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Documentation - Chiropractic Assistant


Documentation 196
2021 Changes for Evaluation and Management (E/M) Services

1.0

$20.00 USD

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  • Apply the new algorithm to choose your E/M code appropriately using either time or decision making
  • Disucss existing E/M codes were deleted and details on the new Prolonged Service codes
  • Uses the the new process for typical chiropractic evaluations
  • Identify elements that count as Time-Activities and how to calculate appropriately
  • Discuss what it means to do a clinically appropriate history and exam

Kathy Mills Chang, MCS-P, CCPC

AudioVisual Course

Documentation 194
1.0

$20.00 USD

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  • Recognize the key documentation requirements and components required to be eligible to treat Veterans Administration referrals
  • Compose documentation that meets these required VA elements, while avoiding missteps most commonly found in denials and audits
  • Appraise and self-audit the VA process from referral through discharge,
  • Determine key factors known to be often missing, and understand what to do to correct the deficiency
  • Demonstrate the proactive steps to take in treating VA patients from clinical and financial submisisons

Kathy Mills Chang, MCS-P, CCPC

AudioVisual Course

Documentation 193
Medicare Mastery Part 2 Complicated Compliance in Medicare

1.0

$20.00 USD

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  • Identify Dually Eligible Individuals (QMB) and Understand How Medicare Works with Medicaid
  • Ascertain the practice’s obligations for QMB patients, regardless of Medicaid participation or coverage
  • Provide accurate and legal advance notice to dually eligible individuals within the new guidelines
  • Recognize the differences between acute, chronic, and maintenance care and how that affects billing and charges
  • Duplicate Medicare financial rules and collections guidance into a process within the practice

  • Kathy Mills Chang, MCS-P, CCPC

    AudioVisual Course

    Documentation 192
    Medicare Mastery Part 1 Medicare Fundamental Regulations

    1.0

    $20.00 USD

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    • Demonstrate the components of recognizing Medical Necessary Care vs. Clinically Appropriate
    • Identify CMT coding trends and indicators as they relate to medical necessity
    • Properly manage treatment effectiveness for exacerbations and reoccurrences
    • Determine Proper Diagnosis and Assessment for Federal Patients
    • Acknowledge and audit CMT coding ratios to evaluate the potential risk

    Kathy Mills Chang, MCS-P, CCPC

    AudioVisual Course

    Documentation 191
    How to Perform a Baseline Documentation Audit

    1.0

    $19.00 USD

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    • Understand the necessary components of initial and routine visit documentation
    • Recognize and evaluate the relationship between documentation and billed codes
    • Demonstrate how to conduct a complete baseline audit of medical record documentation
    • Establish the parameters for subsequent audit requirements

    Kathy Mills Chang, MCS-P, CCPC

    AudioVisual Course

    Documentation 184
    Minimize Medicare Risk for Peace of Mind

    1.0

    $20.00 USD

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    • Recognize the mandatory enrollment guidelines for chiropractors and apply the rules to daily practice
    • Distinguish between active and maintenance care and employ proper procedure to administrate both types of care
    • Complete and document required elements of documentation of active treatment
    • Prepare patients to best differentiate care that Medicare considers medically necessary from care that the patient is expected to pay for
    • Apply the Medicare standard of financial transactions with patients in order to stay within the Federal collection guidelines

    Kathy Mills Chang, MCS-P, CCPC

    AudioVisual Course

    Documentation 183
    The Established Patient Evaluation - Who, What, When and How

    1.0

    $20.00 USD

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    • Evaluate the necessary elements to properly document established patient re-evaluations of all types
    • Deliver appropriate evaluation and management services to justify continued care, assess progress, and discharge from this active care when the time is right
    • Report the necessary components of documenting the transitional diagnosis and treatment plan after a periodic re-evaluation
    • Complete the fundamentals of documenting the assessment of change since the last evaluation as it applies to federal regulations in Medicare

