Evaluation & Management Advanced Training

(Worth 18 AAPC Pre-Approved CEUs and 18 MMI CEUs)

Generally speaking, E&M codes represent established patient services that are not procedures. Because they are the most common set of medical codes, many people assume that they are reporting these services properly. Studies show, however, that as much as 42% of E&M services are coded incorrectly, which in turn costs Medicare billions and results in more frequent audits. If you want to ensure that your practice maintains a steady revenue flow and avoids a potential lawsuit from improper coding, you will need to make sure your E&M skills are honed and up-to-date.

MMI’s Quita Edwards, RMC, REMS, CPC, CPMA, CPC-I will guide you through an in-depth review of the key components (chief complaint, history, exam, and medical decision-making), as well as guidelines of E&M services and:

  • The role medical necessity plays.
  • Why Clinical Documentation Improvement (CDI), ICD-10, and E&M are so important.
  • E&M modifiers every practice should know, as well as correct use of modifiers when a procedure is done the same day as an E&M service.
  • An entire session on time-based E&M coding, counseling, and prolonged service codes.
  • Confusion and controversy between incident-to and split/shared visits, as well as which qualified health professional can bill. Is the complexity of incident-to billing impacting your practice? Whether your problem is loss of revenue or inappropriate payments, we will discuss solutions to appropriately report and optimize the opportunity.
  • Understanding Place of Service rules.
  • A review of the top OIG risk areas for 2017.
  • How to develop a workflow that ensures complete and compliant documentation, as well as effective techniques for communication with physicians.

Plus much more, including countless resources, tools, and tips.

This highly informative online course will provide students with helpful advice and insight into difficult E&M coding situations, as well as the option to discuss real-world examples of tried-and-true tactics in order to gain the knowledge and skills to be an expert at E&M.

Who is this Evaluation & Management Certification for?

The program is specifically geared toward people who are currently in the medical field and who want to advance their careers in healthcare as well as understand the specific rules and regulations with E&M codes (practice managers, compliance officers, nurses, providers, physician assistants, medical assistants, etc.). Many people who are already in a coding position and want to prove their knowledge by having their certification also take this course. Getting an E&M certification will give you opportunities to move up in your career and make you more marketable to current and potential employers.

CEUs & REMS Certification

Continuing Education Units: This course is worth 18 AAPC pre-approved CEUs as well as 18 MMI CEUs. If you only want this course for CEUs, you just need to purchase the course and not the exam.

Registered Evaluation & Management Specialist (REMS) Certification: If you would like to get the REMS credential showing that you are an expert in Evaluation & Management, you will need to purchase both the course and the REMS certification exam.

Session 1

Session I:

The Evidence of Medical Care

Basic Standards for Documentation

Documentation and Medical Necessity

Organization and Structure

Basics to Code Selection

Categories – Subcategories-Code Set

Learning Objectives:

  1. Identify the categories of E&M codes
  2. Learn frequently used and misused E&M codes
  3. Understand the importance of medical necessity
  4. Gain knowledge of documentation guidelines
  5. Learn the risks with cloning and pre-populated notes
  6. Understand OIG’s focus on Place of Service and learn how to correctly assign the POS for provider-based and free-standing clinics
  7. Discuss hot topics for government regulators
Session 2

Session II

Determining the Level of Service Part I Documentation of the History Component

Chief Complaint

History of Present Illness

Review of System

Past Medical, Family, and Social History

Calculating the Overall History

Session Learning Objectives:

  1. Learn the seven components of E&M services
  2. Understand how the history component affects certain E&M codes
  3. Learn proper documentation of reason for the visit/chief complaint
  4. Review the most common coding errors and denials with the history component
  5. Learn who in the clinic can and cannot document CC, HPI, ROS, and PFSH
  6. Discuss EMR pitfalls
  7. Learn rules for communicating with providers
  8. Assign E&M level based on history
  9. Group study—exercises and case scenario
  10. Q&A
  11. Session assessment
Session 3

Session III

Determining the Level of Service Part II

Documention of the Physical Exam

1995 vs. 1997 the Physical Exam

Calculating the Physical Exam

Session Learning Objectives:

  1. Complete a comprehensive study of the 1995 and 1997 guidelines
  2. Understand the 1997 E&M coding guidleines speciality exams
  3. Understand the four levels of the exam
  4. Learn the difference between expanded problem focus and detailed examination
  5. Compare similarities and differences between the two guidelines
  6. Understand why chosing the appropriate guidline is important to coding, reimbursement, and compliance
  7. Understand why it is important to know what level of examination is required by your jurisdictional MAC
  8. Group study—case scenarios for both 1995 and 1997 exams
  9. Q&A
  10. Session assessment
Session 4

