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Measure Regularly, Deliver Compliantly, Consistently and with CareInstructor: Jennifer Dickinson, CPC, CPMA
Course Objective: Understanding the basics of coding and billing compliance

Course Description: Do you want to excel in performing both administrative and clinical tasks to help
ensure maximum reimbursement for your practice?

In this session, certified
professional coder, certified professional medical auditor, and former
chiropractic assistant, Jennifer Dickinson will go through ways staff members
can mitigate compliance issues for the practice as part of their daily tasks.

Course Outline:
Hour One
 The Basics – coding compliance is the process of ensuring that the coding of diagnosis, procedures
and data complies with all coding rules, laws and guidelines.
1. Compliance defined by CMS
2. Organizations that enforce coding and billing guidelines
3. What is healthcare compliance as per AAPC?
4. Goal of compliance- stop fraud, waste, and abuse of funding in healthcare
 What is fraud as defined by law?
 What is abuse as defined by law?
 What is waste as defined by law?
6. Criminal consequences of healthcare fraud
7. HIPAA law and compliance
 What is a compliance plan
 7 components of a compliance plan
Hour Two
 The Cost of Denials
1. Top 3 denial reasons and solutions
 Demographics
a. Eligibility- 1/3 of nearly all denials
 ICD-10 Coding
a. Dx Linking, Exceptions
b. Denial code examples
c. Policy examples
 CPT Coding
a. CCI edits
b. Codes that can’t be billed together without modifier
c. Modifiers – reporting, alerts, review
2. 8 checks to combat denials
 Verify benefits right away
 Call to verify
 Copy of insurance card and id

 Check Dx linking
 Payor policy coding allowances
 MUEs
 CCI edits
 Audit coding
Hours Three and Four
 Coding Changes and Challenges for 2023
1. New E/M Guidelines – review guidelines for E/M prior to 2021 versus the new E/M guidelines
effective
 New vs Old
a. 95/97 guidelines
b. MDM and Time
 Time
a. What’s included in time
b. Services reported separately
 MDM
a. Complexity of problems
b. Data reviewed
c. Risk of complications
2. ICD-10 rules and guidelines
 How to choose an ICD-10 code using an ICD-10 code book and avoiding excludes 1 denials
a. ICD-10 lookup
 Code lookup using an ICD-10 book
b. Excludes 1
 What is ICD-10’s Excludes 1 notes?
 How can you avoid Excludes 1 edits?
 Exceptions to Excludes 1 notes

3. Common CPT codes and the written definition for each code
 9894* , 97012, 97110, 97530, 97535, 97112, 97140, 97124
4. The purpose of modifier in the coding world
 Commonly used modifiers with application and examples
a. 24, 25, 50, 52, 59, XS, XE, XP, XU, 76, 26, TC

References and Resources
Centers for Medicare and Medicaid Services – https://www.cms.gov
American Academy of Professional Coders – https://www.aapc.com
American Medical Association – https://www.ama-assn.org/practice-management/cpt