Package Description

ENROLL

Non-Member $299 | Member Pricing $249

(Must be logged in to receive member pricing)

(4 CEUs AAPC and ArchPro)

General description 

This online/live course is designed for FQHC providers, quality managers, ACO leadership, and revenue cycle staff at rural health facilities who need a high-level explanation of how to report accurate quality metrics related to Performance Measures via CPT-II, HEDIS, HCC, QIP, Risk Adjustment, and ACO Shared Savings, for example.

 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 state/federal payers, ACO, and grant projects.

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.

4 – Generate documentation and revenue for care management services provided in between patient visits.

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 to most accurately report the true complexity of care for your 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. 

Reporting Care Management:  FQHCs provide many valuable clinical services in between patient visits primarily to maintain and adjust a patient’s care plan that they may be responsible for.  Pending a review of the guidelines associated with Principal/Chronic Care Management, Transitional Care Management, Behavioral Health Integration, and the Psychiatric Collaborative Care Model your facility 

should be able to correctly generate documentation and revenue for these vital and reimbursable services.

 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 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. 

Curriculum specifics will include:

·      Overview of key terminology for Value-Based Care/Team Based Care and how CPT/HCPCS-II/ICD-10-CM relate to reporting key quality measures,

·      Comparing Care Management & Quality Reporting

·      How ICD-10-CM codes can impact Per Member Per Month payments to clinics or payers,

·      How to research the full definitions of CPT Category II codes for Performance Measurement via the AMA Clinical Topics Listing,

·      Overview of HEDIS measures

·      Review of how to achieve Shared Savings via Hierarchical Condition Categories and Risk Adjusted Coding

·      Review of the key "2026 ICD-10-CM Official Guidelines for Coding and Reporting"

·      Gathering and Reporting (SDOH) Social Determinants of Health codes

·      Outline Care Management revenue options including Principal/Chronic Care Management, Transitional Care Management, Behavioral Health Integration, and the Psychiatric Collaborative Care Model.

·      Preventive visit vs Sick visit. IPPE vs Well check

·      Clinical Documentation Improvement (CDI): Review what documentation it takes to choose the correct level of service and why that’s important.