Wiki Advice needed on how to handle an external coding company

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LLovett

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I am beyond frustrated and completely at a loss on how to handle an external coding company. I honestly think banging my head against the wall would be more productive than talking with these people.

I have stacks and stacks of documented errors, they have been audited by 4 other external companys (both coding and legal consultants), in addition to the ongoing monitoring I do internally. We all say the same thing, they are putting us a risk and are not following any guidelines known to anyone, including themselves.

Here is my most recent issue. Consults are a pet peeve of mine, I follow very closely what is going on with them because they have been so high on the OIG hitlist for so long.

This company returned a coding detail sheet to us with a visit coded as a consult. It had all the patient demographics, the provider of service, date of service, ICD-9 codes, and the requesting provider was listed as "unclear". Ding ding ding, we have a problem. I respond, with out pulling the notes, if there is no requesting provider there is no consult.

They put this same info on the next report with 2 different providers listed as the requesting. I pull the note. “Due to the patient's hemodynamic compromise,intraaortic balloon pump was placed and the patient was referred to Dr. F for surgical intervention”. I respond to them again, this is not a consult.

Again this info is put on another report. I call them, go over the same info again.

Apparently the 3rd time was not a charm, they put the same info on a 4th report that I got yesterday. I am livid to say the least. I respond, quite calmly, this is still not a consult and attach all the guidelines showing what a consult is and what documentation is needed. The coding manager of this company, who is also a vice president of their organization, responds to me wanting to know why I think the consult code is incorrect. She is the one I have been going back and forth with thru this whole process. I respond with a question since my answers were apparently not good enough. "Why do you think this service is a consult? ", her response " I guess the real question is why do you think that it is not a consult?".

I have no idea how to respond to this. I know what I want to say, I think it is very obvious she has no clue what she is doing. We are trying to get this company out of the picture but they have the doctors totally snowed. I am at my wits end.

I appreciate any advice, or if someone thinks this service could be a consult please tell me how so I can see the other side. The patient was having a heart cath, 90% blockage is found, the cardiologist doing the cath called in our CVT group to the cath lab to take the patient for surgery. The PA provided the service they are calling a consult and the reason dictated is what I posted above. Surgery was done the same day.

Thanks

Laura, CPC, CEMC
 
Laura - You need to back up a little bit and just simply provide to your doctors / office manager / whomever the solid statistical data on their errors. You need to develop a rudimentary spreadsheet where you count the # of charts, the # of possible codes, and the # that are correct - similar to what you would do with a basic type of audit.
WHAT the error is doesn't have to be the focus - the focus should be their % of errors. and then you should approach it also as your time (which equals money) spent on auditing them. Doctors are all about levels of risk - so if their errors are only 5% than statistically that is pretty low and their level of risk from an audit stand-point would be pretty low. And don't forget to look at the DX codes - that is what will typically get some attention. If these coding company is inapproriately attaching DX codes than this can mess up some pretty big stuff for the patients (think pre-existing conditions) and it can also mess up reimbursment when it comes to medical necessity.
Coding isn't always black and white - and neither is medicine. So you need to offer some perspective to your doctors about how big of an issue they may be faced with because of their errors.
At minimum you need to ask for the coding companies training programs, statistics about their staff (how many are CPCs) and who audits THEM.
I hope that helps, Melanie CPC
 
Run...

On a serious note...what more can you do? It appears to me that your efforts along with the other educated reviewers have the cards stacked against you. I say this because you made the statement that the physicians have been "snowed". Are they "snowed" because they like the dollar signs that are presented to them? Or...is it that this company is so skilled at deceiving people, no one knows fact from fiction?

If I were you, I would save all your corresponding emails, record all names involved and file all your proof. RAC is just around the corner. If there is truly an issue, they'll find it. What does your "chain in commmand" say about this? Is there a medical director you can speak with to discuss your concerns? Can you by pass the VP and demand a meeting with the President of this company? If doors are constantly closed on your face...there is always the OIG hotline. If these folks aren't willing to have a "sit down" and iron out the issues...that speaks louder than words. What do they have to hide.....?
 
