Ph Physician ysician Clinical Documentation Im Clinical - - PDF document

8/28/2018 1

Quar Quarterly rly

Ph Physician ysician

Clinical Documentation Im Clinical Documentation Impr provement ement

Putting the Pieces Together: Financial Stability

Ph Physician Clinical Docum ysician Clinical Documentation Im entation Impr provement Series ement Series

Welcome & Introductions Pre-Assessment Survey Jennie Price, HomeTown Health, LLC E/M Note Construction

• Dr. James Dunnick, The

Dunnick Group Upcoming Events & Resources Jennie Price, HomeTown Health, LLC

AGENDA

8/28/2018 2

Physician C ian Clinica ical D Documenta mentation I ion Impr provement ement Series es

Program Goals

Clinical Documentation Improvement programs are critical to rural hospitals in providing complete and accurate patient

• documentation. The purpose of the Physician Clinical

Documentation Improvement Series is to provide physician- to-physician training in common areas of clinical documentation improvement (CDI) in order to support physicians in improving their documentation, identifying the value of their role in CDI programs, and identifying

• pportunities for improvement.

Financial Stability Pre-Assessment Survey Responses

8/28/2018 3

On a scale of 1‐10, with 1 being extremely poor and 10 being outstanding... please rate the focus level of your providers in improving coding and billing speed and accuracy.

We have a physician champion on board to help us in our Clinical Documentation Improvement (CDI).

Yes 12% Yes, but it is a relatively new area of focus 12% No 61% Unsure 15%

8/28/2018 4

We have experienced an audit in the last year that identified areas for improvement related to physician documentation.

Yes 37% No 46% Unsure 17%

Do you have a compliance program in place that audits each providers chart on a monthly basis?

Yes ‐ at least on a monthly basis 14% Yes, but less often than monthly 36% No, but we have plans in place to begin soon 8% No 32% Unsure 10%

8/28/2018 5 If you answered yes to “have a compliance program in place for physicians,” do you provide the feedback of why the chart failed the internal audit?

Yes ‐ in great detail, and there is always conversation follow up 19% Yes ‐ but we could improve in this area 41% No 19% Unsure 22%

We have had training specific to physicians in Clinical Documentation Improvement...

On an ongoing basis, including the last year 15% In the past three years 36% Never, that I know of 29% Unsure 20%

8/28/2018 6

Disclosure of Proprietary Interest

The Dunnick Group does not have any proprietary interest in any product, instrument, device, service, or material discussed during this learning event. The education offered by The Dunnick Group in this program is compensated by the HRSA Small Hospital Improvement Program (SHIP) grant from multiple participating states, including Iowa, Georgia and Florida.

Ph Physician Clinical Docum ysician Clinical Documentation Im entation Impr provement Series ement Series

Speaker Biography

James Dunnick, MD, F

MD, FACC, CHCQ CHCQM, M, CPC CPC, , CMD CMDP

Physician – Boarded in Cardiologist Certified medical coder Certified in Electronic Medical Records Certified in Quality and Utilization Published author Email: jdmd62@gmail.com Website: www.dunnickgroup.com

8/28/2018 7

Qua Quarterly P rly Physicia ysician C n CDI S I Series: ries:

E/M – E/M – Creating a Not reating a Note

Present Presented b ed by Dr

• Dr. James Dunnick

. James Dunnick

Disclaimer

1. Do NOT assume I am correct, I make mistakes. 2. Read and self educate. 3. Government manuals, online resources. 4. Obtain professional teaching, from more than one source. 5. Consultant opinions vary. 6. Auditor opinions will vary. 7. States vary. 8. Payers vary. 9. Rules change. This is meant as general and initial information only.

8/28/2018 8

Explain Explain

why we must do this.

Explain Explain

how to match an evaluation and management level to an ICD- 10-CM code.

Descr Describe be

the differences between the various levels

• f code

selection.

Re Recall ll

the key parts

• f the provider

note – history, physical exam, and medical decision making.

Lear arning O ning Outcomes comes

When you have completed this training, you should be able to:

The Other Point of View

Pa Payers

• They have their problems.
• They have their goals.
• Are they the same as yours?