    Kathy Mills Chang, MCS-P, CCPC

    AudioVisual Course

    Documentation 182
    The 5 Documentation Mistakes You're Probably Making

    1.0

    $20.00 USD

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    • Differentiate and document for the difference between medical necessity and clinical appropriateness
    • Execute a complete and compliant treatment plan that includes all required elements
    • Properly record the elements necessary to justify the full-spine adjustment
    • Command the mechanics of properly documenting clinical rationale for ordered diagnostics and treatment
    • Ensure the inclusion of diagnostic assessment and doctor’s rationale in routine daily visit notes

    Kathy Mills Chang, MCS-P, CCPC

    AudioVisual Course

    Documentation 181

    Evaluation and Management Documentation Guidelines Made Simple Part 2


    1.0

    $20.00 USD

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    • Recognize and apply E/M documentation requirements for medical decision making, to include levels of risk, problem points, and data points.
    • Calculate the appropriate levels of medical decision making based on complexity tables
    • Properly execute the appropriate documentation medical decision-making components necessary to meet E/M documentation requirements
    • Reproduce quality documentation elements necessary in new and established patient documentation
    • Compute, using appropriate algorithms, the levels of E/M coding based on documentation

    In Florida - these count towards General Hours

    Kathy Mills Chang, MCS-P, CCPC

    AudioVisual Course

    Documentation 180 - 181
    2.0

    $40.00 USD

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    • This contains all courses with the educational objectives listed from Documentation 180 through Documentation 181

    Course Group includes all Documentation Courses numbered 180 through 181

    Kathy Mills Chang, MCS-P, CCPC

    AudioVisual Course

    Documentation 180

    Evaluation and Management Documentation Guidelines Made Simple Part 1


    1.0

    $20.00 USD

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    • Recognize and apply E/M documentation requirements for history and consultation
    • Properly execute the four sub-components of history to be documented for new and established patient documentation
    • Properly execute the appropriate documentation for chiropractic examination components necessary to meet E/M documentation requirements
    • Reproduce quality documentation components within history and examination for new and established patients
    • Distinguish necessary elements of E/M documentation guidelines necessary for various levels of coding

    In Florida - these count towards General Hours

    Kathy Mills Chang, MCS-P, CCPC

    AudioVisual Course

    Documentation 179

    Documentation Nuances for All Interested Parties


    1.0

    $20.00 USD

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    • Awareness of the value of orderly documentation to you and others
    • Ability to duplicate key documentation components that auditors and reviewers expect
    • Steps necessary to address how poor documentation can turn a simple record review into a full audit
    • Ability to identify commonly missed links connecting documentation to treatment

    Kathy Mills Chang, MCS-P, CCPC

    AudioVisual Course

    Documentation 178

    Documenting and Coding for Unproven, Investigational or Experimental Procedures


    1.0

    $20.00 USD

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    • Define and recognize common procedures that may be deemed unproven, investigational or experimental
    • Determine how individual state boards and payers view these various treatments
    • Recognize guidance or rulings from state boards that dictate the need for informed consent
    • Properly document the procedures in the medical record
    • Apply correct coding to describe the procedure provided
    • Personalize a sample Consent to Treat for the procedure provided

    Kathy Mills Chang, MCS-P, CCPC

    AudioVisual Course

    Documentation 177

    The Ideal Documentation for an Episode of Care


    1.0

    $20.00 USD

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    • Discover all the elements necessary for appropriate documentation of an episode of care, from the initial visit through the discharge from active treatment
    • Have clearer delineation of the beginning and end of episodes of patient care
    • Decide when an active episode of care should turn into maintenance care, and document the decision making appropriately
    • Identify the required components of documentation as they are outlined in state board documentation requirements, Medicare documentation requirements and other entities’ regulations

