Get Physicians Involved With APC Preparation

Not all facilities have good working relations with their physicians, but ambulatory payment classifications (APCs) will push the issue in every American hospital and clinic. The new billing and coding regulations will force cooperation between many groups of professionals who often dont work together.

Physicians arent technically a part of the APC coding process, but the new outpatient prospective payment system will require them to face more stringent expectations from facilities, says Sue Mote, CPC, director of operations and reimbursement services for Healthcare Practice Enhancement Network, a consulting firm in Los Angeles.

Perhaps the biggest issue for physicians under APCs is coding consistency. If a physician codes a medium-level visit, does that obligate the hospital or clinic to bill at the same level, even if the facility would rank the visit in a vastly different way? No one knows for sure, Mote says. However it turns out, it will help coders if they understand why physicians choose the levels they do.

Doctors Responsibilities

For most physicians, the new Medicare reimbursement system will mean significant changes in their daily routine, Mote says.

1. Doctors will have to deal with hospital staff members from many different departments on a regular basis as the facility changes the way it processes information and works to improve every facet of the recordkeeping process. Coders and staff from health information services should be checking on physician documentation. If there are some inconsistencies, it could raise red flags in the future, Mote says. That could attract everyones attention. This may affect physicians in the end, too, if the Health Care Financing Administration (HCFA) starts looking at the consistency between them and the hospitals.

2. Physicians should be thorough in their dictation of operative reports and documentation in general, says Pat Goebel, director of clinical information services at Jennie Edmundson Hospital in Council Bluffs, Iowa. In dictating operative reports, surgeons must be sure that their documentation is complete and concise. It should include a title that reflects all of the comprehensive pro-cedures described in the body of the report and specific information needed for choosing the most accurate code.

3. New doctors, particularly those in specialties new to the hospital, should consider providing an in-service seminar to prepare coders for the special attention that needs to be given to the physicians documentation, Goebel says. Such front-end consultation with coders could prove helpful any time a facility brings in new technology or starts offering new procedures.

4. Physicians will be held accountable for the details about patients visits that never attracted much attention from the facility in the past. Therefore, their operative reports and case notes must be thorough.

5. Doctors may be expected to become more efficient in their use of resources. Hospital executives concerned about cutting [...]

- Published on 2000-05-01