8/28/2018 9

The Other Point of View

Pa Payers as as the C e CFO

• They are trying to cover lives
• They must be profitable
• Their opinion of fair is fair from their view point

The Other Point of View

Payers They do not want to overpay E/M E/M They do not want to be the victim of fraud Medical Necess Medical Necessity ity They want to receive value ICD 1 ICD 10 None of this seems unreasonable

8/28/2018 10

CMS-Fraud Prevention System

• The Fraud Prevention System was created in

2010 by the Small Business Jobs Act, and CMS has extensively used its tools made possible by the Affordable Care Act.

CMS news letter July 2015

CMS Fraud Prevention System

FPS FPS

• Predictive analytics
• Outliers
• Billing patterns

8/28/2018 11

Fraud Prevention System

2010 – 2012 prevented $820 M of payments 2014 prevented $420 Million Million in payments 2011-2015 returned returned $25 Billion Billion of payments

CMS news letter July 2015

ECONOMIC PENALTIES

• Civi

Civil f fals lse claim claims act: act:

• 1. $5,500 – 11,000 per claim
• 2. Three times the value of each claim
• Cri

Criminal al f fals lse claim claim act: act:

• 1. Felony
• 2. Up to 5 years imprisonment
• 3. $25,000 fine
• MC/MC civil mone

MC/MC civil monetary penalties la penalties law: w:

• 1. $10,000 per claim
• 2. Three times the value of each claim

Corporate Integrity Agreement (CIA) Exclusion List

8/28/2018 12

Penalties

CMS t CMS terminat rminates Idaho es Idaho hospit hospital's Me al's Medicar care co contract* ract* Flori Florida Hospi a Hospital al f fine ned 85 million 85 million Detr Detroit Area Hospital

• it Area Hospital Syst

System t em to Pa Pay $8 y $84.5 4.5 Million** Million**

* Written by Ayla Ellison (Twitter | Google+) | July 27, 2018 **Department of Justice Office of Public Affairs August 2, 2018

Penalties

Louisiana psy Louisiana psychiatrist con hiatrist convict icted d of Medicare fraud ($258

• f Medicare fraud ($258 millio

million)*

• 7 years in prison

Car Cardiologist con iologist convict icted of d of 350 f 350 false claims ($238,230)** lse claims ($238,230)**

• Pay back $721,960
• 1.7 years in prison

Car Cardiologist indict iologist indicted f ed for unnec r unnecessar essary pr procedures and

• cedures and testing

sting**

***

• Hospital f

Hospital faces 1 ces 15 la law w suits suits

*On August 25, 2014, Assistant Attorney General Leslie R. Caldwell of the Justice Department’s Criminal Division announced **Written by Ayla Ellison (Twitter | Google+) | August 02, 2018 | Print | Emai ***lSecurities and Exchange Commission filing Written by Ayla Ellison (Twitter | Google+) | February 13, 2015

8/28/2018 13

Penalties

2017 an EHR company was fined 155 million dollars and CIA

• Falsified certification standards

2018 fined 132K dollars

• Failed to report patient safety issues with in 48 hours

Written by Julie Spitzer | July 31, 2018 Becker’s Hospital Report

Penalties Inadvertent

Raleigh Hospital

• Audited 263 claims (MC billing requirements); 187 were accurate;

71% passed.

• 76 charts failed; $250,000 over payment
• Extrapolation; $697,000

8/28/2018 14

Penalties Inadvertent

Dentist $84,000 Family Practice Physician 162,676 ENT 750,000 Pediatrician 336,298 Coders Fined

Exclusion list Examples; August

Medical Practice Medical Practice

• Pediatrician; LPN on Exclusion list
• $45,735.42
• Allergy and Asthma MD; RN on Exclusion list
• $61,142.

Posted by CJ Wolf Aug 13, 2018 11:00:00 AM

8/28/2018 15

Tr Trying t to Adapt

26 states that have seen at least one rural hospital close since 2010

https://www.beckershospitalreview.com/finance/state-by-state-breakdown-of-83-rural-hospital-closures.html

7 rural Georgia hospitals have closed since 2010 8 hospitals have closed between June 1 and July 26 2018

Written by Ayla Ellison (Twitter | Google+) | August 02, 2018 | Print | Email

Objectives

• 1. Recall the key parts of the provider note – history, physical exam,

and medical decision making

• 2. Describe the differences between the various levels of code

selection

• 3. Explain how to match an E/M level to an ICD-10-CM code.
• Explain why we must do this

8/28/2018 16

What is E/M?

