Pulmonology Coding Alert

Question: As the office manager in my practice, I am often stuck in the middle between the physicians and the billers, but I’m having trouble getting them to connect personally. For instance, the biller will tell me the doctors aren’t being thorough enough with their documentation so they’re having to down code claims, but when I report it to the doctors, they tell me to educate the billers on reading documentation better. I feel stuck in the middle — is there a solution here?

Codify Subscriber

Answer: As the office manager, you are in a tough spot to be stuck in the middle, but you unfortunately have to insist that the two parties forge a better communication system, and you will probably have to be the central figure that has to make it happen.

Because both the billers and the doctors are probably very busy, you might start with a face-to-face meeting after hours where you work with them on the major issues that your practice is facing. Share the documentation that the physician submitted and have the billers explain what’s missing from it that precludes them from reporting the codes that the doctor circled. Have the physician offer his thoughts on why he believes his documentation supports his coding selections, and moderate the back-and-forth between the two parties so they understand each other’s position.

If that goes well, follow-up meetings can probably take place quarterly, with any issues in-between taking place over email or the phone, since at this point the doctors and billers have hopefully developed a rapport. If they haven’t, then you should follow that first meeting with additional biweekly or monthly face-to-face get-togethers, and not move toward quarterly meetings with email supplements until the rapport is established.

Both the billers and the doctors should bring materials to the meetings that will help the other group see their side of things. For instance, the billers might bring a case study showing how a physician’s poor documentation led to down coding a claim and forfeiting $120. The doctor might bring a list of acronyms that he uses in his documentation to help the biller more accurately read it.

The key is opening the lines of communication so the issues will be quelled in the future.