM codes) and how their health center may need to adjust the codes on a claim to meet various payer rules.
Our provider training class provides a complete overview of key resources, references, and responsibilities related to proper medical records documentation capture and proper reporting of the HIPAA mandated CPT, HCPCS-II, and ICD-10-CM code sets with a focus on Medicare since they serve as foundation for billing to many payers. Medicaid is unique to each state, and it is difficult to provide accurate Medicaid billing advice.
The following groups will benefit from the session and are encouraged to attend:
Providers who create clinical documentation (e.g., MD/DO/PA/NP/CP/CSW) in medical records and need training on the AMA’s CPT documentation guidelines, HCPCS-II coding, and ICD-10-CM diagnosis codes.
Tentative Agenda/Topics
- Deliver an overview of the documentation, coding, reporting, and reimbursement issues that impact providers in and HHS-certified FQHCs/RHCs related to the CPT, HCPCS-II, and ICD-10-CM.
- Outline the vital distinctions between clinical documentation protocols vs. professional coding rules vs. varying requirements of insurance payers vs. reporting accurate quality metrics (if required by payers).
- Identify solutions to the inherent limitations of EHR and billing software with a goal to increase revenue, facilitate quality reporting, and decrease audit risk.
- Provide detailed instruction on the AMA’s and CMS Evaluation & Management documentation guidelines and the distinction between proper reporting of “Sick” and “Well” visits and when they can both be reported on the same encounter.
- Identify the CMS-covered Preventive Services including the Initial Preventive Physical Exam, Annual Wellness Visits, and 25+ additional preventive services Medicare will cover on a periodic basis.
- Review key areas of the 2024 “ICD-10-CM Official Guidelines for Coding and Reporting” in the context of the revenue cycle and quality care reporting including the Social Determinants of Health.
- Compare/contrast traditional Telehealth versus Virtual Communication Services
- Outline Care Management revenue options including Principal/Chronic Care Management, Transitional Care Management, Behavioral Health Integration, the Psychiatric Collaborative Care Model, and new CMS care management options for 2024.
- Overview of Risk Adjustment, HCC, UDS reporting, and assorted Quality Measures.
This continuing education session is available to MRHA members free of charge thanks to a grant from Healthy Blue and the Missouri Department of Health and Senior Services Bureau of Immunizations.