E/M E/M

• It is how payers turn cognitive effort into $
• Every office note, hospital note
• In patient or out patient
• The largest cost to payers
• The largest focus of upcoming audits

What is E/M?

• E/M has parts
• Each part has parts
• Parts have components
• Components have elements
• The elements leads to levels
• Each level has requirements
• Some parts have points
• Points are defined and added together
• Risk is defined and labeled
• All are needed and in the correct combination

37

8/28/2018 17

What is E/M? What is E/M?

Three key E/M components A.

• A. H

History

• 1. History present illness
• 2. Past medical family social history
• 3. Review of systems
• B. Ph
• B. Physical

ysical Exam Exam

• 1. 1995-Body areas or organ systems
• 2. 1997- General or specialty specific

C.

• C. Medical Decision Making

Medical Decision Making

• 1. Problem points
• 2. Data points
• 3. Risk

What is E/M? What is E/M?

Three key E/M components A.

• A. H

History 1. . Hist Histor

• ry pres

y present illnes ent illness

• 2. Past medical family social history
• 3. Review of systems
• B. Ph
• B. Physical

ysical Exam Exam

• 1. 1995-Body areas or organ systems
• 2. 1997- General or specialty specific

C.

• C. Medical Decision Making

Medical Decision Making

• 1. Problem points
• 2. Data points
• 3. Risk

8/28/2018 18

E/M HPI

Has components called elements. 8 Elements: Location Timing Severity Duration Quality Modifying Factors Context

• Assoc. Sym or Signs

E/M HPI

Le Level of HPI l of HPI Problem focused Brief ( 1-3 ) Expanded PF Brief ( 1-3 ) Detailed Extended ( 4-8 ) Comprehensive Extended ( 4-8 )

8/28/2018 19

E/M 99211-99215

HPI: HPI: John is a 42 year old man who presents with two days of severe abdominal pain. No nausea nor vomiting. No constipation. Location- Ye Yes Severity- Ye Yes Quality- No Context- No Timing- No Duration- Ye Yes Modifying Factors- No

• Assoc. Signs Symptoms- Ye

Yes

E/M 99211-99215

CC: CC: Abdominal pain HPI: HPI: John is a 42 year old man who presents with two days of severe abdominal pain. No nausea nor vomiting. No constipation. Location- No Severity- Ye Yes Quality- No Context- No Timing- No Duration- Ye Yes Modifying Factors- No

• Assoc. Signs Symptoms- Ye

Yes

8/28/2018 20

E/M 99211-99215

CC: CC: Abdominal pain HPI: I: John is a 42 year old man who presents with two days of severe abdominal pain. No nausea nor vomiting. No constipation. No fever nor chills. Eatin Eating has made it has made it worse. e. Location- No Severity- Ye Yes Quality- No Context- No Timing- No Duration- Ye Yes Modifying Factors- Ye Yes

• Assoc. Signs Symptoms- Ye

Yes

E/M 99211-99215

CC: CC: Abdominal pain HPI: I: John is a 42 year old man who presents with two days of severe right lower quadrant abdominal pain. No nausea nor vomiting. No constipation. Location- Ye Yes Severity- Ye Yes Quality- No Context- No Timing- No Duration- Ye Yes Modifying Factors- No

• Assoc. Signs Symptoms- Ye

Yes

8/28/2018 21

E/M 99211-99215

CC: CC: Sore throat HPI: HPI: John has had a runny nose and scratchy sore throat for two days. OTC medicines have helped a little. Associated signs and symptoms – runny nose Quality -- scratchy Duration – two days Modifying factors – OTC have helped

What is E/M? What is E/M?

Three key E/M components A.

• A. H

History

• 1. History present illness

2. . Past medical f Past medical family social hist mily social histor

• ry
• 3. Review of systems
• B. Ph
• B. Physical

ysical Exam Exam

• 1. 1995-Body areas or organ systems
• 2. 1997- General or specialty specific

C.

• C. Medical Decision Making

Medical Decision Making

• 1. Problem points
• 2. Data points
• 3. Risk

8/28/2018 22

E/M 1995

PFSH PFSH

• Past Medical History
• Family History
• Social History
• The categories of subsequent hospital care, follow-up inpatient

consultations and subsequent nursing facility care, CPT requires

• nly an "interval" history. It is not necessary to record information

about the PFSH.

