In this webinar session we review opportunities for Community Health Centers to improve their clinical documentation, professional coding, and medical billing with a focus on the unique CMS rules and regulations we face when reporting our valuable health services to our various insurance entities. Your clinical providers (ex. MD, PA, NP, CP, CSW), facility leaders (ex. CFO, revenue cycle managers, office managers), are invited to join in along with professional coders and medical billers.
The overall focus of the class is to help you generate 100% of the revenue you are entitled to, but no more than you are allowed. All content is presented from the perspective of a CMS-approved federally qualified Health Center with a focus on details found within CMS Claims/Benefits Manuals Chapters 9 and 13.
Additionally, we will pay particular attention on how all staff can work together to balance your clinical and business goals through proper application of the CPT, HCPCS-II, and ICD-10-CM code set rules when reporting quality data (ex. HEDIS, UDS, Performance Measurement, and Risk Adjusted Coding) and submitting an accurate annual cost report. Attendees will gain a better understanding on how various insurance companies want community health centers to report fee-for-service claims versus daily encounter rate claims versus other payment models such as capitated plans where you may receive a per-member-per-month payment.
• Clinical providers will gain usable recommendations on how to improve their clinical documentation through exposure to the HIPAA-mandated code sets including the CPT, HCPCS-II, and ICD-10-CM manuals while maintaining a focus on patient care.
• Managers and coders will identify revenue opportunities and/or compliance risks that will impact the maintenance of their community health center’s policies and procedures that affect their revenue cycle.
This project was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of an award totaling $6,625,000 with 0 percent financed with non-governmental sources. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS, or the U.S. Government. For more information, please visit HRSA.gov.