    Kathy Mills Chang, MCS-P, CCPC

    AudioVisual Course

    Documentation 176

    Document Clinical Rationale for Active Care Rehab


    1.0

    $20.00 USD

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    • Perform functional testing to identify patients who will benefit from active care rehab
    • Correlate functional testing findings with a protocol-driven care plan customized to the patient’s diagnosis
    • Recognize and document preferred outcomes that result from properly executed active care techniques
    • Follow clinical algorithms to best understand the beginning, middle and end points of active care rehab
    • Properly document the clinical rationale for active care rehab by linking it to the diagnosis and treatment plan of initial visit documentation

    Kathy Mills Chang, MCS-P, CCPC

    AudioVisual Course

    Documentation 174

    Compliant Documentation for Adjusting Multiple Spinal Regions


    1.0

    $20.00 USD

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    • Interpret in documentation, the difference between active, medically necessary care vs. clinically appropriate but possibly maintenance adjustments
    • Able to distinguish compensatory vs. primary subluxations and document them properly
    • Specify proper documentation techniques as a full spine adjuster
    • Demonstrate the ability to classify documentation for each chiropractic technique employed

    Kathy Mills Chang, MCS-P, CCPC

    AudioVisual Course

    Documentation 173

    Why Render A Prognosis? Defining the Problem


    5.0

    $100.00 USD

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    • Describe the need for prognosis
    • Summarize what a prognosis is
    • Demonstrate the use of prognostic tools
    • Appraise your individual patient’s outlook for recovery.
    • Measure the progress
    • Make evidence based clinical decisions
    • Substantiate your opinion for expert testimony.
    • Illustrate the evidence for care.
    • Prescribe evidence based care plans.
    • Properly document and code complicated cases
    • Improve the patient report of findings and discharge procedures

    David Taylor, DC, DABCN, FIACN

    AudioVisual Course

    Documentation 172

    In-Processing Federal Patients: Active or Maintenance


    1.0

    $20.00 USD

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    • Recognize and document the difference between active and maintenance care
    • Use a decision-making matrix to determine the reportability of active treatment, and to be able to help the patient understand the distinction
    • Apply the Medicare standard of recordkeeping to intake requirements to establish a baseline for episodes of care
    • Determine whether routine visits qualify as active treatment when presented with new and updated complaints

    Kathy Mills Chang, MCS-P, CCPC

    AudioVisual Course

    Documentation 171

    Ancillary Services: Yes, You Have to Document Those Too


    1.0

    $20.00 USD

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    • Know how to document exactly what’s required for initial visit treatment plans including physical medicine procedures
    • Apply sample language to include in each daily visit note that will meet documentation guidelines for these modalities and procedures, including properly recording time for timed services
    • Command the mechanics of how to authenticate documentation for services provided by auxiliary team members
    • Tie the patient’s diagnosis to the treatment plan for tissue-specific, physical medicine solutions
    • Tell a complete and coherent account of the patient’s daily visit journey, outlining the crucial language necessary to justify medical necessity for all services rendered

    Kathy Mills Chang, MCS-P, CCPC

    AudioVisual Course

    Documentation 170

    Medicare and the Quality Payment Program


    1.0

    $20.00 USD

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    • Discuss Medicare’s guidelines for documenting quality measures 
    • Discuss Medicare’s Merit-Based Incentive Program (MIPS)
    • Identify and determine the eligibility requirements for MIPS
    • Identify and discuss the 4 categories under MIPS (Quality, Cost, Promoting Interoperability (PI) and Clinical Practice Improvement Activities (CPIA)
    • Recognize how Medicare calculates MIPS to determine payment adjustments

    Paul Sherman, DC

    AudioVisual Course

    Documentation 169

    Triage Your Patients with Compliant Treatment


    1.0

    $20.00 USD

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    • Compose Complete and Accurate Treatment Plans
    • Formulate multiple Standard Treatment Protocols for better compliance and efficiency
    • Differentiate patient care plans per Patient condition severity
    • Propose recommendations based on exam findings, not third party coverage

