Track A: Coding

• 9:45 am – 10:45 am

Teri Romano, Senior Consultant, BSN, MBA, CMCP

This session provides an in-depth understanding of the Global Surgical Package, focusing on E&M reimbursement for major and minor surgical services performed pre-operatively. It emphasizes the correct application of modifiers 25 (Significant Separate Identifiable E&M on the Same Day as Another Service) and 57 (Decision for Surgery) within the context of pre-operative evaluation and management (E&M) services.

Learning Objectives:

• Compare and contrast the guidelines for the E&M modifiers in the context of global surgical package as defined by CPT and Medicare.

• Learn how to appropriately use Modifier 25 for a significant, separately identifiable evaluation and management (E/M) service provided on the same day as a minor procedure.

• Recognize scenarios where Modifier 25 should not be used.

• Understand when to use Modifier 57 for an E/M service, which results in the initial decision to perform a major procedure within 24 hours.

Track B: Reimbursement and Regulatory

• 9:45 am – 10:45 am

Cathy McDowell, President & CEO, BSN, MBA 

This session will offer an in-depth look at coding denials and how they continue to increase and/or cause delayed or inaccurate reimbursement. In addition, strategic tips on how to effectively review denials and write appeal letters will be provided, which will lead to the creation of preventive strategies that enhance the quality and accuracy of clinical documentation.

Learning Objectives:

• Understand denials and identify denial patterns.

• Create a strong appeal letter.

• Assess recurring denial problems that provide opportunities to improve denial rates.

Track A: Coding

10:50 am – 11:50 am

Karen L Whelan, Consultant, CPC CPCO CPMA CGSC COSC CCVTC 

Dive deep into the intricacies of Evaluation and Management (E/M) services with this comprehensive session focused on the critical aspects of time-based coding versus medical decision-making (MDM). This session is designed for healthcare professionals seeking to enhance their understanding and application of E/M coding guidelines. Through detailed lectures and tips, you will gain the expertise needed to document and code E/M services accurately.

Learning Objectives

• Identify what is included when reporting E/M services based on Time.

• Master the elements of MDM:

  • Problems Addressed – Define the terms to identify where they fit.

  • Data Reviewed and Analyzed – Understand what counts.

  • Risk of Patient Management – Recognize the risk of treatment options.

• Recognize the similarities and differences between E/M categories depending on Place of Service

Track B: Reimbursement and Regulatory

10:50 am – 11:50 am

Deborah Grider, Executive Consultant, CPC, CPC-I, CPC-P, COC, CEMC, CPMA, CCS-P, CDIP

Processing, Deep Language Learning, Machine Learning, and Generative Artificial Intelligence. The coder's role is changing to require an elevated level of expertise. While AI offers many advantages, such as increased efficiency and reduced error rates, it is unlikely to replace human medical coders completely.  Instead, AI may help coders focus on more complex, nuanced tasks while improving overall productivity.

Learning Objectives:

• Review the future impact of the traditional coder role.

• Explore the transformative impact of artificial intelligence (AI) on medical coding.

• Review the advantages and disadvantages of using AI for medical coding.

Track A: Coding

12:50 pm – 1:50 pm

Teri Romano, Senior Consultant, BSN, MBA, CMCP

Healthcare payors, including Medicare, Medicare Advantage, Medicaid, and commercial insurers, increasingly deny claims for non-specific diagnosis codes when more specific codes are available. To avoid claim denials and ensure accurate reimbursement, physicians and other qualified healthcare providers (QHCPs) must use the most specific diagnosis codes supported by the patient's complaint, history, and plan of care. "Unspecified" codes should be used when the medical record lacks sufficient information to assign a more specific code.

Coders have the opportunity to educate and collaborate with physicians and QHCPs to improve diagnosis code selection. Sometimes, issues with the EHR vendor can contribute to coding problems. This session will also address the integration of Social Determinants of Health (SDOH) into E&M and diagnosis coding.

Learning Objectives:

• Recognize the importance of coding specificity in healthcare documentation and reimbursement.

• Assign the most precise diagnostic codes based on clinical documentation and learn when to query the physicians and providers.

• Identify documentation gaps related to specificity and work with physicians and QHCP’s to narrow the gaps.