E/M 99211-99215

PFSH PFSH

• PMH:

PMH: Pneumonia 2 years ago.

• Allergies: None
• Medicines: None
• FH:

FH: Dad died of a heart attack in his 70’s

• SH:

SH: Married, smoker, works for the post office

8/28/2018 23

E/M 1995 PFSH

Level PFSH

• 99211
• 99212
• 99213

1

• 99214

1

• 99215

2

E/M 1995 PFSH

Level PFSH

• 99201 0
• 99202 0
• 99203 1
• 99204 3
• 99205 3

8/28/2018 24

E/M 1995 PFSH

Level PFSH

• 99221 1
• 99222 3
• 99223 3

What is E/M? What is E/M?

Three key E/M components A.

• A. H

History

• 1. History present illness
• 2. Past medical family social history
• 3. Revie

view of syst

• f systems

ems

• B. Ph
• B. Physical

ysical Exam Exam

• 1. 1995-Body areas or organ systems
• 2. 1997- General or specialty specific

C.

• C. Medical Decision Making

Medical Decision Making

• 1. Problem points
• 2. Data points
• 3. Risk

8/28/2018 25

ROS 1995

• Constitutional symptoms
• Eyes Ears, Nose, Mouth, Throat
• Cardiovascular
• Respiratory
• Gastrointestinal
• Genitourinary
• Musculoskeletal
• Integumentary (skin and/or

breast)

• Neurological
• Psychiatric
• Endocrine
• Hematologic/Lymphatic

Allergic/Immunologic

ROS 1995

• Pr

Proble

• blem per

pertin inen ent t ROS inquires about the system directly related to the problem(s) identified in the HPI. DG: The patient's positive responses and pertinent negatives for the system related to the problem should be documented.

• Ext

Extend nded ed ROS inquires about the system directly related to the problem(s) identified in the HPI and a limited number of additional

• systems. DG: The patient's positive responses and pertinent negatives

for two to nine systems should be documented.

• Com

Complete ROS inquires about the system(s) directly related to the problem(s) identified in the HPI plus all additional body systems.

8/28/2018 26

ROS 1995

Pr Problem per

• blem pertinent R

inent ROS inq S inquires about the syst ires about the system directly relat em directly related t d to the pr the problem(s) identif

• blem(s) identified in

ied in the the HPI. DG: The

• HPI. DG: The patient's positiv

patient's positive responses and responses and per pertinent negativ inent negatives f es for the syst r the system relat em related t d to the the pr proble

• blem should be

m should be docume document nted. ed. Pr Problem P

• blem Pertinent

inent CC: CC: I’m short of breath RO ROS: Productive cough, but no fever

ROS 1995

Ext Extended R ended ROS inq S inquires about the ires about the syst system directly relat directly related t d to the the pr problem(s) identif

• blem(s) identified in

ied in the HPI and the HPI and a a limit limited number of additional d number of additional syst

• systems. DG: The patient's positiv
• ems. DG: The patient's positive responses and

responses and per pertinent inent negativ negatives f es for tw r two t

• to nine

nine syst systems should be document ems should be documented. ed. Ext Extended ended CC: CC: I’m short of breath RO ROS: Productive cough, mild distal edema, no fever

8/28/2018 27

ROS 1995

Com Complet lete R ROS inq S inquires about the sy ires about the syst stem(s) directly relat em(s) directly related t d to the the pr problem(s) identif

• blem(s) identified in

ied in the HPI pl the HPI plus all additional body syst us all additional body systems. ems. Com Comple lete CC: CC: I’m short of breath RO ROS: Productive cough…………all additional body systems negative

E/M CMS

RO ROS: “A t ten en point re point revie view of syst

• f systems is

ems is negativ negative.” e.”

• 1. This is a short cut for recording. Not a short cut for asking the

questions.

• 2. Add pertinent negatives.

8/28/2018 28

E/M ROS

CC: CC: My ankles are swollen RO ROS: A ten point review of systems is negative. There is no sob, nor

• rthopnea.

