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Learn how to code physician/patient visits.
In this video, Mrs. Ortega journeys you through each and every E&M case. Watch, learn and master the skill as she simplifies E&M coding with her very unique approach to getting it done right the first time.
Instant Access Online Training. 30 Day Access. No refunds.
Memorize all 81 of the most frequently used medical abbreviations and prescription notations with this Go To Coders® Abbreviations/RX Notations Flashcards set! This step is instrumental in passing the national certification exams on your first try.
Also available in the Go To Coders® Medical Coding Exam Prep Kit
Memorize all 143 of the most frequently used medical terms with this Go To Coders® Medical Terminology Flashcards set! This step is instrumental in passing the national certification exams on your first try.
Also available in the Go To Coders® Medical Coding Exam Prep Kit
Memorize all 32 of the most commonly used medications in medical coding with this Go To Coders® Medication Flashcards set! This step is instrumental in passing the national certification exams on your first try.
Also available in the Go To Coders® Medical Coding Exam Prep Kit
Memorize all 35 of the most invaluable set of CPT modifiers used in medical coding with this Go To Coders® Modifiers Flashcards set! This step is instrumental in passing the national certification exams on your first try.
Also available in the Go To Coders® Medical Coding Exam Prep Kit
Go To Coders® Tabbing System includes 192 tabs that are vibrantly colorful to keep you highly organized. This tabbing system will have you find key pages in record time. The templates include instruction on how to place them throughout your 3 medical coding books (CPT, HCPCS, ICD-10).
Go To Coders® Flashcards set will help you memorize medical terminology, abbreviations, medications, and modifiers. They include:
Also sold individually.
Need help making your RESUME stand out?
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A Compliance Officer is required to have a vast knowledge of government laws, regulations and guidelines since the Officer develops and monitors compliance departments, including internal compliance reviews, audits, and risk assessments.
This 1-day course is only taught at the Dallas headquarters and prepares students for the national board exam for CPCO® by learning the following:
*Non-refundable deposit will be applied towards the total cost.
Risk Adjusters assign the correct diagnosis (ICD-10-CM) codes. In this course, students will learn to identify and communicate documentation deficiencies to providers in order to improve accurate risk and audit adjustment coding.
HCC coding stands for Hierarchical condition category. It is a risk-adjustment model created by CMS in 2004. It was designed to estimate future health care costs for patients. Hierarchical condition category relies on ICD-10 coding to assign risk scores to patients. Each HCC is mapped to an ICD-10 code. Along with demographic factors (such as age and gender), insurance companies use HCC coding to assign patients a risk adjustment factor (RAF) score. Using algorithms, insurances use the patient’s RAF score to predict future costs. Hierarchical condition category coding helps communicate patient complexity and paint a picture of the whole patient. In addition to helping predict health care resource utilization, RAF scores are used to risk adjust quality and cost metrics. CMS calculates a risk score, or “risk adjustment factor” (RAF) score, for each individual beneficiary and provides this information to each payer quarterly. Deriving these scores from HCCs is relatively straightforward. Adding the weights together produces a risk score for that beneficiary. Accurate coding drives accurate risk adjustment, which will increasingly affect the providers’ bottom line. In this course, coders learn that risk adjustment greatly affects physicians’ reimbursement. Students will learn about HCCs and gain an understanding of how CMS uses them to calculate expenditure benchmarks are for providers to earn shared savings and avoid shared loss. This understanding will become increasingly relevant to the operational viability of independent practice owners and health systems as well. The ultimate goal is to improve patient outcomes at reduced costs and to make providers accountable for.
In addition, it is no longer enough to correctly code the patient’s diagnosis. The plan of care must support the diagnosis for each condition listed, and the condition must be reestablished, along with the appropriate care plan, each year. In other words, the previous coding resets to zero if not reestablished. It may seem that the coding for amputation would carry forward from year to year, but that is not the case. Each chronic medical problem must be coded and documented annually to be incorporated by CMS into an annual risk score recalculations.
The CMS-HCC risk-adjustment model was designed to most accurately predict spending at the group level, not the individual beneficiary level. Thus, the expenditure predicted for an individual beneficiary is likely to be less accurate than the expenditure predicted for a group of beneficiaries. It is more helpful, then, to look at risk scores at the practice level. To manage risk effectively, a practice should know its risk score for each insurer with which it has a value-based contract. If your practice doesn’t have this data, it is important for the coder to ask for it. For example, a patient with few serious health conditions could be expected to have average medical costs for a given time. However, a patient with multiple chronic conditions would be expected to have higher health care utilization and costs. See the below example:
| Patient: John A 68-year-old male patient is diagnosed with type 2 diabetes with no complications, hypertension, and a body mass index (BMI) of 37.2 E11.9 Type II Diabetes with no complications (RAF 0) I10 Hypertension (RAF 0) Z68.37 BMI 37.2 (RAF 0) Total Risk: 0
| Patient: Sue A 66-year-old female patient is diagnosed with type 2 diabetes with no complications, hypertension, and a body mass index (BMI) of 37.2 I10- Hypertension RAF (0) E11.42 Type II Diabetes with polyneuropathy (RAF 0.0368) I 10 Hypertension (RAF 0) Z68.37 BMI 37.2 (RAF 0) E66.01 Morbid Obesity (RAF 0.365) Total Risk: 1.1808
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HCCs are derived from ICD-10 codes via retrospective review of claims data. ICD-10 codes are factored into the algorithm regardless of the site of service (inpatient or outpatient), provider type (physician or extender), or order of diagnosis (primary or secondary). An ICD-10 code maps to exactly one HCC, but not all ICD codes map to an HCC. The CMS-HCC model focuses on chronic health conditions likely to affect long-term health expenditures and purposefully excludes non-diagnostic diagnoses (e.g., a diagnosis of abdominal pain), clinically insignificant diagnoses (e.g., a sprain), or diagnoses that are definitively treated (e.g., acute appendicitis).
