Solutions for Common Pain Points in Facility Coding

Today's presenter is Melinda Craig. Melinda serves as the director of coding services for AAPC. Melinda has over twenty years experience in the health care industry working closely with providers and staff within the health information management department. She has worked in a variety of settings, including acute care hospital, inpatient rehab, physician practice, home health, and hospice, and education.

Prior to, her work with AAPC Services, Melinda worked for a large multi-facility organization overseeing all aspects of coding as well as managing products from start to finish. Some notable projects include the transition from paper to electronic records as well as the transitions and implementation of software products, including encoders, CACs, and charging modules. During this time, Belinda also standardized and approved coding processes between multiple facilities, achieving best practices for all. In twenty nineteen, Melinda was a contributing member to our team, that was awarded the Grace Award.

Throughout her career, Melinda is known for challenging the status quo and building strong confidence teams.

Also on the call today is Stephanie Scott, AAPC services vice president.

She's gonna be here to answer, some additional questions and monitor the chat. And with that introduction, I'm gonna turn the time over to Melinda.

Thanks, Cordell.

We'll go ahead and get started with the agenda for today.

It's pretty brief, and we'll try to go fairly quickly through, the pain points because we basically have a general idea of what those are. And then I'll try to spend more time on the strategies and solutions for those pain points. And then like Cordell mentioned, if we have time at the end, we will, open it up for some QA q and a.

Next slide. There we go.

Alright. So we're talking about pain points. Right? So why would I put codes up here? Well, because there are so many of them. Each code set has vast number of codes to cover every possible medical condition and procedure and each variation of those conditions and procedures.

All those codes are constantly being updated, changed, and revised, not to mention adding new codes incorporating, the new diseases, the treatments, and technologies. So codes themselves can be a pain point.

Detailed documentation requirements. The list shown here is just a brief list of the various documentation requirements.

But with that, how many of you have started seeing or been seeing denials due to using unspecified codes or the codes are correct per the documentation that you have, but the documentation being is being reviewed, or denied for lack of medical necessity or for clinical validation.

Cordell just put up a interactive poll for you guys. So if you could answer that, we'll give it a second, and and we'll see what your results are.

Alright, Melinda. We're just about at sixty percent, response, so I'm gonna go ahead and just share the results.

Okay.

Yes. Okay. This is pretty much what I expected to see, in my last, prior to me coming to the AAPC, we had started seeing, some of those very same denials.

You know, we know back in two thousand fifteen when when ICD ten first first came out that that we were told they're going to be denying based on unspecified codes. And, and a lot of times, it's it's more so the documentation issues that, you know, the providers aren't writing left or right or acute or chronic or whatnot. So, I'm glad to see that you're I mean, I'm not glad to see, but, it it seems to be pretty standard now that that everybody's starting to see kind of the same things.

Alright. We'll move ahead on to the next slide. Thank you.

So not only are there the frequent code changes, but then, of course, there's the guideline changes, payer specific changes, updates with coding clinics or CPT assistance. And when those updates with coding clinics or CPT assistance come out, those likely change our mindset on how we've been assigning codes or how we're assigning codes. So it's really hard to keep up.

And then, of course, there's audits. Let's talk audits. Good audits, bad audits. You name it. There seems to be an audit for it.

Rack audits.

Does anyone still have accounts out there waiting on the ALJ to review, or did you end up settling or take minimal payment, when we had that big backlog?

Do you have a denials team, a team to review the denials, write appeals, following up on them? And then, of course, you know, maybe you don't have a denials team. Again, we're talking pain points.

Maybe a pain point is you need people. You need people to be that denials team.

Human error. You can avoid it.

Even the best of the best still make mistakes, and it's known to error as human.

According to the British Journal of Anesthesia, for discrete work related tasks, workers average one error every one thousand to ten thousand accounts.

And a safety transcript from Los Alamos National Laboratory states, everyone makes mistakes. An average of five mistakes each hour. And most of the time, we aren't even aware that we make these mistakes.

And inconsistent documentation. I mean, everyone has the most perfect provider documentation ever. Right?

I think you're all just laughing. Just kidding.

Providers are humans as well. So we know from the facts just mentioned that they're going to make mistakes too.