I agree, having been a consultant for the billing service I was appalled at what I saw going on. You need to make an onsite appearance to the billing service wherever they are located and get a first hand look, a spontaneous unannounce visit would be best. The one I worked with was providing horrible service and they were "fixing" the reports delivered to clients so the errors were hidden. They would put rejections into a pile and tell the provider that they were bundled and therefore not collectable, just anything you can imagine. I tried my best to educate and train but I was just bruised from hitting my head too many times so I finally left them to their own devices. The best thing you can do is a site visit and request to see the operation first hand and have them walk you through the process. As far as the question you asked regarding consults, it was extremely rude for her to answer with a question. I would continue to press her for her her answer, ask for it in writing and cc her supervisor as well as your physicians. The important thing to remember and remind them, is you are the client and you are in the position to make demands not the other way around. Good Luck!
 
Thanks for your advice

The doctors are the ones that "found" this company. They feel they are the only true "experts" in CVT coding.

The doctors are employed by the hospital, so none of this is coming out of their paychecks. The hospital is bowing down to them because they don't want to lose them, at the end of the day they are excellent surgeons.

I think run might be the best idea! lol. I am so frustrated, I was brought in because someone had already made that hotline call and they are under scrutiny for E/M, it is no wonder based on what I see everyday. The official error rate is 97%. It is all well documented. As it stands today, this company is not going anywhere anytime soon and I have to figure out how to play nice.

The thing that makes me the most upset is when it is all said and done they won't get in trouble because the contract states we are ultimately responsible for everything we send out.

Thanks for the support, I certainly need it!

Laura, CPC, CEMC
 
"The thing that makes me the most upset is when it is all said and done they won't get in trouble because the contract states we are ultimately responsible for everything we send out."........ ( :eek: )

I think the "press" would STOP until this is resolved. Sounds like someone has played this game before.

Laura,

You've worked very hard to get where you are...be careful (from friendly coder to friendly coder)
 
Thanks Rebecca.

The press has stopped, for now. I have not allowed any of their coding to be put thru for over a month (this is when I found out how bad it was). The problem is we continue to pay them, and they continue to code incorrectly.

If you ever deal with an outside coding company, read their contract, they all have the out clause. Or at least all of the ones I have dealt with, and actually I have dealt with quite a few now that I think about it. I've added a new skill to my bag of tricks, contract analysis!

Laura, CPC, CEMC
 
I agree with Melanie. Just keep track of the errors and report them to whoever has the authority to cancel the contract. If you need another coding "experts" opinion, I work a big national firm that does free coding audits. If you'd like their contact info PM me.
 
I'm sorry to hear your dilema - we had an outside billing service that was recommended by the accountant so in turn the physician was reluctant to act on any problems - but we convinced them by showing $ lost in their error or in experience - we logged actual accounts by showing what was being lost in revenue and it got there attention - it was alot of work & time - but it did pay off
also keep in mind that these billing services are insuranced for errors and omissions & that could be your leverage if you proceed cautiously - good luck many of us know what your dealing with
 
I just logged on after several days and after reading about your situation I can only shake my head at the ignorance of some people (this VP in particular). That is a highly unprofessional demeanor, somehow demonstrating a lack of integrity and knowledge - returning with a question is not a sign of being well informed to say the least.
Besides documenting everything and holding the error-claims, is there a Better Business Bureau where you could file a complaint against them?
Also, to get through to your doctors, how about telling them about the risk involved with bad claims, e.g, fraud & abuse and Medicare's CIAs?
If the outside firm is coding based on maximizing profit and sacrifice integrity in the process that puts the individual providers at risk as well as the institution.
Don't let them bring you down!
 
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