Session IV

Determining the Level of Service Part III Documentation of the Medical Decision-Making

The Number of Diagnoses and Treatment Options

Amount of Complexity of Data

Risk of Complications and Morbidity or Mortality

The Final Calculation of Medical Decision-Making

Session Learning Objectives:

  1. Understand the core elements of medical decision-making
  2. Learn how to calculate the diagnosis
  3. Learn how to calculate the physician’s work
  4. Understand the risk table
  5. Learn the scoring system and how to assign point levels
  6. Discuss tips on how to avoid the most common medical decision-making mistakes
  7. Group study—case scenarios
  8. Q&A
  9. Session assessment
Session 5

Session V

Determining the Level of Service Part IV

Calculating the Level of the Complete Note

Coding Based on Time

Prolonged Services

Critical Care Services

Observations Services Consultation Services

Session Learning Objectives:

  1. Learn to pull it all together using the three key components
  2. Learn E&M modifiers as well as common errors and denials because of incorrect coding
  3. Understand the rules for documenting time and the exceptions
  4. Learn proper reporting for time-based services
  5. Understand the guidelines for prolonged services and appropriate documentation
  6. Gain knowledge of accurate critical care reporting
  7. Discuss tips to avoid common coding errors for time-based services
  8. Group study—case scenarios
  9. Q&A
  10. Session assessment
Session 6

Session VI

Incident-To Services Shared/Split Visits Case Management Services

Chronic Care

Complex Chronic Care

Tele-Services

Session Learning Objectives:

  1. Learn who can bill incident-to services
  2. Review Medicare rules and guidelines for incident-to billing
  3. Learn how a practice can benefit from incident-to services and billing
  4. Understand the risks associated with incident-to billing if not done accurately
  5. Learn the difference between incident-to and shared/split visits
  6. Gain knowledge of the rules and guidelines for Medicare and some other payers (e.g. BCBS for shared/split visits)
  7. Learn appropriate documentation for shared/split visits
  8. Discuss tips to avoid common coding errors for incident-to and shared/split visits
  9. Review the chronic care management codes and guidelines
  10. Learn who can bill chronic care management
  11. Group study—case scenarios
  12. Q&A
  13. Session assessment
About the Instructor

The E&M/REMS training and certification program was created by Quita Edwards, RMC, REMS, CPC, CPC-I, COSC, CPMA. She has over 30 years of experience in the medical industry, including 22 where she was employed with a multi-physician Orthopaedic Surgery and Rehabilitation Center. She is now owner and CEO of Practice Dynamics, an independent billing company, as well as CASE Contracting Services, where she is an independent contractor for consulting, auditing, and educational services for physicians, their staff, and professionals pursuing certifications through the AAPC.  She holds specialty certifications in Orthopaedic Surgery and Medical Auditing.

Required Textbooks

Medical Coding Certification Book Requirement

  1. CPT® Professional Edition (current year), AMA Publisher

This textbook is not included but is available to purchase through MMI at a discounted rate when enrolling in the program.

Prerequisites

At MMI, we want to make sure that you have a successful learning experience. In order to sign up for the E&M/REMS coding certification and training, you must have some knowledge of medical coding and have already been working in a medical setting.

Online Training Format

General Online Training Format: Enrolling in the program will create an account that will allow you to begin training online. The platform includes an optional group discussion board, engaging reading material, and interactive learning tools consisting of practice exams and e-flashcards to test your knowledge and progress throughout. Additionally, this training includes instructor support via email/phone, so you will always have access to MMI’s network of certified instruction staff throughout your studies. Upon completion of the training program, you will be given access to the REMS certification exam, proctored online through MMI’s learning platform (provided that you purchased the full REMS test and not just the CEU course). The results will be available immediately upon submitting the exam. Upon successful completion, you will officially be a Registered Evaluation & Management Specialist and member of the Medical Management Institute. We will mail you the REMS certificate and membership card, and you will receive the benefits of an MMI membership for one year.

Payment Plan & Group Rates

Interest-free payment plan options are available through MMI and PayPal.

Payment Plan through PayPal: If you would like to set up a payment plan through PayPal, you can do so at the checkout page by following the instructions below:

  1. Select the “Checkout with PayPal” button after placing training in cart
  2. Log in with your PayPal account (or create a new one)
  3. Select the “Apply Now” button at the bottom of the page

Payment Plan through MMI: Contact an MMI representative to set up an interest-free payment plan through the Medical Management Institute. Typically, a down payment of $350 is required and the remaining balance is paid off over four months.

Group Rates: Discounted rates are available upon request for groups of three or more. Contact us to get started.

AAPC Approved