This live course is designed for Rural Health Clinic (RHC) providers, quality managers, ACO leadership, and revenue cycle staff at rural health facilities who need a high-level basic explanation of how to report accurate quality metrics and who deal with HEDIS, HCC, QIP, Risk Adjustment, and Share Savings.
RHC Overview: We will begin with a RHC documentation>coding>billing overview including:
- How coding and billing is different in a RHC.
- Review of the key elements of the CMS Benefits and Claims Manual sections (chapters 9 & 13)
- Which services are included in the All-Inclusive Rate and which services get paid via fee-for-service or via a flat fee when billing Medicare?
- Preventive Medicine for the IPPE, AWV, and almost a dozen other “sometimes covered” G-codes performed by a RHC.
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 in order to most accurately report the true complexity of care for your ACO 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.
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 ACOs.
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.
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 have 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.