Course description
Evaluation and Management Advanced Training Course - E/M Documentation
Generally speaking, E&M codes represent established patient services that are not procedures. Because they are the most common set of medical codes, many people assume that they are reporting these services properly. Studies show, however, that as much as 42% of E&M services are coded incorrectly, which in turn costs Medicare billions and results in more frequent audits. If you want to ensure that your practice maintains a steady revenue flow and avoids a potential lawsuit from improper coding, you will need to make sure your E&M skills are honed and up-to-date.
MMI’s Quita Edwards, RMC, REMS, CPC, CPMA, CPC-I will guide you through an in-depth review of the key components (chief complaint, history, exam, and medical decision-making), as well as guidelines of E&M services and:
- The role medical necessity plays.
- Why Clinical Documentation Improvement (CDI), ICD-10, and E&M are so important.
- E&M modifiers every practice should know, as well as correct use of modifiers when a procedure is done the same day as an E&M service.
- An entire session on time-based E&M coding, counseling, and prolonged service codes.
- Confusion and controversy between incident-to and split/shared visits, as well as which qualified health professional can bill. Is the complexity of incident-to billing impacting your practice? Whether your problem is loss of revenue or inappropriate payments, we will discuss solutions to appropriately report and optimize the opportunity.
- Understanding Place of Service rules.
- A review of the top OIG risk areas for 2020.
- How to develop a workflow that ensures complete and compliant documentation, as well as effective techniques for communication with physicians.
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Upcoming start dates
Who should attend?
At MMI, we want to make sure that you have a successful learning experience. In order to sign up for the E&M/REMS coding certification and training, you must have some knowledge of medical coding and have already been working in a medical setting.
Training content
Session 1:
- The Evidence of Medical Care
- Basic Standards for Documentation
- Documentation and Medical Necessity
- Organization and Structure
- Basics to Code Selection
- Categories – Subcategories-Code Set
Session 2
- Determining the Level of Service Part I Documentation of the History Component
- Chief Complaint
- History of Present Illness
- Review of System
- Past Medical, Family, and Social History
- Calculating the Overall History
Session 3
- Determining the Level of Service Part II
- Documention of the Physical Exam
- 1995 vs. 1997 the Physical Exam
- Calculating the Physical Exam
Session 4
- Determining the Level of Service Part III Documentation of the Medical Decision-Making
- The Number of Diagnoses and Treatment Options
- Amount of Complexity of Data
- Risk of Complications and Morbidity or Mortality
- The Final Calculation of Medical Decision-Making
Session 5
- Determining the Level of Service Part IV
- Calculating the Level of the Complete Note
- Coding Based on Time
- Prolonged Services
- Critical Care Services
- Observations Services Consultation Services
Session 6
- Incident-To Services Shared/Split Visits Case Management Services
- Chronic Care
- Complex Chronic Care
- Tele-Services
Certification / Credits
Learning Objectives:
Session 1
- Identify the categories of E&M codes
- Learn frequently used and misused E&M codes
- Understand the importance of medical necessity
- Gain knowledge of documentation guidelines
- Learn the risks with cloning and pre-populated notes
- Understand OIG’s focus on Place of Service and learn how to correctly assign the POS for provider-based and free-standing clinics
- Discuss hot topics for government regulators
Session 2
- Learn the seven components of E&M services
- Understand how the history component affects certain E&M codes
- Learn proper documentation of reason for the visit/chief complaint
- Review the most common coding errors and denials with the history component
- Learn who in the clinic can and cannot document CC, HPI, ROS, and PFSH
- Discuss EMR pitfalls
- Learn rules for communicating with providers
- Assign E&M level based on history
- Group study—exercises and case scenario
- Q&A
- Session assessment
Session 3
- Complete a comprehensive study of the 1995 and 1997 guidelines
- Understand the 1997 E&M coding guidleines speciality exams
- Understand the four levels of the exam
- Learn the difference between expanded problem focus and detailed examination
- Compare similarities and differences between the two guidelines
- Understand why chosing the appropriate guidline is important to coding, reimbursement, and compliance
- Understand why it is important to know what level of examination is required by your jurisdictional MAC
- Group study—case scenarios for both 1995 and 1997 exams
- Q&A
- Session assessment
Session 4
- Understand the core elements of medical decision-making
- Learn how to calculate the diagnosis
- Learn how to calculate the physician’s work
- Understand the risk table
- Learn the scoring system and how to assign point levels
- Discuss tips on how to avoid the most common medical decision-making mistakes
- Group study—case scenarios
- Q&A
- Session assessment
Session 5
- Learn to pull it all together using the three key components
- Learn E&M modifiers as well as common errors and denials because of incorrect coding
- Understand the rules for documenting time and the exceptions
- Learn proper reporting for time-based services
- Understand the guidelines for prolonged services and appropriate documentation
- Gain knowledge of accurate critical care reporting
- Discuss tips to avoid common coding errors for time-based services
- Group study—case scenarios
- Q&A
- Session assessment
Session 6
- Learn who can bill incident-to services
- Review Medicare rules and guidelines for incident-to billing
- Learn how a practice can benefit from incident-to services and billing
- Understand the risks associated with incident-to billing if not done accurately
- Learn the difference between incident-to and shared/split visits
- Gain knowledge of the rules and guidelines for Medicare and some other payers (e.g. BCBS for shared/split visits)
- Learn appropriate documentation for shared/split visits
- Discuss tips to avoid common coding errors for incident-to and shared/split visits
- Review the chronic care management codes and guidelines
- Learn who can bill chronic care management
- Group study—case scenarios
- Q&A
- Session assessment
Why choose MMI?
Founded in 1986
Over 4000 certified alumni since 2000
Tens of thousands of CEU course attendees since founding
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Medical Management Institute
MMI has a 30+ year history in distance learning and certifications for business professionals in the healthcare industry. The Institute offers 6 certifications for: medical coders (including 2 specialized certifications for E/M coding and HCC risk-adjustment coding), billers, internal auditors,...