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CCPP Certification Program
Module 28: Advanced Collaborative Care Services and Revenue Integration
From Consultant to Indispensable Partner: Mastering the Language of Medical Billing and Integrated Care.
Beyond the Basics: Becoming an Integrated Health System Asset
In the previous module, you laid the essential groundwork for your entrepreneurial journey. You learned how to craft a business plan, price your services, and build foundational revenue streams through both direct-to-consumer and basic collaborative models. You have successfully transitioned your mindset from that of a clinical employee to a business owner.
This module is designed to elevate you to the next, and most advanced, level of practice: deep integration. To become a truly indispensable and highly compensated partner in the healthcare ecosystem, you must move beyond simply providing services “incident to” a physician and begin operating as a fully integrated clinical and financial asset to their practice. This requires a new level of fluency in the complex languages of medical billing, coding, and advanced care models.
We will deconstruct the sophisticated billing codes that drive primary care revenue, including Evaluation and Management (E/M) and Behavioral Health Integration (BHI). You will learn not just what these services are, but how to seamlessly embed your expertise into the physician’s workflow to optimize them. We will master the nuances of revenue cycle management and explore scalable legal frameworks like Collaborative Practice Agreements. By the end of this module, you will have the knowledge to transform your consulting practice from a valuable service provider into a strategic revenue-generating partner for any medical group you work with.
Your Roadmap to Advanced Practice Integration
This module provides the master key to unlocking the most advanced, and lucrative, opportunities in collaborative care.
Understanding CCM, TCM, and PCM Distinctions and Synergies
A nuanced exploration of the key care management codes. We will go beyond the basics to master the subtle but critical differences between them and learn how to strategically stack and sequence these services for a single patient to maximize both clinical impact and revenue.
E/M Coding and Pharmacist Integration into Physician Workflow
A deep dive into Evaluation and Management (E/M) codes, the lifeblood of primary care billing. You will learn how your clinical work—medication reconciliation, patient histories, and complexity analysis—directly contributes to the level of E/M service a physician can bill, and how to structure your services to become a revenue optimizer for the practice.
Advanced Care Planning and Behavioral Health Integration (BHI, G-codes)
An exploration of two critical, yet often underutilized, service lines. We will break down the CPT codes for Advance Care Planning and the G-codes for Behavioral Health Integration, providing a playbook for how pharmacists can lead these vital—and reimbursable—conversations and care models.
Revenue Cycle Optimization and Collaborative Billing Models
A masterclass on the business of healthcare billing. We will cover the entire revenue cycle, from eligibility verification to claims submission and denial management. You will learn how to “scrub” claims, analyze remittance advice, and structure sophisticated billing partnerships with medical practices to ensure you and your partners are paid appropriately for your work.
Using CPA and CBA Templates for Real-World Implementation
A practical, hands-on guide to the legal frameworks of advanced practice. We will provide and deconstruct templated Collaborative Practice Agreements (CPAs) and Collaborative Business Agreements (CBAs), giving you the tools and confidence to formalize your partnerships and define your scope of practice in a compliant and scalable way.
