Are you missing modifiers? Misplacing modifiers? If so, you’re losing money and wasting time working denials. Slapping a modifier on “just to be safe” (modifier 59 users, this one’s for you) can result in payment when none was due or denials. Coding denials due to incorrect or missing modifiers can cost a practice money.

This six and a half hour presentation is for managers, coders and physicians, and is presented in person.

Description:
Evaluation and Management (E/M) services account for 30% of the revenue paid by Medicare for all physician services. For many specialties, E/M codes account for 60-70% of total revenue. Maximum reimbursement depends on understanding the rules related to these services. The goal of this one day seminar is to teach these rules with the goal of revenue enhancement and compliance.

These presentations are interactive, hands-on practical sessions: bring your toughest “what if’s” and your most confusing E/M scenarios! All specialties that bill E/M services will find this helpful. The final session of the day is a bonus session for primary care practices on E/M services.

Agenda:
8:30-10:30 – Office Visits

• New and established
• Consults
• Prolonged services
• Use of modifiers
• Selecting a code
• Pre-ops

10:45-12 – “Other” E/M services

• SNF
• Care plan oversight
• Home visits
• Work related or medical disability E/M services
• Independent Medical Exams
• E/M with a procedure

12:00-1:00 – Lunch

1:00-2:00 Hospital Services

• Inpatient visits
• Observation
• Critical care
• ED visits

2:00-3:00 – Teaching Physician Rules

• E/M services, procedures, endoscopies
• Primary care exception
• Medical students

3:00-3:15 – Break

3:15-4:30 – Bonus Session for Primary Care Practices: Preventive Care

• Billing for preventive services to Medicare patients
• Split visits
• Welcome to Medicare
• Diagnostics

 Learning Objectives:

• Describe how to select the correct category of E/M service
• Identify the rules related to each category of code
• Demonstrate mastery of the Teaching Physician rules

CEUs:
Can be applied for with 45 days notice.

CCM and TCM are complex services, which may be a reason why practices that could benefit from them don’t try. A 2015 survey found only 22% of practices had a CCM program, and only half of them had successfully submitted a claim. Billing for TCM is up, but CMS keeps adding new rules for it – for example, in 2015 they changed the date-of-service requirements – which providers may find confusing. In fact, some providers are outsourcing their CCM and/or TCM work.
Participants will learn

• The basic MDRs for each service-what you have to do to bill
• Levels of support your practice needs to perform CCM or TCM
• Changes CMS has made to TCM and CCM requirements since they were introduced in 2013 and 2014
• The pros and cons of outsourcing CCM or TCM services
• The most common reasons for denials of claims for both services, and how to avoid them