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Alabama Reporting Quality & Care Management Services in Rural Health
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Alabama Reporting Quality & Care Management  Services in Rural Health

When: November 8, 2019
9:00 am - 3:00 pm
Where: Clanton Conference Center
2030 7th Street S
Clanton, Alabama  35045
United States
Contact: Julia Scott

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General description

This live course is designed for Rural Health Clinic (RHC) providers, quality managers, ACO leadership, and revenue cycle staff at rural health facilities who need a high-level basic explanation of how to report accurate quality metrics and who deal with HEDIS, HCC, QIP, Risk Adjustment, and Share Savings.


RHC Overview: We will begin with a RHC documentation>coding>billing overview including:

·       How coding and billing is different in a RHC.

·       Review of the key elements of the CMS Benefits and Claims Manual sections (chapters 9 & 13)

·       Which services are included in the All-Inclusive Rate and which services get paid via fee-for-service or via a flat fee when billing Medicare?

·       Preventive Medicine for the IPPE, AWV, and almost a dozen other “sometimes covered” G-codes performed by a RHC.


Reporting Quality:  After a brief overview of HEDIS/HCC and other Quality Improvement programs, we will dive into relevant sections of the ICD-10-CM's "Official Guidelines for Coding & Reimbursement" and will review the instructional notes associated with key diagnoses in order to most accurately report the true complexity of care for your ACO patients and to:


·      recognize the impact of medical documentation on the accuracy and completeness of quality data,

·      properly reporting Care Management services to coordinate treating chronic diseases,

·      report accurate and complete Quality Metrics via historical claims data,

·      how to fully report the true complexity of your patients via ICD-10-CM documentation rules.



General Objectives


1 - Attendees will be able to unify their clinical documentation goals with the requirements of Managed Care/ACO's to adjust payments based on clinical complexity of its patient population.


2 - Attendees will learn about the specific documentation guidelines and base code instructional notes associated with the major disease categories being tracked by ACOs.


3 - Attendees will learn a structure by which they can train their providers on those additional codes and HCC categories that may become a focus in the future and how their EHRs may hinder effective training.



The following groups will benefit from class:


·       Providers who create clinical documentation (e.g. MD/DO/PA/NP) and have primary responsibility for capturing documentation necessary to support .


·       Nurse/Quality Managers who manage people and policies related to voluntary or contractually-required reporting of data via CPT, HCPCS-II, and ICD-10-CM codes and who serve as a link between the clinical and business staff.


·       Coders/billers who have do not have experience in measuring and reporting key quality metrics via UDS, HEDIS, HCC, and internal ACO requirements related to educating providers on proper code usage.


Required Course Materials: CPT, ICD-10-CM. HCPCS is optional.

Basic Agenda (times may vary slightly)


·       9:00 am -  10 am

    • Course registration and attendee takes pre-test (10 questions to be compared to results in post-test)
  • 11 am - 12:00 pm
    • Orientation to course materials and HIPAA-approved coding manuals
    • Roles and responsibilities for documentation vs. coding vs. billing
    • What makes RHCs different?
    • When should we get paid the encounter rate vs. fee-for-service vs. another payment method?
  • 12:00 pm – 12:30 pm
    • Introduction to reporting quality and reporting chronic disease management
  • 12:30 pm – 1:00pm – LUNCH PROVIDED
  • 1:00 pm - 2:45 pm
    • Roles and staffing responsibilities for quality reporting
    • Basics of HEDIS, HCC, ACO Shared Savings, and Risk Adjusted Coding
    • Where can diagnoses be pulled from in an encounter note?
    • Overview of CPT Category II codes and ways to increase revenue
    • Deep review of the ICD-10-CM Official Guidelines for Coding & Reporting
    • Balancing clinical care and quality reporting requirements
    • Hands-on individual and group exercises
  • 2:45 pm – 3 pm
    • Course wrap-up and "Where do we go from here"
    • Attendees take post-test

CEU– 6 CEUs approved by AAPC & ArchProCoding



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