Reader Question: Restructuring Departments

Question: I know Im going to have to modify the flow of billing and coding information after ambulatory payment classifications (APCs) take effect. What are some ways I could restructure my departments to make the most of the personnel I have?

Wisconsin Subscriber

Answer:The size of the department, the volume of records to be coded, and the experience and training of your coders are all issues that must be addressed in a restructuring effort. Individuals involved in the APC coding and billing process should, at the very least, receive some level of in-service on the APC system and the effects it is expected to have on their area of responsibility.

Coders will need to be aware of how their coding translates into the actual APC and payment. Most important, they will need instruction concerning how to best assign HCPCS codes to reflect the highest level of service documented in accordance with Medicare coding rules.

Many hospitals have considered outsourcing the emergency department and outpatient coding to ensure a smooth transition and minimize financial losses that may arise because hospital coders have limited experience with these kinds of codes. Other facilities are bringing in educators to train hospital coders.

If you consider these outsourcing options, be sure that the individuals you select have experience and expertise in the areas you outsource to them. You should check their credentials and interview other facilities that have used their services to ensure they can do the job as promised. Then you can use your coders to focus on the remaining departments while learning more about the emergency department (ED) and outpatient coding process.

- Published on 2000-07-01