Package Description

Coding and Billing for Rural and Community Health Agenda and Learning Objectives

Section 1: RHC/FQHC Foundations

• Review of HIPAA Mandated Code Sets (CPT/HCPCS-II/ICD-10-CM)
• How are RHCs and FQHCs different than traditional doctor’s offices for Medicare?
• Key CMS Resources to Monitor
• CMS Valid Encounters Defined
• Key 2024 CMS Updates for RHC/FQHC
• Compare/Contrast CPT and similar HCPCS-II Codes
• Compare/Contrast: CMS1450/837i vs. CMS1500/837p
• Expected Variations with Non-Medicare Billing
• Potential Non-Medicare Participation Contract Issues to Research

Section 2: Documenting Patient Visits

• Nursing’s Role in Clinical Documentation
• Overview of the 2024 E/M Guidelines
• A Focus on Coding from Medical Decision Making vs. Time
• Hands-on Self Study with the E/M Section
• Researching, Documenting, and Coding Preventive Medicine Services
• Coding for Care Management Services
• Telehealth Versus Virtual Communication Services

Section 3: Coding the Full Encounter

• Overview of the 2024 ICD-10-CM Official Guidelines for Coding and Reporting
• Basic Tenets of Diagnostic Coding and Billing
• How to Research Detailed Specialty-specific ICD-10-CM Issues
• Impact of Diagnostic Coding on Quality Reporting and Revenue Cycle
• Using “MEAT” to Determine which Codes get Reported
• Social Determinants of Health and Coding for Population Health
• Hands-on Self Study with the ICD-10-CM and Minor Surgical Procedures

Section 4: Billing for Optimal Reimbursement

• Possible HCPCS-II H-codes and T-codes for Medicaid Use
• Review of the 5 FQHC-only PPS Visit Codes
• Billing Nuances of Preventive Medicine and Care Management
• General Overview of Type of Bill and Revenue Codes Used on the CMS1450/837i Claim Form
• Reminder of Differences in RHC vs. FQHC CMS Billing
• Split Billing for Medicare Diagnostic Tests
• Vaccine Billing for RHC/FQHC
• Accessing the Resource-Based Relative Value System (RBRVS) and national Correct Coding Initiative (NCCI) for RHC/FQHC Billing
• Modifier -25 and -59 Basics and Hands-on Self-Study on CPT/HCPCS-II Modifiers
• RHC/FQHC Surgical Package Options for Onsite and Offsite Surgeries
• How Medicare global billing rules do not apply to RHC/FQHC services
• CMS’ Surgical Package definition to use for a Medicare patient if the procedure is performed outside of your RHC/FQHC