Session Topic

Understanding Medical Necessity and Nature of Presenting Problem

2020 Evaluation and Management Symposium: Virtual Conference

Presented Tuesday, September 22, 2020


Most of us have struggled with the different sets of the Official Guidelines for E/M services since their origin in the 1990’s. Now it has become necessary to dig deeper in the proposed changes for 2021 and evaluate the expected impact on our offices and clinic operations. Although the changes only directly affect the office and other outpatient E/M codes for 2021, they may set a trend for potential changes in other E/M codes in the future. In addition to the AMA & CMS guidelines, there are also various policies, coverage determinations and requirements that must be consider for each major payor. Join Maxine Collins on this journey to achieve a greater understanding of the proposed rules that you must be prepared for and implement by January 1. Focusing on two specific items, Maxine will present pertinent facts and explore questions regarding Medical Necessity and Nature of the Presenting Problem(s). These are very important in the process of determining the correct level of care documented for billing E/M codes 99202-99215.

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  Maxine I. Collins, MBA, CPA, CMC, CMOM, CMIS — Consultant/Instructor Practice Management Institute — Director of Compliance, Audits & Education, CoreMD Partners LLC — (Max for short)
Maxine has more than thirty years of experience in medical practice management, adult education and general business. She has taught courses at various levels, including teaching business communications and accounting at Midwestern State University in Texas. Maxine has extensive experience teaching administrative and clinical personnel essential medical office skills such as medical terminology, coding, reimbursement, OSHA, and HIPAA compliance. She is adept at personnel management, government rules and regulations, accounting and budgeting. Additionally, her experience with practice marketing and development make her a knowledgeable and much sought-after practice management resource.

Maxine has served as an administrator of a multi-specialty clinic, where she was responsible for all clinic operations including medical records, billing and collections, OSHA, HIPAA and Medicare compliance, and all accounting operations. She also has experience in medical practice consulting and has successfully launched multiple practices.