The path from a patient’s initial encounter or emergency surgery to final payment is a complex and interrelated process. This process requires accurate assignment of CPT codes, modifiers, and diagnoses codes; the submission of a “clean” claim; and an understanding of government and payer rules. All of these components contribute to receiving the correct payment. Overlooking even one step – or making the wrong coding choice – can result in a denial and impede cash flow.
In this session, you’ll learn the processes necessary to effectively code, bill, and collect for patient encounters and surgeries. We will also cover practice management essentials such as tracking financial metrics, evaluating RVU reports, implementing time of service collections and surgery deposits, effectively contracting with plans, and understanding the basics of MACRA and MIPS quality initiative. Attendees will leave with the knowledge that puts payments on the fast track. The workbook appendix includes coding rules for teaching physicians.
As a result of attending this course, participants will be able to:
Identify the services that are part of the global package and services that may be billed in addition to procedure codes.
Assess the accuracy of E/M code selection.
Explain when critical care services may be billed in the global period, and integrate the rules for billing critical care in trauma.
Demonstrate an understanding of diagnosis coding for medical necessity and risk based coding.
Define the role and reimbursement of a non-physician practitioner in a surgical practice and analyze the ROI.
Apply management principles such as reviewing metrics, RVU reports, and monitoring contract payment terms.