E/M 1995 ROS

Level ROS

• 99211 0
• 99212 0
• 99213 1
• 99214 2-9
• 99215 10

8/28/2018 29

E/M 1995 ROS

Level ROS

• 99201 0
• 99202 1
• 99203 2
• 99204 10
• 99205 10

E/M 1995 ROS

Level ROS

• 99221 2
• 99222 10
• 99223 10

8/28/2018 30

What is E/M? What is E/M?

Three key E/M components A.

• A. H

History

• 1. History present illness
• 2. Past medical family social history
• 3. Review of systems
• B. Ph
• B. Physical

ysical Exam Exam

• 1. 1995-

995-Bod Body areas or orga areas or organ syst n systems ems

• 2. 1997- General or specialty specific

C.

• C. Medical Decision Making

Medical Decision Making

• 1. Problem points
• 2. Data points
• 3. Risk

E/M 1995 Exam Body Areas

• Head, including the face
• Neck
• Chest, including breasts and axillae
• Abdomen
• Genitalia, groin, buttocks
• Back, including spine
• Each extremity

8/28/2018 31

E/M 1995 Ex E/M 1995 Exam am Organ Syst Organ Systems ems

• Constitutional (vital signs,

general appearance)

• Eyes
• Ears, nose, mouth, and throat
• Cardiovascular
• Respiratory
• Gastrointestinal
• Genitourinary
• Musculoskeletal
• Skin
• Neurologic
• Psychiatric
• Hematologic/lymphatic/immun-
• logic

What is E/M? Exam

1995 7 Body areas or 12 organ systems. Level Number needed PF 1 area or system EPF 2-7 limited exam areas or systems Det 2-7 extended exam areas or systems

8/28/2018 32

What is E/M? Exam

1995 7 Body areas or 12 organ systems Level Number needed PF 1 area or system EPF 2-4 2-4 areas or systems (2-7 lim) Det 5-7 5-7 areas or systems (2-7 ext) Com Comp 8-12 8-12 syst systems

E/M 1995 EXAM

Level EXAM

• 99211 0
• 99212 1 PF
• 99213 2-7 Limited (2-4) EPF
• 99214 2-7 Extended (5-7) DET
• 99215 8 COMP

8/28/2018 33

E/M 1995 Exam

Level EXAM

• 99201 1 PF
• 99202 2-7 EPF
• 99203 2-7 DET
• 99204 8 COMP
• 99205 8 COMP

E/M 1995 EXAM

Level EXAM

• 99221 6 DET
• 99222 8 COMP
• 99223 8 COMP

8/28/2018 34

What is E/M? What is E/M?

Three key E/M components A.

• A. H

History

• 1. History present illness
• 2. Past medical family social history
• 3. Review of systems
• B. Ph
• B. Physical

ysical Exam Exam

• 1. 1995-Body areas or organ systems
• 2. 1997- General or specialty specific

C.

• C. Medical Decision Making

Medical Decision Making

• 1. Pr

Problem

• blem poin

points ts

• 2. Data points

Data points

• 3. Risk

Risk

What is E/M?

Medical Decisio Medical Decision Making Making

• Problem points (MDM1)
• Data points (MDM2)
• Risk Table (MDM3)
• These add together to define MDM. Need 2 out of three.

8/28/2018 35

E/M Problem Points

MDM MDM Pr Problem points

• blem points

self limited. Max 2. 1 established problem stable 1 established problem worse 2 new problem. No w/u. Max 1. 3 new problem. w/u. 4

E/M Problem Points

MDM: MDM:

• 1. Chronic anemia. This is under good control.
• 2. COPD. This appears stable.
• 3. Dyslipidemia. His numbers are not as good as we need and I

have increased his statin.

• 4. Weight loss. Coupled with his tachycardia this may be thyroid
• disease. I have ordered a thyroid panel.

8/28/2018 36

E/M Data Points

MDM MDM Data points Data points review/order labs 1 review/order xray 1 review/order echo, ecg, pft 1 discuss test with md 1 independent review 2 decision for old records 1 review/sum old records 2

E/M Data Points

MDM: MDM:

• 1. Chronic anemia. I reviewed his recent CBC and the Hgb level is

stable on his iron supplement.

8/28/2018 37

E/M Data Points

MDM: MDM:

• 1. Chronic anemia. I reviewed his recent CBC and the Hgb level is

is 11 11.6 and this is stable on his iron supplement.

