Future-Proofing Your Practice: 2024 E&M Revisions, CMS 2025 Proposals, and Efficient Use of Modifier 22

Session 1 - 2024 Evaluation and Management (E&M) Updates

Pre-recorded Webinar (Instant Access)

Duration - 60 minutes

Speaker - Lynn M. Anderanin

Over the last couple of years, the Evaluation and Management section of CPT® has had some drastic changes, and 2024 is no exception.  In an effort to reduce the time it takes to document and streamline the work involved, in 2024 revisions are being made to clarify issues with the new documentation guidelines.  There also is a new CPT® code added to the E&M section that some providers will be able to take advantage of.  In 2024, there also are changes being made in the CMS Physicians Fee Schedule Final rule that affect some E&M services when they are performed via telehealth now that the Public Health Emergency has ended. 

Webinar Objectives

The E&M codes are an important part of nearly every physician specialty having to do with the actual visit with the patient.  The E&M services require the review of the medical documentation for determination of the level of service either by time or medical decision making. The method used can be chosen by the provider from one patient to another.  The difference in reimbursement between the levels can be substantial.  We will look at what changes were made, as well as some common areas of concern.  Insurance companies also perform audits to prove fraud and abuse which could lead to refunds and denials, along with possible penalties.

Webinar Agenda

This session will look at the changes and determine what must be changed in the documentation to meet the requirements.  If the documentation is not appropriate, then it may be considered not done.  Some may be responsible for educating other staff, so fully understanding what is needed is an important to know and share with others.

Webinar Highlights

• Revisions to many codes by clarifying the requirements when time is the chosen method
• Description changes for shared/split visits
• Can we now report multiple E&M visits on the same day?
• New guidelines related to codes in which to determine the level of service is time.
• Inpatient and observation guideline changes
• Addition of guidelines and tables for the prolonged service with direct contact
• The first year of an E&M code as an add on for pelvic examinations

Session 2 - CMS 2025 Proposed Physicians Fee Schedule

Pre-recorded Webinar (Instant Access)

Duration - 60 minutes

Speaker - Lynn M. Anderanin

Each and every year CMS goes through the process of creating the Physicians Proposed Fee Schedule to become effective on January 1st of the following year.  The proposed rule is available in July, and there is a 60-day comment period in which anyone can comment on the proposed rule.  At the end of the 60 days, CMS reviews all the comments and in the first week of November the final rule appears in the Federal Register.  There can be differences between the proposed rule and final rule, but most frequently there are revisions, but not major changes.

Webinar Objectives

The annual Physicians Fee Schedule Proposed Rule can have a major impact on the reimbursement for particular procedures or services, or all of the items on the CMS fee schedule.  Understanding the possible rules before they are final helps office prepare for the upcoming year in determining the procedures and services they will offer, and the financial impact of the changes to their bottom line. 

Webinar Agenda

• Implementing the changes from a workflow perspective
• Applying it to the practice to understand the financial impact to the practice
• Education of the pertinent staff within the practice in time for the changes

Webinar Highlights

• Highlights of the Proposed Fee Schedule
• How do the proposed rule differ from the present rules
• How to analyze the rule to implement the pertinent changes to your practice
• Preparing to make revisions when the Final Rule is published
• How to submit comments to CMS about the proposed rule

Session 3 - Unlisted Procedures and the Use of Modifier 22

Pre-recorded Webinar (Instant Access)

Duration - 60 minutes

Speaker - Lynn M. Anderanin

The CPT manual has over 10,000 codes, but there isn’t always a CPT code that represents a unique or new procedure, or a procedure that was more complex than normal due to special circumstances.  Unlisted procedure codes and modifier 22 can help with these special cases to share with the insurance company those times when special, distinctive situations occur.  This webinar will examine the use but will also look at options available when insurance companies are not reimbursing these cases.

Webinar Objectives

Unlisted codes and modifier 22 situations like to be avoided because not only does the documentation have to clearly support the coding and billing, but the insurance companies most commonly deny these cases delaying reimbursement and causing physician’s staff to spend countless hours appealing these cases to receive the deserved reimbursement.

Webinar Agenda

• Correct uses of unlisted codes and modifier22
• Discussion of documentation necessary for proof of situations eligible for the coding.
• Writing appeals for insurance company denials for these cases

Webinar Highlights

• Proper documentation for
• Unlisted codes and their purpose
• Determining what to charge for these cases
• Circumstances that require a modifier 22
• Verification that reimbursement received is appropriate.
• Writing appeals to the insurance company when there is a denial or unacceptable reimbursement

Who Should Attend

Coders, auditors, billers, compliance, physicians, Physicians Assistants, Advanced Nurses, Medical Assistants, Scribes, Physicians, CEO, CFO, Administrators, Managers, surgery schedulers, auditors, Scribes, Prior Authorization, Qualified Healthcare Professionals, Claims Adjuster, Nurses, Medical Assistants, Surgery Scheduler