The Office of Inspector General (OIG) of the U.S. Department of Health and Human Services (HHS) has performed auditing work and determined that 42% of claims for Evaluation and Management (E/M) services were incorrectly coded, which included both upcoding and downcoding (i.e., billing at levels higher and lower than warranted, respectively), and 19% were lacking documentation. They also noted that a number of physicians increased their billing of higher level, more complex and expensive E/M codes. Many providers submitted claims coded at a higher or lower level than the medical record documentation supports. This can put physicians and their practices at an increased compliance risk. On the flip side, if physicians are billing E/M codes at a lower level than warranted then they are potentially leaving legitimate reimbursement on the table.
E/M coding can be confusing, complex and difficult for physicians and their staff. This workshop will break down the 1995 and 1997 documentation guidelines for E/M services from the perspective of a physician. Your presenter is an MD who has been a certified coder for almost 20 years. This workshop is unique in the fact that not only will Dr. Wolf present the coding guidelines for E/M services, but he will provide clinical insights into those guidelines. He will share with you how a doctor thinks and works in the context of the E/M guidelines.
Additionally, we will discuss the major announcement by CMS to adjust their requirements as it relates E/M guidelines.
Topics will include:- A review of key and recent compliance enforcement and settlements as they relate to E/M coding issues
- The difference between the E/M guidelines concept of “medical-decision making” (aka MDM) and “medical necessity”
- Clinical perspectives on key language and documentation physicians provide relating to patient history, physical exam and medical decision making.
- Billing E/M services on coordination of care time.
- The difference in CPT E/M coding categories and corresponding HCPCS “G-codes”
- The 2019 proposed changes to E/M documentation rules.
Learning Objectives:
- Comprehend the current regulatory enforcement environment as it relates to E/M services
- Review recent settlement cases due to a lack of E/M documentation compliance
- Analyze and apply the three key components of E/M coding
- Understand the 1995 and 1997 documentation guidelines as they relate to history, physical exam and medical decision making.
- Gain insights into the physician's clinical thought process in the context of E/M coding and documentation
Areas Covered:
- Enforcement trends and government authority for E/M services under the U.S. False Claims Act
- Medical History component of the 1995/1997 guidelines including chief complaint, history of present illness, past/family/social history, review of systems.
- Physical Exam component of the 1995/1997 guidelines including body areas, organ systems and specialty specific exams.
- Medical decision-making component of the 1995/1997 guidelines including number of diagnoses or management options, amount and/or complexity of data reviewed, and risk of complications and/or morbidity or mortality.
- Medicare Claims Processing Manual, Chapter 12, Section 30.6 "Evaluation and Management Service Codes"
- Modifiers related to E/M coding including documentation requirements for modifier -25, Significant and Separately Identifiable Services
- E/M coding based on time
- The 2019 proposed changes to E/M guidelines
Who will benefit:
- Physician Practice Manager
- Billing
- Coding
- Auditor
- Compliance Officers
- Physician practice partner
- Physicians
- Physician's Assistants
- Nurse Practitioners
- Nurses
- Medical Assistants
- 8:30 AM - 8:59 AM: Registration Meet & Greet.
- 9:00 AM - 10:00 AM: Lecture 1
- Seminar objectives review, expectations and scope.
- Healthcare Enforcement Climate and Expectations/Requirements related to E/M Service’s
- Settlement Examples from Lack of Compliance
- 10:00 AM - 11:00 AM: Lecture 2
- The Types of E/M Categories (New Patient, Established Patients, ED visits, etc.)
- Overview of the three key components of E/M services
- Overview of 1995/1997 guidelines
- 11:00 AM - 12:00 Noon: Lecture 3
- Compare/Contrast of History Differences between 1995/1997 guidelines
- Compare/Contrast of Physical Exam Differences between 1995/1997 guidelines
- 12:05 PM - 1:00 PM: Lunch
- 1:00 PM - 2:00 PM: Lecture 4
- Compare/Contrast of Medical Decision-Making Differences between 1995/1997 guidelines
- Coding E/M Services on Time
- Application: Code Actual Physician Documentation of E/M services
- 2:00 PM - 3:00 PM: Lecture 5
- Application: Code Actual Physician Documentation of E/M services
- 3:00 PM - 4:00 PM: Lecture 6
- Overview of 2019 CMS proposed changes to E/M Guidelines
- 4:00 PM - 4:30 PM: Lecture 7
- Questions and Answers
- Dismiss and Departure
CJ Wolf,
M.D, CHC, CCEP, CIA, Educator/Compliance Executive
C.J. Wolf, MD, M.Ed. has been involved in healthcare for over 20 years beginning with his years in medical school. Shortly after graduating Dr. Wolf made a career change to healthcare administration, reimbursement and compliance. He has worked in various coding, reimbursement or Chief Compliance Officer roles for Intermountain Healthcare, the University of Texas MD Anderson Cancer Center, the University of Texas System and Merit Medical Systems. He currently is Sr. Compliance Executive at Healthicity.
Dr. Wolf has a passion for teaching and education. He has developed and taught curricula for adult employees seeking national coding certifications, trade workshops and seminars, and has served as adjunct faculty for Salt Lake Community College and currently is Faculty at Brigham Young University-Idaho and adjunct faculty at the University of Illinois at Chicago College of Medicine.
In addition to his medical degree from the University of Illinois at Chicago College of Medicine, Dr. Wolf holds a master of education (M.Ed.) from the University of Texas at Brownsville. He completed his B.S., magna cum laude, from Brigham Young University, Provo, UT.