    Kathy Mills Chang, MCS-P, CCPC

    AudioVisual Course

    Documentation 168

    The Secrets of Chiro-Compliant Coding


    1.0

    $20.00 USD

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    • Utilize documentation requirements for the most commonly used CPT codes in the profession
    • Apply coding techniques and algorithms to ensure the proper code is selected to meet E/M documentation guidelines
    • Recognize the codes that carry the highest degree of risk and confirm that documentation meets the code requirements
    • Identify the mandatory elements of medical review policy for selected chiropractic codes

    Kathy Mills Chang, MCS-P, CCPC

    AudioVisual Course

    Documentation 167

    The Life Cycle of a Patients Chart


    1.0

    $20.00 USD

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    • Apply best practices for using abbreviations, addressing legibility, authentication of signatures, and managing the day-to-day flow of your patient records 
    • Clearly delineate the beginning and end of episodes of patient care, proper recording of these episodes, and boundary discussions with patients 
    • Locate and utilize the definitions of medically necessary care, and apply it as a differentiator from clinically appropriate care
    • Assess documentation across the life cycle of the patient’s chart from history to discharge and on through maintenance and wellness care based on live examples demonstrated
    • Identify the deficiencies that may be present in your documentation through the eyes of an auditor

    Kathy Mills Chang, MCS-P, CCPC

    AudioVisual Course

    Documentation 166

    Documentation and Coding of Therapeutic Activities


    1.0

    $20.00 USD

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    • Cite the difference between Therapeutic Exercise and Therapeutic Activities
    • Properly document all aspects required when utilizing timed therapy services
    • Assimilate payer policy details to ensure proper code utilization
    • Discuss common errors when documenting and billing therapy services

    Kathy Mills Chang, MCS-P, CCPC

    AudioVisual Course

    Documentation 165

    Compliant Coding and Documentation for all Chiropractic Techniques


    1.0

    $20.00 USD

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    • Recognize the varying specific requirements for documenting unique adjusting techniques in regards to compliant records and risk management
    • Properly document patient encounters for medical necessity
    • Discuss the Medical Review Policy insurers use in reviewing medical documentation
    • Review case studies and examples to identify documentation errors during self-auditing

    Kathy Mills Chang, MCS-P, CCPC

    AudioVisual Course

    Documentation 164

    Compliance with Federal Guidelines for Timed Physical Medicine Procedures


    1.0

    $20.00 USD

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    • Differentiate between supervised modalities, constant attendance modalities, and therapeutic procedures
    • Properly document the time and service for any physical medicine modality and procedure
    • Clearly define the rationale for these services within the patient's medical record

    Kathy Mills Chang, MCS-P, CCPC

    AudioVisual Course

    Documentation 163

    Documenting for Medical Necessity of Manual Therapies


    1.0

    $20.00 USD

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    • Properly document findings and recommendations around muscle therapies
    • Master the documentation necessary in daily visits to verify medical necessity
    • Identify and implement strategies the most important findings and rationale necessary to add muscle therapies to the treatment plan
    • Recognize how to differentiate between various manual therapies to meet the requirements of third-party payers' medical review policy

    Kathy Mills Chang, MCS-P, CCPC

    AudioVisual Course

    Documentation 162

    Regs and Risk Management with Maintenance Care


    1.0

    $20.00 USD

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    • Differentiate between active and maintenance care in clinical documentation
    • Execute the use of advance notice in third party patients correctly and accurately
    • Identify and implement strategies to clarify the difference between active and maintenance care in documentation
    • Recognize and adopt best practices in proper notification about maintenance care vs. active treatment