HCCs are called hierarchical because, for some disease states such as diabetes, multiple HCCs capture differing severity of illness. Within an HCC grouping, a patient is assigned only the HCC that corresponds to the most severe manifestation documented. For example, if review of a beneficiary’s claims data finds ICD codes mapping to both HCC 17, Diabetes with acute complications (e.g., ICD-10 code E0811), and HCC 19, Diabetes without complication (e.g., ICD-10 code E089), the model would assign only HCC 17, because it is the more severe manifestation of diabetes.
Most physicians are aware of the various risk models however, many physicians are unaware of how critical accurate coding is under these models to characterize risk, enhance shared savings, and provide patient-centered care. Insurance companies are increasingly paying physicians based on how their system performs in value-based care. Insurance plans have leveraged the HCC methodology with significant financial success. Due to differences in resource use between groups of Medicare beneficiaries and the inability of a single statistical model to predict expenses for all groups, CMS employs several different versions of the CMS-HCC model. Risk for the majority of Medicare beneficiaries is calculated using the “community” model.
The shift toward providing more specific and complete documentation of all medical problems on an annual basis is a challenge for many practices. This could be particularly problematic in the outpatient setting, which typically has less administrative infrastructure to support adequate coding. However, aligning current payment-focused billing and documentation practices with evolving risk-adjustment-focused coding practices will only become more important for all ambulatory settings in the future. Failing to adequately capture a patient’s risk through documentation and coding may lead to an inaccurately low level of attributed risk and eventually to reduced reimbursements.
The following subjects also taught in this CRC course:
*Non-refundable deposit will be applied towards the total cost.
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Medical Billers are vital to the financial success of a medical practice. This 1 Day Certificate & Exam Prep Course prepares medical billers with skills to maintain all aspects of the revenue cycle. Students will learn health payer regulations, private payer policies, payment postings, payment adjustments, claims adjudication and the appeals process.
These skills are crucial to the financial success of the professional services claims process.
Also taught in this course:
– Types of Insurance
– Billing Regulations
– HIPAA & Compliance
– Reimbursement & Collections
– Billing
– Coding
– Case Analysis
*Non-refundable deposit will be applied towards the total cost.
Certified Medical Auditors utilize their knowledge of medical coding and documentation guidelines to improve the revenue cycle of medical practices. A medical auditing career includes working with medical records technology and health services administration. , applying your medical coding skills in a new realm. Taught in Dallas, this one-day course will help you pass the national board exam on the first try!
You’ll learn all about:
Outpatient Medical Coders are in high demand since physicians often leave their private practice to join hospital groups. Career opportunities are often found in Outpatient facilities such as Ambulatory Surgical Centers or hospital outpatient billing and coding departments. A COC® credential from AAPC or CCA® credential from AHIMA validates your knowledge as an Outpatient coder in addition to your CPT, ICD-10 and HCPCS Level II coding skills. This course will prepare you to pass the national board exam on the first try.
This 1-day course is only taught at the Dallas, TX headquarters location.
– Payment Methodology
– Compliance & Regulatory
– CPT Outpatient Guidelines (Hospital & Facility based)
– ICD-10-CM Outpatient Guidelines (Hospital & Facility based)
– HCPCS Level II Guidelines (Hospital & Facility based)
– Medical Terminology
– Anatomy& Physiology
– Modifiers
*Non-refundable deposit will be applied towards the total cost.
Become a certified medical coder by earning your Certified Professional Coder CPC® certification from AAPC or Certified Coding Specialty-Physician certification CCS-P® from AHIMA.
These are the most recognized medical coding certifications in the healthcare industry.
Over 105,000 certified professionals help maintain compliance and profitability within medical practices through accurate medical coding and documentation.
Take this 3-day course to prepare you to pass the board exam on the first try!
This course includes lessons on:
– Payment Methodology
– Compliance & Regulatory
– CPT Guidelines (physician-based)
– HCPCS Level II Guidelines (physician-based)
– ICD-10-CM Coding Guidelines (physician-based)
– Medical Terminology
– Anatomy & Physiology
– Modifiers
*Non-refundable deposit will be applied towards the total cost.