I read an interesting article that said something about multitasking doesn't really happen, that it's physically impossible to do two things at once, that our brains can only do one thing at a time. Our brains can get super fast at switching between multiple things, so it may give the illusion that we can do more than one thing at a time, but we actually can only do one thing at a time.

Anyway, just going to say that providers are are humans as well, and they try to multitask the best they can, but it's it's it's challenging.

Anyway, some documentation related pain points that I've seen over time include the incomplete documentation. It's just not finished.

No signatures on their documentation, so the coders can't necessarily code from it.

Conflicting documentation.

Maybe one place in the record it says left and the others place in record it says right.

A consultant may say one thing, and then the attending provider might say something totally contradictory or provider saying history of when it's actually maybe a current condition that's being treated.

EHRs are great. They streamline everything and everyone, and it makes us all more efficient.

But have you ever had an outage or downtime or worse, unexpected downtimes, updates that end up breaking your workflow and fixes need to get put in, or upgrades that feel like downgrades.

Most recently, I think everybody's well aware of the crowds CrowdStrike software outage that, unintentionally took tons of businesses out. I I mean, technology is great, but it can also have its pain points as well.

IT resources or good IT resources are just about as hard to find nowadays as good coders are.

Almost everything we do requires some form of IT support. And this can be a huge pain point if you're wanting or needing to make a change to your technology, but maybe you have to get approval or it has to get put on the list and be prioritized before it can be completed?

Or how many of you have been told, oh, I can do that, but you need to put in a ticket first?

An interesting fact that I found while doing some research, according to the Black Book research, IT the IT managed, service sector alone accounts for sixty billion, and this was in two twenty twenty three.

Sixty billion dollars mainly to support EHR systems, maintain the help desk, and sustain, IT infrastructure.

Training new coders takes time.

Lots of time and, of course, resources to do it. It's a huge balancing act or can be a huge balancing act, especially if you don't have a specific training or education team. You generally have to pull your best coder to train the new person. And when you do that, obviously, your best coder is not doing production coding work.

Coders need ongoing education to keep up with those coding changes.

It isn't a secret, but it's hard to fit in when you have, AR and excuse me. AR and backlogs and training new colleagues to all worry about. If you have a smaller facility, you may lack the resources to be able to do this. You may have to consider outsourcing or, have a consultant come in to assist, and outsourcing can be great to supplement, be a great supplement to your team, whether it's for ongoing support or clearing out backlogs.

That being said, when you consider outsourcing, be sure to thoroughly vet the potential vendor. Ask specific questions, especially about whether or not they have certified or credential coders, or better yet, if all of their staff are certified. It can be common for some of the BPOs out there to have a couple credentialed coders on their team, and then all the rest of all the rest of their coders be noncredentialed or, or new grads that don't have actual real life experience.

At AAPC, all of our coders that are in the coding services division, are required to have at least one credential and five years of experience.

A question that I get asked often by clients or potential clients is, what's your productivity standards?

And oftentimes, the answer is, it depends. It depends on what the coder is doing or is expected to do.

A few months ago, I wrote an article that was published in the AAPC magazine, about coder productivity and, coder productivity and coding productivity, and there is a huge difference.

So when folks ask this, it's it's really challenging to answer. Is the coder just doing straight coding, which is your coding productivity? Or are they abstracting? Are they validating department charges? Are they correcting charges?

Are they doing claim edits, working denials, collaborating with CDI, querying physicians.

How's the documentation? Are the coders assigning chart deficiencies or, record record deficiencies?

All that can affect the productivity and the efficiencies, of the coders.

All more pain points.

Interdepartmental coordination. Communication gaps. Nobody has this problem. Right?

If you don't, that's fabulous. But oftentimes, we see see these types of interdepartmental gaps. Oftentimes, information is not conveyed clearly, and it can lead to misunderstanding and errors.

There may be ambiguous instructions that can result in confusion about roles, responsibilities, and expectations.

We have an overreliance on emails. I mean, how many of you will have around a hundred new emails waiting for you after you finish this webinar if you haven't been multitasking during it?

Important messages can get buried in those email threads or lost in your inbox.

Inconsistent messaging.

Different departments may receive different versions of the same information, again, leading to inconsistency or confusion.

Employees may feel their ideas or or concerns are not heard, leading to more frustration and disengagement.

