Wiki Raising Coding Awareness to our provider network

[leannm21]

I am a medical coder at a health care plan and my project right now is to come up with a plan to raise awareness of our provider network in diagnosis coding.

I have a few questions that if you could shed some input on would help us as a health care plan relate to our provider network.

For the coders working in the provider offices:
What would be one piece of information you would like to know from a health plan?
What are a few questions you would like to ask a health plan relating to coding practice?
What outcome would you want to see if I were to come into your office to provider awareness on this ever changing and sometimes confusing world of diagnosis coding (icd-9), or any coding set?
Do you know what quality measures are?

Also, as a coder in a facility what do you think the most effective way to approach a practice would be?

I am trying to connect with our providers and turn this into a partnership and not just a 'training' session I want them to know that I am here to support them and help with their coding needs.

Any feed back would be much appreciated!

Thank you!

 

[Pam Warren]

I would want to know who the person is that I can speak to who understands correct coding and payment policies for all your plans. Customer service reps read from a menu, and provider relations people don't have that expertise. I'd like to ask if you follow Medicare guidelines. Do you use CCI or McKesson edits? Do you accept G codes? Other temporary codes? I would want to be sure that you understood the AHA Coding Clinic and didn't expect us to code for patient satisfaction (payment). I understand the concept of pay-for-performance, but wonder how payers are going to adjust pament based on the non-compliant patient, or based on coverage issues that prevent and interfere with clinically-sound treatment that are responsible for poorer patient outcomes.I know that coders in private practices are overworked, underpaid and often don't have the resources for continuing education. That doesn't make them bad coders, but it makes it that much more difficult for them to get the information they need to code correctly. Offering support (and CEUs) from the payers would be a breath of fresh air. Patients are just as dissatisfied with their insurance (even more so) than they are with providers. How about lending some clarity to claims adjudication. Coding and claims submission should be consistent across all payers. It shouldn't have to be a guessing game.

 

[leannm21]

Thank you

Thank you so much for your feed back. This is exactly what I am trying to give our private practices a resource, through myself and my team of coders that will be giving support training and help with all their coding needs. It is something that no other (that I know of) health plan provides. And hopefully this will be the stepping stones for other plans to follow. Again thank you for your wonderful feed back.