Extra Responsibilities Under APCs

Q Many people believe that coders will get extra job responsibilities after APCs take effect. What kind of duties might be added to the average facility coder's job description?

Oregon Subscriber

A Coders may find themselves responsible for ensuring that all charges are identified so that coding can be completed in a timely manner to reduce the incidents of late charges. Under APCs, all charges must be reported together to allow Medicare to accurately convert the total package of services to the appropriate APC level. Therefore, a charge checkpoint will need to be established to avoid losing any part of the service.

Coders also might find themselves responsible for creating some form of exception report to generate feedback to providers when documentation is deficient. These documentation review forms are invaluable in helping to identify documentation problems and provide quick and efficient feedback to physicians, physician assistants, registered nurse practitioners, and nurses to help them improve the documentation necessary to code at the level of service performed.

If we all agree that the level of medical decision-making illustrates the true level of service provided, then exception reports might be issues when the history and physical exam level fall below the level of medical decision-making indicated on the record.

Because accurate identification of nursing levels in the outpatient facilities will be a major determinate of the level of service billed, nurses will need assistance in developing progress notes and various other tools to assist them in completing their portion of the record. In addition, better documentation of supplies and medications will facilitate better identification of these services for those providers that will continue to pay on charges, not under the prospective payment methodology.

For Medicare, even though supplies and medications will be bundled into the APC payment level, it will still be necessary to accurately track use of these materials to ensure inventory controls and accurate identification of general cost/charge/payment ratios across all payers.

Source for Reader Questions: Caral Edelberg, CPC, CCS-P, president of Medical Management Resources an emergency department coding consulting firm in Jacksonville, Fla., and Sue Mote, CPC, director of operations and reimbursement consulting services for the Healthcare Practice Enhancement Network Inc., a healthcare management consulting firm in Los Angeles.

- Published on 2000-06-01