Diverse teams could could face challenges in understanding each other simply due to cultural or language barriers.

And a lack of strong leadership can result in poor coordination and accountability.

Managers may not effectively communicate the importance of, interdepartmental collaboration, especially if they're siloed.

Departments that are siloed tend to operate in isolation and prioritize their own goals versus, working towards the common organizational objectives, and that can oftentimes result in a lack of cooperation or sharing of the critical information that's needed.

Processes and workflows may not be well integrated across departments, leading to delays or redundancy, the same person doing the same or different people doing the same work, and not realizing it.

Technologies can be different in different siloed departments as well, or they might be incompatible.

And then on standardized workflows, when everyone's doing their own thing, it's extremely difficult to track and manage.

It's usually very helpful and more efficient to to standardize those things where possible.

It it feels like as though denials are happening for almost any reason nowadays.

Sometimes it feels like, a payer will deny a plane a claim just because they can.

According to AHIMA's best practice brief, there was a study done in November of twenty twenty two.

It was conducted by a rev cycle analytics company found that the initial denial rate for over seventeen hundred hospitals had reached upwards of eleven percent.

It's pretty significant.

And although timely and costly, organizations that view denials as learning opportunities strengthen their ability to successfully appeal, and reduce future denials.

If the various stakeholders can get together, collaborate, and determine that a denial is legitimate, they can perform a root cause analysis and, try to correct the root of the problem.

Denials can be very helpful in identifying knowledge gaps, not just for coders, but for clinicians as well.

And financial implications. All the pain points that we've talked about so far cost money, or they could easily be solved if money wasn't a problem.

Right? Respondents to the Black Book at Market Research's twentieth annual outsourcing service survey revealed some interesting statistics that I'll share with you guys here today too. According to, eighty seven percent of administrators, smaller hospitals' cash flow problems make outsourcing the only viable option for certain services.

Ninety three percent of hospital leaders report having intensified their strategic planning efforts to employ more third party vendors for cost efficiencies, allowing hospitals and physician groups to focus on their priorities of, you know, improving other priorities, improving patient access, replacing old equipment, bettering their profit margins, and, you know, you know, improving their technologies.

Fifty five percent of hospitals and seventy nine percent of physician organizations, are expected to lose money this year. Outsourcing appears to be a growing solution for many of them, with with estimated cost savings between twenty seven and sixty four percent.

And then another interesting trend that I've started to see, is that many organizations that were previously opposed to offshore vendors are now starting to change their internal policies, to allow for offshore works in efforts to to realize some of the cost savings that can happen there.

Alright. Now that we've talked about a lot of the pain points, we'll move on to the strategies, and solutions for some of these pain points.

This slide is probably the most important slide or in my opinion, investing in training, investing in your people, investing in in everybody.

In a previous slide, we talked about denials and appeals.

Invest in time.

Time, I can't say it enough. I can't emphasize it enough. Time. Give your coders time. Allow your coders some time, extra time to be able to learn from the denials.

Build time into your productivity standards so they don't feel rushed.

If they are feeling rushed, it could result in missed query opportunities, lack of attention to their coding guidelines, their conventions incorrectly, assigning POAs.

I know it's difficult, but it's necessary to find that nice balance between efficient coating and high quality coating. And those the coders need to need to be able to have a little bit of time for some of that learning.

Have regular training sessions and professional development for those coders to keep them updated on their latest on the latest coding standards and changes and technologies.

We all know the health care industry is highly regulated, and staying informed about changes in the laws and regulations is critical.

Coders that stay up on these can help ensure that the organizations remain compliant and potentially avoid costly legal issues down the road.

Again, we all know that accurate coding is essential for proper billing, which directly impacts the financial health of all the healthcare facilities and reduce the risk of audits and penalties.

A study that was published by the Journal of provide CEUs or opportunities for your coders to provide CEUs or opportunities for your coders to obtain those CEUs.

If your organization is willing to purchase these for these coders, it can be a major, coder retainer.

CEUs can get very expensive for the individual coater, especially, you know, most coders need anywhere from twenty to fifty CEUs, in their in their recredentialing cycle. So, that can be a huge, huge quota retainer for your organization if if you're willing to provide those to your staff your coding staff.

Money is the root of all evil. Right? Everything we talked about here is expensive and cuts money.