• Integrate SDOH into coding practices to enhance the accuracy of health records.
  

Track B: Reimbursement and Regulatory

12:50 pm – 1:50 pm

Christine Banks, Consultant, RHIA, CPC, CPCO 

This presentation will cover the latest update on APP billing and CPT guidance on how to bill Direct, “Incident to” and Split/Shared services. There will be further discussion on billing and documentation requirements and what practices are doing today to leverage their APPs.

Learning Objectives:

• Understand the concept and difference between Direct, “Incident to” and Split/Shared visits.

• Learn the billing requirements of APP billing: Advantages and Disadvantages.

• Stay current with the latest update on APP billing.

Track A: Coding

1:50 pm – 2:50 pm

Christine Banks, Consultant, RHIA, CPC, CPCO

Meeting ongoing patient needs, such as furnishing and coordinating medically necessary medical services, is impossible without documenting each patient encounter completely, accurately, and promptly. Documentation is often the communication tool used by and between medical professionals. Records not properly documented with all relevant and important facts can prevent the next provider from furnishing sufficient services or supporting medical necessity for the claim(s) submitted. The outcome can result in erratic or even dangerous treatment and cause unintended complications. While meeting patient needs is the most important reason for documenting services, it is not the only one. Another reason for reporting medical services is compliance with federal and state laws. These laws require practitioners to maintain the records necessary to “fully disclose the extent of the services,” care, and supplies furnished to patients and support claims billed.   This session will cover an overview of medical necessity and why complete and accurate documentation matters.

Learning Objectives:

• Define the term 'Medical Necessity' as related to Clinical Documentation

·       Prioritize the importance of coding and documentation issues

• List two or more consequences of poor documentation of medical necessity

• Describe at least one strategy to improve documentation to support medical necessity

Track B: Reimbursement and Regulatory

1:50 pm – 2:50 pm

Deborah Grider, Executive Consultant, CPC, CPC-I, CPC-P, COC, CEMC, CPMA, CCS-P, CDIP

Knowledge is the Key to surviving a payor audit. Thorough and accurate documentation is essential to support all services billed. Healthcare providers must prioritize medical coding best practices to minimize errors and ensure compliance with coding guidelines. Failure to meet legal and regulatory standards in medical coding can result in costly audits for practices. With the increasing prevalence of healthcare fraud, Medicare, Medicaid, and private payors are paying closer attention to coding discrepancies. To avoid medical coding audits, practices must adhere to strict regulatory compliance and adopt best practices in coding. A good understanding of the type of audits, how to respond to an audit, and the steps to ensure compliance are essential for every medical practice.

Learning Objectives

• Review of the various types of audits

• Explore what triggers a coding audit.

• Navigate the steps to survive any payor audit.

Track A: Coding

3:00 pm – 4:00 pm

Teri Romano, Senior Consultant, BSN, MBA, CMCP

Accurate coding is crucial for proper reimbursement and compliance in the healthcare industry. This session, "Think Like an Auditor: Catch Common Coding Mistakes Before They Are Made," is designed to help healthcare and coding professionals identify and prevent common coding errors. Frequent mistakes will be discussed, such as incorrect modifier use, unbundling, upcoding, downcoding, diagnosis linkage, outdated codes, and more. This fast-paced session aims to equip coders, billers, managers, and providers with awareness and knowledge to enhance coding accuracy, reduce denials, and ensure coding compliance.

Learning Objectives:

1. Identify and Prevent Common Coding Errors Before They Happen!

2. Detect Incorrect “Unbundling” of Services Prior to Claim Submission

3. Recognize “suspicious’ modifier usage in code combinations.

4. Collaborate with others to ensure clean claim submission and resubmissions

Track B: Reimbursement and Regulatory

3:00 pm – 4:00 pm

Cathy McDowell, President & CEO, BSN, MBA 

This presentation will cover the journey of a claim and its impact on how it can affect a low- or high-functioning revenue cycle. This course will provide the latest regarding prior authorization issues and solutions to process improvement.

Learning Objectives:

• Understand the process of billing claims and its impact on the revenue cycle.

• Identify issues/gaps related to a low-functioning revenue cycle.

• Optimize and improve prior authorization workflows.