• Date: May 18, 2024
• Time: 8:30am - 12:30pm CST
• Location: TBD

Registration Information Coming Soon!! 

ArchProCoding can conduct a training session(s) lasting approximately 4 hours titled “Overview of Clinical Documentation, Coding, and Billing for Community Health Clinical Providers” on items including updated E/M documentation guidelines, 2024 ICD-10-CM Official Guidelines for Coding & Reporting, minor procedures, reporting quality measures via CPT Category II codes, Evaluation & Management documentation guidelines, preventive vs. sick visits vs. covered-CMS preventive services, and modifiers specifically for FQHCs. This session designed to provide foundational knowledge on the key topic areas on the unique rules and regulations facing FQHCs/RHC’/CAH’s. 

General description specific training curriculum

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 together:

• Primary Group = 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

1. Deliver an overview of the documentation, coding, reporting, and reimbursement issues that impact providers in and HHS-certified Federally Qualified Health Centers related to the CPT, HCPCS-II, and ICD-10-CM.
2. 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).
3. Identify solutions to the inherent limitations of EHR and billing software with a goal to increase revenue, facilitate quality reporting, and decrease audit risk.
4. 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.
5. Identify the CMS-covered Preventive Services including the Initial Preventive Physical Exam, Annual Wellness Visits, and other covered preventive services Medicare will cover on a periodic basis.
6. Review key areas of the “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.
7. Identify how different payers may want a health center to bill for minor surgical procedures using different definitions of the “global surgical package.”
8. Compare/contrast traditional Telehealth versus Virtual Communication Services.
9. Outline Care Management revenue options including Principal/Chronic Care Management, Transitional Care Management, Behavioral Health Integration, and the Psychiatric Collaborative Care Model.
10. Gathering and Reporting (SDOH) Social Determinants of Health codes
11. Preventative vs Sick visit. IPPE vs Well check