But does it really in the long term? You know, upfront, it can be a huge expense.

But in the long term, if you invest in your people and their continuing education, they'll likely save you money in the long run by not having as many errors and getting things, and they'll get things right the first time around versus having to rework things or having things done multiple times or reviewed by multiple people.

So it it does seem like a huge expense upfront. But, again, think about, is it really that huge of expense if they're getting things right the first time?

Finally, with the people, strong leadership. This was discussed in a previous slide as well.

However, I feel like it's worth mentioning again.

Invest in developing and training your leaders. It's crucial to have leaders that are willing to collaborate with other leaders.

Leaders that are willing to educate, share knowledge, and hold their team accountable. So don't don't just invest in your coders, but invest in your leaders as well.

A recent a recent Gallup poll of more than one million workers concluded the number one reason that people quit their jobs is a bad boss for an immediate supervisor.

Along the same lines, an article in CWL's Business Transformation stated, we've learned that seventy five percent of workers who voluntarily leave their jobs do so because of their bosses and not to position the role or the company itself.

So, again, I just wanna double, triple, quadruple emphasize that invest in in your coders, in your people, and your leaders as well.

Excuse me. Staying informed about advancements in coding software and electronic health records is also crucial.

Coders who are proficient in the latest technologies are are more efficient and can handle higher volumes of work.

And they can do that the greater the higher volumes of work with greater accuracy.

Another study that I found by Black Book Market Research, which is becoming one of my very most favorite research study sites, found that health care, providers that adopt advanced health IT solutions, including updated coding software, see improvements in revenue cycle management and operational efficiency.

Encoders can help the coders find find their codes more quickly.

EHRs, obviously, they have edits built in, or you can have l edits built in to help your coders with their accuracy, with, you know, combo codes or assigning codes that that, you know, can't or codes that can't be assigned together and so on and so forth. CACs can speed up the coding process by pre reading the record and suggesting codes for, to help the coder out. And then, of course, AI.

AI is the big talk now. You can't go anywhere without AI. Even watching the Olympics, Google's new Gemini thing, all AI out there. But, again, AI is making coders more efficient as well. Essentially, kinda turning the coders, kinda like CAC did when that was first introduced several years ago, turning them more into auditors. But, leverage the technology that you have out there or look into those, different technologies. There's so many products out there to help the coders be more efficient.

AAPC offer also offers various software solutions to help the coders out too.

That can simply be found on our, on our website as well.

And then going back to when we talked about siloed departments, if your billing department is using a software that's different from your coding department or your HIM department, or your coders and CDI are on different platforms, look into standardizing, and getting them all on the same platform.

The critical teams all kinda it's helpful and more efficient if the the critical teams are all on the same using the same systems. And many of the latest technologies integrate integrate right into the EHRs.

Or if they don't integrate, they can communicate with your EHRs, making the work flow seem a bit more, seamless and streamlined.

Encourage thorough and accurate documentation practices among providers, through training and clear guidelines.

Provide real life examples of how a chart is coded with poor documentation.

And then using that same example, beef up some of the documentation and recode it. And then actually show the providers the differences in, how they code how the original record is coded and then the beefed up documentation record is coded and actually share with them the differences. But when you do that, be careful, that you don't wanna give off the wrong vibes, and you don't want them thinking it's all about money. So so really be careful with how how you do this.

It needs to be more about the enhanced patient care and the advanced document the better documentation. We all know that the providers are giving the best care possible, but a lot of times their documentation doesn't necessarily support that or reflect that. So we know they're doing it, but they need to document it. And just it often helps to show them their original CDI do a really great job at CDI do a really great job at bridging the gap between clinical and coding information.

Find a physician champion.

You need physician buy in for for a strong CDI program. This person needs to be a respected physician that understands the goal of the CDI program.

He or she can help promote the program to their peers and act as a liaison for some of the more challenging providers.

Some providers are more likely to listen to information if it's received from a peer rather than from an HIM director or a coder or CDI or an RN.

And then again, I'm gonna mention it leveraging the technology.

I said it before. I'll say it again. Give the code the CDI the same or similar tools that the coders have.

