Practice Management Alert

So, you've performed yet another internal audit and are still finding the same documentation, coding and billing errors. What can be done to make it easier for you and your physicians to communicate necessary information quickly and efficiently?

"It's education, education and more education," says Lorraine Goupee, CPC, CMA, professor for the Health Information Technician and Medical Assistant programs, Duluth Business University, Minnesota. "Policies and procedures are constantly changing. For example, E/M documentation requirements for some payers have increased for higher-level office visit codes."

Many physicians are unhappy about supplying the extra documentation to warrant the use of level-four and -five E/M codes, and some are even insulted because they feel the diagnosis is self-explanatory. "However, we have been noticing an increase in level-four and -five denials as well as downcoded claims. Therefore, there is a problem and we need to figure out how to communicate the importance of this to our physicians," Goupee says. "One reason for the increase in denials is that many private payers have increased their staff of reviewers. We need to prepare."

Because physicians learn best when you provide empirical data, you should conduct periodic internal audits on outgoing claims. Take documentation from several charts and review it. Code the documentation separately without looking at the billing. Then compare what the audit revealed to what was billed. If you find that the claim should have been downcoded, then you owe the insurance company money. "You can use this as an opportunity for education and review the results with the physician to help make the guidelines clearer," Goupee says.

If you find that you have a trend in underdocument-ing, then all E/M codes should be held for complete documentation and reviewed before a claim is released.

Education on guidelines must be current to ensure everyone is up-to-date. Randomly quizzing staff on the new changes can suggest who has read your update. For example, ask, "What's your opinion on the new MRI codes?" This is a casual way of finding out whether the memo was read, Goupee says.

Address the changes in a memo to physicians. One of the keys to making sure physicians read the new changes is to keep written communication short and include bullet points and/or highlighted sections. This makes it easier to scan. If you have different-colored fonts on your computer, use them to section out portions of the notification. For example, use red for new codes and yellow for deleted codes.

"You should follow up on the memo with a one-on-one meeting between the 'trainer' and 'trainee' especially if a pattern of denials is showing up," says Catherine A. Brink, CMM, CPC, president of Healthcare Resources Management Inc., a practice management and reimbursement consulting firm in Spring Lake, N.J. She believes that, unless it is an exceptionally large practice, the one-on-one meeting is the most effective and efficient way to get the message across. "You're not wasting the time of those who have no problems with the changes," she says.

Educating the physician is an ongoing process of memos, meetings, prospective audits and so on. Brink extracts the practice-specific information and summarizes it in what she calls a "nutshell" memo that the physicians initial. The biller writes the memo to inform physicians and other staff of coding and billing change, payer especially Medicare updates/changes and specific requirements. "I used to put it in the folders for them, but they may not read it, so handing it to them is more practical," she says.

The use of a signature form on memos, news bulletins and especially the Medicare Part B newsletters is essential to ensure that everyone has seen the changes. The signature form, which has names of all members of the staff and requires their initials stating they read the information, is a good backup to make sure the circulation of the information is complete.

Brink recommends dinner workshops where physicians and coding and billing staff systematically review coding changes and discuss problems that audits have revealed. Coding changes should be reviewed based on timeliness and priority of implementation.

The dinner workshop is especially effective for smaller practices because it helps to develop relationships among the coders/billers, auditors and physicians. Getting away from the workplace has additional advantages including fewer interruptions and a less-structured atmosphere. The best location is a small conference room where dinner can be catered at a time that suits the agenda.

Larger practices may find the dinner too costly, but setting up training sessions can still be accomplished off-site at a reasonable cost. There are many community centers, conference rooms in libraries, or even some churches that are viable places to conduct training.

Goupee says their monthly training sessions are scheduled after hours, usually lasting about one hour. The important factor is to have a thorough agenda and get through it in a timely and professional manner. Everyone wants the information, but they are also busy and don't want a meeting or training session that doesn't accomplish its goals.

Brink says the training efforts should be documented in the physician file folder. "The notes don't have to go into detail a synopsis should be sufficient," she says. The physician file folder should contain copies of all correspondence, signature sheets and documented conversations with the physician.

Another important factor in the education process is going over the achieved improvements. Feedback is important in any education process. "Everyone coders, billers and physicians likes to know that they are improving their skills," Brink states.

Goupee adds the specter of competition into the equation, to show who is really interested in improving coding knowledge, by posting the names of the attendees of the training classes. And she gives out certificates, which are displayed at the work areas of those who have completed the training. There are many ways to show that improvements have been made and to demonstrate appreciation that the training sessions are being taken seriously. It doesn't matter whether it's just a note on the desk with new updated statistics or the physician's favorite candy bar and a "thanks for the improvement" note, because it is the effort that counts. $ $ $