Online Training Course

Prod ID: 318
Medical Necessity and Nature of Presenting Problem

Join Maxine Collins on this journey to achieve a greater understanding of the rules that you must be prepared for and implement by January 1, 2020. Focusing on two specific items – Medical Necessity and Nature of the Presenting Problem, Maxine will present pertinent facts and explore questions regarding these essential factors in E/M Coding. These are very important in the process of determining the correct level of care documented for billing E/M codes 99202-99215.




90 min



This session addresses pertinent facts about Medical Necessity and Nature of the Presenting Problem that are critical for determining the correct level of care documented for billing E/M codes 99202-99215.

Maxine Collins


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.

Maxine holds a MBA in business from Midwestern State University. She is also a Certified Public Accountant and holds three PMI credentials.

Clinical and non-clinical medical office staffs will benefit from reviewing this session to be informed of 2021 evaluation and management guideline changes and understand the impact for proper doumentation and billing for office and outpatient services thereafter.

Providers and medical coders have struggled for years with the Official Guidelines for E/M services, ever since their origin in the 1990’s. In 2021 some of these guidelines will change. Now is the time to thoroughly review the details on these changes and evaluate the expected impact on your 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.


  • Medical Decision Making vs Time
  • Modifications to MDM criteria
  • The role of history and exam in 2021
  • Medical necessity for preauthorizations
  • Impact of carrier claims processing edits

Self-paced online program includes unlimited review of previously recorded instruction and the downloadable PowerPoint handout for 6 months.

Comments from past participants who reviewed this training program:

"Amazing sharing of knowledge!"

"Maxine did a great job of going into detail about how to research and prepare for the upcoming changes."

"Excellent! This webinar was very informative in regards to medical necessity issues."

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