I know they're not necessarily coders, but they do a lot of coding to perform their job. In addition, give them the clinical documentation tools. There's lots of CDI programs out there, that or software out there that will help give the CDI team indicators or prioritize the records that need help or could potentially add value to the organization, and make streamline their work if, if if is just overwhelming.

There's a lot of high volume and whatnot.

And then accountability. Provide hold your providers accountable.

Look at your provider suspension or privilege relinquishment process. I know it's kinda changed names over the years of what what we call that. But do the providers have consequences in your organization for not completing their documentation in a timely manner?

Or have they learned that they might just keep getting warnings warning letters from HIM or whomever, but nothing really happens other than a slap on the hand or whatnot.

If you don't have some sort of consequences in there, you might consider working with your med exec team to get that into your bylaws or something something for that accountability to improve the turnaround time of documentation, documentation or answering queries or whatnot. And I guess talking about queries too is, are queries a part of your legal medical record?

If they are, are they included in your deficiency process?

Might be helpful to get those providers that don't typically like to answer queries to answer those queries in a more timely fashion.

Create an environment where coders feel safe to discuss the tough coding topics without being penalized.

Coding is hard. It we all know it's hard.

Oftentimes, coders just need to talk through their thoughts. They might need to just say thing what they're thinking out loud, or they might wanna just have somebody to to listen to what they're thinking just to verify or validate their thoughts.

You can set up various ways to achieve this. You can do it on, teams, in a group chat, a department meeting, old fashioned phone call. But, again, allow some time or invest in some time allowing even just a couple minutes into their productivity, so they feel like they can do this.

Build an environment where coders and CDI can't live without each other, where they truly rely on one another to fully understand both the clinical and the coding worlds.

Have coders CDI meetings where they can discuss difficult cases. Allow the CDI to ask the hard, the tough why questions and allow the coders to answer.

Let them be open and say, you know, we don't necessarily agree with with that, but it's the coding guidelines. It's the rules. We have to code things this way because of x y z.

A few sessions back and forth like this, and and both sides, both the CDI and the coders will will see that there's reasons why they think the way they do.

They build their relationship, and they begin trusting each other.

The environment kinda goes from it's kinda neat to see. It goes from us versus them, coders versus CDI, to a let's collaborate or what do you think?

The initial time investment, again, can be be tough, but, ultimately, it results in a very strong, efficient CDI team that ultimately feels like they can't live without each other.

And then do the same or something similar with your CDI and your providers.

I know we're living in a remote world and communication can be done faster via email or an in basket or a staff message, but relationships aren't built that way. And face to face conversations are still the best. That being said, that doesn't necessarily mean that the CDI has to be in the hospital. I know we're, again, in a remote world, but it could be via video chat or screen sharing.

Being face to face, it just gives that extra it demonstrates the importance.

And you can also get a feel some added benefits are getting a feel for the body language or reading into those unspoken signals.

It can enhance your credibility, and it builds the trust between the CDI and the providers.

Once that relationship is built, the providers are more likely to answer the query, in the medical record right away and not get mad about it or ignore it.

Establish a robust, QA program to regularly audit coding practices, and identify areas for improvement.

Analyze where your team's shortfalls may be.

You know, is there low hanging fruit? Things that are quick fixes? Things that you can if there are, you see those quick fixes, tackle those first.

If you don't have time or resources to analyze, it's okay. Just do a random chart grab, and things will begin to pop out at you. Things that that maybe didn't seem initially like low hanging fruit at first, but things that that actually are low hanging fruit and things that you can fix rather quickly.

Audits.

External audits. At least once per year. It's recommended that that you do at least one external audit per year. If you don't currently have them set up, AAPC can help with that too. There's lots of auditing companies out there, but we do that as well.

We have fabulous audit teams.

Not only do they audit for pro fees, but they audit facility coding as well.

Internal audits.

And when I say internal audits, I don't mean just with an internal auditing team.

In a previous role, I set up a rotation with coders auditing coders.

And initially, the coders hated it, but after a few rounds of doing it, they loved it.

They loved the peer feedback.

It also helped get everyone on the same page.

We all have our internal guidelines, but with everything, as you know, people can interpret things differently.

Doing this fostered communication between the coders.

If they couldn't come to an agreement on the interpretations of the guidelines that they were supposed to follow or whatever whatever was in question, they bubbled it up to a team lead or a supervisor, and the supervisor would ultimately give the intended interpretation.

