In this course, participants will gain a comprehensive understanding of the Primary Care Exception (PCE) in the context of Medicare reimbursement for medical services involving residents. This course delves into the definition and requirements of PCE, covering essential topics such as the types of services included, conditions that must be met, and the specific reportable E/M and HCPCS codes applicable to PCE services. Participants will also explore modifiers, organizational impact, and the significance of accurate coding in maintaining a practice's financial health and legal compliance.
Included Lessons:
What is a Primary Care Exception (PCE)
Definitions
Services Include
Conditions that Must be Met
Reportable E/M And HCPCS Codes for PCE Services
When PCE Criteria is Not Met
Modifiers
Organizational Impact
CEUs available for the following credentials:
AAPC
COC, CPC, CPC-P, CEMC, CFPC, CPB, CPPM
AHIMA
CCA, CCS, CCS-P, RHIT, RHIA, CDIP, CHDA, CHPS
Key Takeaways
Understanding of PCE: They will have a thorough understanding of what the Primary Care Exception (PCE) is within the context of Medicare reimbursement.
PCE Eligibility Criteria: Knowledge of the specific conditions and eligibility criteria that must be met for a medical service to qualify under PCE, including the approved residency program and the role of teaching physicians.
Types of Services Covered: Familiarity with the range of medical services covered under PCE, which includes acute care for undifferentiated problems, chronic care for ongoing conditions, and coordination of care across various specialties.
Coding Proficiency: Proficiency in identifying and assigning the appropriate reportable E/M (Evaluation and Management) and HCPCS (Healthcare Common Procedure Coding System) codes for PCE services, including new and established patient visits and Medicare wellness visits.
Modifier Usage: Understanding when and how to apply modifiers like GE and GC to indicate whether a service was performed independently by a resident or under the direction of a teaching physician.
Organizational Impact: Awareness of the financial and legal implications of PCE on medical practices, including how it may impact the ability to apply higher-level codes independently.
Benefits of Taking this Course
Deeper Comprehension of PCE Rules and Regulations
Increased Accuracy
Career Advancement
Expanded Knowledge
Competitive Edge
FAQs
What is the Primary Care Exception (PCE)?
The Primary Care Exception (PCE) is a Medicare provision that allows teaching physicians to bill for lower and mid-level Evaluation and Management (E/M) services provided by residents without a face-to-face interaction between the teaching physician and the patient. It is designed to support the education and training of residents while ensuring appropriate reimbursement.
What types of medical services are covered under PCE?
PCE covers a range of medical services, including acute care for undifferentiated problems, chronic care for ongoing conditions (including chronic mental illness), coordination of care furnished by other physicians and providers, and comprehensive care not limited by organ system or diagnosis.
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