ENROLL NOW

This training is designed for Rural Health Clinics (RHCs) and Community Health Centers (FQHC) 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.

1. Quality Reporting & Care Management in FQHCs-RHCs
2. DETAILS and DEFINITIONS of Quality Reporting 
3. ICD-10-CM's IMPACT on ACO's Shared Savings via HCCs
4. Researching CPT Category II Performance Measures
5. Compare Codes 99490 and G0511

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

• How coding and billing is different in a Rural/FQHC.
• 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.

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.

Recommended Course Materials: CPT, ICD-10-CM, HCPCS