• 2. COPD. His COPD appears stable.
• His most recent chest xray shows hyperinflation.
• I reviewed his chest xray and it does shows hyperinflation.
• I requested old chest xrays to compare progression.
• I reviewed his old chest xrays and I do not see significant progression.
• 3. Dyslipidemia. His LDL is still over 100 at 142. I have increased his

statin.

E/M Risk Table

MDM MDM Risk T Risk Table ble Minimal Low Moderate High

8/28/2018 38

E/M Risk Table

MDM MDM Presenting Pr Presenting Problem

• blem

Proced cedure re Manageme Management optio nt options Min 1 mn lab-v, cxr rest Low 2mn/1chr lab-a, bx

• tc, pt/ot

Mod 2chr stable, bx, lhc rx, ivf+k 1 undx new High sev flare chr egd+rf dnr/mj surg Need only one

E/M Risk Table

MDM - Risk Presenting Presenting Pr Problem

• blem

Procedure cedure Management options Management options Min 1 mn x x Low 2mn/1chr x x Mod 2chr stable x x High sev flare chr x x Need only one

8/28/2018 39

E/M Risk Table

MDM MDM - Risk Presenting Pr Presenting Problem

• blem

Procedure cedure Management options Management options Min 1 mn x x Low 1chr x ivf ivf Mod 2chr, undx new x rx rx, i ivf+k High sev flare chr x dnr dnr Need only one

E/M 1995 MDM

Type of decision making Pr Problem points

• blem points

Data points Data points Risk Risk Minimal (1) None (1) Min Limited (2) Limited (2) Low Multiple (3) Moderate (3) Mod Extensive (4) Extensive (4) High

8/28/2018 40

E/M 1995 MDM

Type of decision making Problem points + Data points + Risk = Type of decision making pe of decision making Minimal (1) Minimal (1) Min Straigh Straight f forwar ard Limited (2) Limited (2) Low Lo Low Multiple (3) Moderate (3) Mod Mod Mod Extensive (4) Extensive (4) High High High

E/M Put Together

Level History Exam MDM Time

• 99211

No physician service needed

• 99212

PF PF SF 5

• 99213

EPF EPF Low 15

• 99214

DET DET Mod 25

• 99215 COMP COMP

HIGH 40

8/28/2018 41

E/M Put Together

Le Level Hist istory Exam Exam MDM MDM

• 99201 PF PF SF
• 99202 EPF EPF SF
• 99203 Det

Det Low

• 99204 Comp Comp

Mod

• 99205 Comp Comp

High

E/M Put Together

Le Level Hist istory Exam MDM Exam MDM

• 99221 Det

Det SF

• 99222 Comp Comp Mod
• 99223 Comp Comp High

8/28/2018 42

E/M MDM

• Medical decision making seems to have a special role in

determining the level of a patient encounter, even though it's supposed to be weighted evenly with the history and exam.

• Reviewers are likely to regard the medical decision making

component as a reality check on the other two key elements.

• The physician who consistently documents a high-level history

and a high-level exam on a patient with a minor problem is asking for trouble.

Robert L. Edsall and Kent J. Moore Fam Pract Manag. 2010 Jul-Aug;17(4):10-15.

E/M Cloning

Cloning Cloning

• Copy Forward
• Copy Paste
• Super Click
• Non Provider Entry

8/28/2018 43

E/M Cloning

Not Cloning Not Cloning

• ROS may be filled out by staff or even the patient
• Provider must document they reviewed
• PFSH may be filled out by staff or even the patient
• Provider must document they reviewed

E/M Cloning

The The pr provider must do ider must do the the

• CC
• HPI
• Exam
• MDM

8/28/2018 44

E/M Compliance

Question Question Should the provider select their own E/M level?

• If yes, it places tremendous responsibility on the provider.
• This slows patient care as the provider then audits
• If no, the office or facility must have a coder specially trained in

E/M

• This is an extra cost to the office or facility, but likely worth it.

