Package Description

Agenda

Onboarding – Clinical Provider Documentation and Coding Training for RHC/FQHC (5 parts)

Section 1: Clinical Provider Documentation Foundations

• HIPAA Required Code Sets: Using Manuals vs. Software
• Overview of AMA’s Current Procedural Terminology (CPT) Code Sets
• Understanding CPT Category I, II, and III Codes
• Importance of Accurate Documentation and Coding
• Professional Coding: Extracting Codes from Medical Records
• Effective Medical Billing: Ensuring Accurate Reimbursement
• Key Themes for Consideration in Clinical Documentation
• Importance of Understanding Insurance Impact on Billing and Documentation

Section 2: What Makes RHC/FQHC Coding and Billing Different?

• Billing for RHC/FQHC Claims: Unique Challenges
• Overview of CMS Fact Sheets and Resources
• Key CMS References for RHC/FQHC: Policy Manuals
• Defining CMS "Valid Encounters" for RHC/FQHC
• New Provider Types for RHC/FQHC in 2024
• Understanding Multiple Visits and CMS Exceptions
• Differences in Claim Forms: CMS 1500 vs. CMS 1450
• Linking CPT, HCPCS-II, and ICD-10-CM Codes in Billing
• Examples of FFS Claims for Medical and Mental Health Services
• Navigating the Challenges of RHC/FQHC Billing

Section 3: Documenting Patient Visits and E/M Coding

• Nursing’s Role in Clinical Documentation
• Overview of Updated 2024 E/M Guidelines
• Core Principles of Documenting Visits
• Hands-On with the E/M Section of the AMA CPT Manual
• Documenting Care Management Services
• Telehealth vs. Virtual Communication Services
• Documenting "Incident-to" Services by Nurses
• Common Provider Medical Record Documentation Issues

Section 4: Preventive Medicine and Care Management Services

• Importance of Preventive Medicine in Primary Care
• Coding and Billing for Preventive Services
• Medicare Coverage for Preventive Medicine
• Care Management Services: Overview and Billing
• Chronic Care Management (CCM) Services
• Transitional Care Management (TCM) Services
• Behavioral Health Integration in Primary Care
• Telehealth Services in Preventive Medicine

Section 5: ICD-10-CM Official Guidelines for Coding and Reporting

• Introduction to ICD-10-CM Diagnostic Code Sets
• Learning the Official Guidelines for Coding and Reporting
• Clinical Providers' Training on ICD-10-CM Guidelines
• Managerial Oversight of ICD-10-CM Coding
• Coders' Role in ICD-10-CM Code Selection
• Billers' Responsibilities in ICD-10-CM Coding
• Locating Instructional Notations in ICD-10-CM