Register Now
Online using Credit card
Get the Invitation
Pre-Register yourself and get the official Invite when venue and dates are announced for this seminar.
Call here to register +1-888-717-2436 or email at [email protected]
Other Registration Option
- Download the Order Form
- Fill this form with attendee details & payment details
- Fax it to +1-650-362-2367, or
- Email it to [email protected]
Payment Mode
ComplianceOnline (MetricStream, Inc),
6201 America Center Drive Suite 240
San Jose, CA 95002
USA
Register / Pay by Wire Transfer
Please contact us at +1-888-717-2436 to get details of wire transfer option.Terms & Conditions to Register for the Seminar/Conference/Event
Your registration for the seminar is subject to following terms and conditions. If you need any clarification before registering for this seminar please call us @ +1-888-717-2436 or email us @ [email protected]
Payment:
Payment is required 2 days before the date of the conference. We accept American Express, Visa and MasterCard. Make checks payable to MetricStream Inc. (our parent company).
Cancellations and substitutions:
Written cancellations through fax or email (from the person who has registered for this conference) received at least 10 calendar days prior to the start date of the event will receive a refund - less a $150 administration fee. No cancellations will be accepted - nor refunds issued - within 10 calendar days before the start date of the event.
On request by email or fax (before the seminar) a credit for the amount paid minus administration fees ($150) will be transferred to any future ComplianceOnline event and a credit note will be issued.
Substitutions may be made at any time. No-shows will be charged the full amount.
We discourage onsite registrations, however if you wish to register onsite, payment to happen through credit card immediately or check to be submitted onsite. Conference material will be given on the spot if it is available after distributing to other attendees. In case it is not available, we will send the material after the conference is over.
In the event ComplianceOnline cancels the seminar, ComplianceOnline is not responsible for any airfare, hotel, other costs or losses incurred by registrants. Some topics and speakers may be subject to change without notice.
Attendance confirmation and documents to carry to the seminar venue:
After we receive the payment from the registered attendee, an electronic event pass will be sent to the email address associated with the registrant 5 working days before the seminar date. Please bring the pass to the venue of the event.
Conference photograph / video:
By registering and attending ComplianceOnline conference, you agree to have your photographs or videos taken at the conference venue and you do not have any objections to ComplianceOnline using these photos and videos for marketing, archiving or any other conference related activities. You agree to release ComplianceOnline from any kind of claims arising out of copyright or privacy violations.
Offers:
We are pleased to offer several exhibitor, sponsorship and media partnership options designed to maximize your company's exposure and networking opportunities before, during and after the event.
Benefits of becoming a Sponsor/Exhibitor/Media Partner:
- Logo on website, marketing email, branding materials & the registration booth
- Exhibit Space
- Free event pass
- Speaking opportunity
- Social media campaign
For more details and other sponsorship options at this event, please contact Event Manager: [email protected] or call: +1-650-238-9656
Media Partner:
Local Attractions of Salt Lake City, UT
Temple Square and Related Sites
Temple Square is Salt Lake City's most popular attraction. With its grand six-spired temple, two visitor's centers, lovely flower gardens and fountains - and nearby sites related to the Church of Jesus Christ of Latter-Day Saints. Area attractions include the Assembly Hall, Tabernacle, Museum of Church History and Art, Family Search Center, Beehive House, Lion House, Brigham Young Historic Park, LDS Conference Center and Joseph Smith Memorial Building. Temple Square offers hundreds of free movies, dramatic programs and music events every year.
The Gateway
The Gateway on the west side of downtown Salt Lake is the city's best outdoor shopping center.
City Creek Center
It's designed to be a walkable shopper's paradise, with six acres of green space, the namesake creek, two 18-foot waterfalls, and a massive retractable roof.
Capitol Hill
The Utah State Capitol, at 300 N. State St., sits atop a hill overlooking the Salt Lake Valley. The building was constructed in 1912-1916 and renovated in 2004-2008.
Hogle Zoo
Utah's Hogle Zoo dates from 1931 and is located at the mouth of Emigration Canyon at 2600 E. Sunnyside Avenue. The Zoo is one of the most visited attractions in Utah and the top paid-for tourist attraction in Salt Lake City. It covers 42 acres and includes more than 800 animals.
This is the Place Heritage Park
This is the Place Heritage Park includes a restored pioneer village with live demonstrations of pioneer life and a restored Brigham Young farmhouse.
University of Utah
The University of Utah is not only one of the state's leading educational institutions but also an important cultural and sports center for the city and the state of Utah.
Liberty Park and Tracy Aviary
Liberty Park is Salt Lake City's second largest public park and includes trails, playgrounds, a pond, paddle boat rentals, tennis courts, picnic facilities, amusement rides and a water play area. Liberty Park includes the Chase Home Museum of Folk Arts and the excellent eight-acre Tracy Aviary, one of two free-standing aviaries in the United States.
Library Square
Library Square, at 210 East 400 South, includes not just the award-winning Salt Lake City main library, but also shops, a cafe, a Salt Lake Community College Writing Center and the studios of KCPW, a local NPR affiliate.
Bingham Canyon Copper Mine
The Kennecott Bingham Canyon Copper Mine in the southwest corner of the Salt Lake Valley is the world's largest man-made hole in the ground and has produced more copper than any other mine in history. It is one of two man-made objects seen from space.
Thanksgiving Point
Thanksgiving Point is a huge recreation area near the Point of the Mountain that includes spectacular themed gardens, a farm and agriculture center, movie theaters, an IMAX, shops, restaurants, a golf course, party and reception facilities, and the world's largest indoor dinosaur museum.