E/M Proposed Changes

• 1. MDM
• 2. Time
• 3. No change
• Flat rat

Flat rate

• Take away the burden of documentation

8/28/2018 45

E/M Proposed Changes

• Established patient 16-31 minutes
• New patient 20-38 minutes

E/M Proposed Changes

Level 201 018 201 019

• 99212 $43.19 $88.90
• 99213 71.62 88.90
• 99214 105.81 88.90
• 99215 142.16 88.90

8/28/2018 46

E/M Proposed Changes

Le Level 2018 2019

• 99202 $73.42 $129.20
• 99203 104.37 129.20
• 99204 159.44 129.20
• 99205 200.10 129.20

Mail Comments

CMS-1676-P 2 Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS-1676-P P.O. Box 8016 Baltimore, MD 21244-8013.

8/28/2018 47

Next Presentation: Nov 27, 2018

The R The Rules les of Medical Necess

• f Medical Necessity

ity We will discuss:

• 1. Recognize the importance of medical necessity
• 2. Comprehend the cost of noncompliance with revenue loss
• 3. Identify ways to document for payers and auditors a given

medical need

HomeTown Health Webinar Series

E/M – E/M – Creating a reating a No Note August 28, 2018 James Dunnick, MD jdmd62@gmail.com

8/28/2018 48

Explain Explain

why we must do this.

Explain Explain

how to match an evaluation and management level to an ICD- 10-CM code.

Descr Describe be

the differences between the various levels

• f code

selection.

Re Recall ll

the key parts

• f the provider

note – history, physical exam, and medical decision making.

Lear arning O ning Outcomes comes

Now that you have completed this training, you should be able to:

Conta Contact:

jdmd62@gmail.com Or hthtech@hometownhe althonline.com

here here goes goes

TEXT TEXT

Questions? Questions?

8/28/2018 49

Upcoming Events & Consortium Announcements

Jennie Price, Director of Business Development, HomeTown Health, LLC

jennie.price@hometownhealthonline.com

Quarterly Physician CDI Training Series

Webinar Date Training Title Intended Audience

Aug 28, 2018 The Rule of Provider Note Construction – Physician E&M Services Hospital and physician office physicians, coders, CDI specialists, scribes, and revenue cycle directors. Nov 27, 2018 The Rules of Medical Necessity Hospital and physician office physicians, coders, CDI specialists, scribes, and revenue cycle directors. Feb 26, 2019 Watch an Auditor Audit – Vulnerabilities & Opportunities in the Medical Record Hospital and physician office physicians, coders, CDI specialists, scribes, and revenue cycle directors. May 28, 2019 Physician Coding – Opportunities for Return in Rural Hospitals Hospital and physician office physicians, coders, CDI specialists, scribes, and revenue cycle directors.

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Financial Stability Program Upcoming Webinars

Webinar Date Training Title Intended Audience

9/12/2018 Monthly Medicare Reimbursement Update Webinar Medicare Billers, Business Office Managers and CFO's 9/19/2018 Quarterly RHC Billing and Compliance Update Rural Health Clinic Managers/Administrators, Billers, and Compliance 9/25/2018 Quarterly Coding Webinar: ICD‐10‐CM Annual Updates HIM, Coding, and other Hospital Financial Leaders (CFOs, Revenue Cycle Directors, Business Office leaders) 10/10/2018 Monthly Medicare Reimbursement Update Webinar Medicare Billers, Business Office Managers and CFO's 10/23/2018 Iowa Medicaid Update + Anatomy of an Appeal Medicaid Billers, Business Office Managers and CFO’s 11/14/2018 Monthly Medicare Reimbursement Update Webinar Medicare Billers, Business Office Managers and CFO's 11/27/2018 Physician CDI Training: The Rules of Medical Necessity Physicians, Hospital and Physician Office Coders, CDI Specialists, and Revenue Cycle Directors

CONSORTIUM RESOURCES

There are on-demand training and certification programs available in HTHU’s:

• School of Revenue Cycle Management
• PFS/BO Certifications
• School of Coding & Documentation
• School of Clinical & Staff Compliance
• School of Physician Office Education
• School of HIT & Transformation
• Board & Governance Training
• School of Behavioral Health

Questions? Contact Meghan Williams at meghan.williams@ hometownhealthonline.com

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CONSORTIUM DASHBOARD

Georgia/ Florida Hospitals: www.hthu.net/htc18 Password Protected Iowa Hospitals: www.hthu.net/iahtc18 Password Protected

Email hthtech@hometownhealthonline.com or Jennie Price at jennie.price@hometownhelathonline.com for your password.