    Kathy Mills Chang, MCS-P, CCPC

    AudioVisual Course

    Documentation 160

    ICD-10: Navigating the Coding Maze


    1.0

    $20.00 USD

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    • Discuss the history of ICD-10-CM codes
    • Discuss the Official ICD-10-CM Guidelines for Coding and Reporting
    • Identify and discuss the tools needed to navigate the ICD-10 codes
    • Discuss the General Equivalence Mappings (GEM’s) and their significance and how they relate to ICD-10-CM Tabular List of Diseases and Injuries
    • Identify and discuss how to select the appropriate ICD-10 code to its highest specificity
    • Examples to be discussed

    Paul Sherman, DC

    AudioVisual Course

    Documentation 103

    Medicare Documentation - Part 2


    4.0

    $80.00 USD

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    Hour 1

    • Demonstrate the key elements pertaining to Medicare’s documentation requirements for initial and subsequent patient encounters  
    • Describe the three categories of chiropractic care covered through Medicare and the one category exempt from Medicare coverage
    • Apply Medicare’s x-ray requirements for documenting a subluxation
    • Utilize Medicare Advance Beneficiary Notification (ABN) form and its guidelines 
    • Use Medicare’s PARTS system to document a subluxation
    • Summarize the transformation of Medicare’s PARTS system utilizing the AIR S & M method               
    • Include proper Medicare documentation for daily progress notes (SOAP), in order to meet insurance guidelines and meet medical necessity 

    Hour 2

    • Integrate a 4 step approach to meet E/M (Evaluation/Management) coding requirements to meet Medicare’s guidelines

    Hour 3

    • Review Medicare Access and CHIP Reauthorization Act of 2015 (MARCA) aka Medicare Quality Payment Program (QPP) and the Merit Based Incentive Payment Program (MIPS)                                                                    

    Hour 4

    • Apply the critical components of Chiropractic Manipulative Treatment (CMT) coding and Medicare’s requirements for documentation
    • Use diagnostic codes ICD-10 (primary subluxation M-codes biomechanical lesions and secondary medical codes) to meet Medicare’s diagnosis requirements
    • Recognize Current Procedure Terminology (CPT) codes and how it relates to the Medicare system
    • Utilize Medicare modifiers   
    • Identify some of the key items with regards to completing the Center for Medicare and Medicaid Services (CMS) 1500 claim form   
    • Summarize Medicare’s mandatory claims submission policy                                   
    • Explain the five levels of Medicare appeals process
    • Distinguish between Medicare participating vs. non-participating provider requirements

    Paul Sherman, DC

    AudioVisual Course

    Documentation 102

    Medicare Documentation - Part 1


    4.0

    $80.00 USD

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    Hour 1

    • Utilize improved patient communication skills with Medicare Patients 
    • Apply appropriate risk management procedures to enhance patient communication
    • Identify the four elements of legal malpractice and recognize the key components to avoid a malpractice action  
    • Utilize key components of good documentation and record keeping
    • Integrate the legal requirements of informed consent in your informed consent process 

    Hour 2

    • Summarize why doctors are held to higher standards
    • Discuss the Do’s and Don’ts of record keeping
    • Use the 21 NCQA guidelines for appropriate medical record keeping and integrate the 3 key components of Evidence Based Practice (EBP)

    Hour 3

    • Assess Medicare’s mandatory Electronic Health Records (EHR) requirement        
    • Discuss key items related to the Office of Inspector General (OIG) reports regarding Medicare and chiropractic services
    • Summarize Executive Order issued by the White House titled reducing improper payments and eliminating waste in the Federal Programs

    Hour 4

    • Determine what triggers an audit and key items to consider if audited
    • Utilize a step by step approach to meet all Federal Medicare Documentation guidelines 
    • Summarize Medicare’s guidelines for necessity of chiropractic care and its covered services
    • Prepare treatment plans per Medicare’s regulation requirements
    • Recognize Medicare’s policy requirements pertaining to x-ray/diagnostic reimbursement
    • Determine if ordering vs. referred services meet Medicare’s policy when performed by a chiropractic physician

    Paul Sherman, DC

    AudioVisual Course