Who Should Attend This Course
Getting paid is a team effort—and surgeons lead the team. If the doctors don’t understand what’s needed in an operative report from a coding and reimbursement point of view (something they don’t teach in residency) they are short changing themselves.
Practice Administrators and Managers
You are the chief compliance officer in most private practices. In order to supervise the economic engine of the practice you must understand the business office operations.
Coders and Billers
If you’re responsible for entering data, working denials, applying modifiers, posting payments, and filing appeals, your expertise in surgical and office coding must be exacting in its execution!
Hospital or MSO Executives Running General Surgery Practices
Maximize your profits! Understand what is special and unique about billing for the general surgery service line, and keep your surgeons happy and bonus-able. (Not to mention reduce compliance headaches.) Learn the rules and avoid using incorrect and expensive assumptions that result in fiscal disaster.
As a result of 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.
What’s On the Agenda
How You Get Paid: The Mechanics of Coding
- Difference between coding and reimbursement
- E/M modifiers
- Initial patient evaluation—Planned vs. urgent
- Category of code
- Medicare fee schedule
- RVU and time values for surgical services
- New Medicare requirement for post-op visit reporting
Don't Let the EMR Run Away with You
- Select the accurate E/M code supported by documentation
- When to use time to select a code, and what may –and may not—be included in your time
- Reducing audit risk
- Critical care for trauma
- Critical care—When is it part of the global period and when may it be billed in the post-op period?
- Screening versus diagnostic
- Use of modifiers
- Importance of diagnosis coding
- Coding for moderate sedation
- Benign and malignant lesions
- Soft tissue tumors
- Wound repair
- Wound care, debridement
ICD-10 Issues and Problems
- General principals
- Status codes
- When to report personal history codes
- Reporting co-morbidity
- Post-procedural complication code changes
- 7th character extender review
- HCC’s and risk adjusted diagnosis coding
Non-Physician Practitioners in a Surgical Practice
- Incident to, shared and direct billing
- Payment and policy essentials
- Audit tool to check for compliance
- Direct and indirect benefits of a PA or NP: Justifying ROI
MACRA Rules: MIPS and APM
Practice Management Essentials
- How to monitor if your payment amounts are correct
- Checking RVU reports for accuracy
- Denials and strategic appeals (when to appeal, when to write off: approaches and resources)
- Contracting 101
- Time of service collections and surgical deposits
- Financial metrics—what the surgeon needs to know