And then subsequently, you know, the the team leader supervisor would collect all those those random things that that were conflicting between the coders themselves and add them to, as a topic on the department meeting agenda, to discuss and make sure that everybody on the entire team was on the same page. Because you know if there's a couple that aren't on the same page, you know there's more out there that likely aren't on the same page either.

But, again, in order to do this, you have to allow non productive time for the coders. Otherwise, it will fail miserably. You won't get buy in from the coders to do this.

And then, of course, reaudit.

After your audits and your education, your departmental meetings, after you've done all that, of course, you have to reaudit and hold the coder accountable.

If the reaudit and the accountability in there, you're basically just wasting your time or just checking off a box to say that you completed an audit and did it. The the reaudit is is crucial to success.

Mhmm. Staying informed. And I know I said this before, but I'll say it again. Medical coders who stay informed about coding guidelines and updates are less likely to make errors.

Active participation in the professional organizations provide coders with access to the latest industry news, to continuing education, into networking opportunities.

Engaged coders learn the best practices and advance more quickly in their careers as well.

Medical coders who pursue continuous education, and credentialing, such as whether it be CPC or CCS, what whatever it is, they tend to have better career, prospects as well.

The AAPC salary survey said that certified coders earn twenty seven percent more than noncertified coders.

The Bureau of Labor Statistics projects that employment of medical record and health information technicians, which includes medical coders, will grow eight percent from twenty nineteen to twenty twenty nine, much faster than the average for all occupations.

Coders that stay informed about the industry trends are better positions better better positions to, take advantage of the growing demand.

So, again, stay informed, join those different organizations, professional organizations, or have your coders join those professional professional organizations.

It's just really important for the coders to help stay on top of everything. And from there, that is all of my slides. So I think we can open it up for any q and a that we might have.

And we do have. You want me to just dive in?

Sure.

Alright. First question is, is it possible to bill for a facility charge even if there is no physician charge? For example, if the teaching physician guided, guidelines were not meant to allow coding the professional service, can we still bill for a service related to facility for items such as room charges, ancillary staff, etcetera?

Yes. You can. There, there are, if you have utilized your facility resources, you absolutely can. The challenge comes in if you don't have, any documentation from, a provider that's signed for a diagnosis to go on that claim with with it. You know, know, in the event that somebody left AMA, you would, you know, code to the best that you can with what you have and then make sure that your dis discharge disposition has that, left as AMA.

K. Thank you. Next question is, generally speaking, in a facility setting, what is your take on coding comorbidities, HTN, DM, COPD, etcetera, and other factors such as smoking from the HMP in addition to postoperative diagnosis on the operative note. Some say it is important to paint the clinical picture of the patient, but others may say it is drag on productivity.

Well, anything anything that affects the the patient's stay should be coded as a secondary diagnosis. So, the smoking, the COPD, all that stuff typically is should be coded, because it it's going to involve more resources. You're you're likely gonna have maybe respiratory therapy coming, and and you're gonna want to paint the full picture. You want on the facility coating, you're painting the full picture of the patient's stay from the time that they walk through the door of the facility to the time that they leave the facility.

So you wanna capture everything possible that's pertinent, that's being treated with those. So I I am a fan of if it's documented and it was treated by some some means.

Again, going back to the UHDDS guidelines, you should be coding it. You should be picking it up. I don't whether it's a productivity, taker or not, it's correct coding. You should be coding anything that's affected this day.

Alright. Next question. Is there a community of coders for small clinics to be able to discuss coding issues? For me, I am the only coder in our behavioral health clinic.

I believe there are.

I I'm pretty sure and, Steph, I might need your help on this. And I think AAPC has, some sort of of I don't know if it's a chat or something, that can, people can collaborate, a work group. I know AHIMA has something like that. I've also surprisingly found that on Facebook. But, again, take it with a grain of salt. If you're just looking for a community of of folks to network with, Facebook has a lot of groups that are coders, and coder related, that you can talk back and forth about various things. Steph, what were you gonna say?

Yeah. So AAPC has the forums that you can develop, relationships and communications. But, again, you definitely would want to validate the the recommendations that are given off the form. Right? We AAPC, we do not moderate them for accuracy. It's just basically, chat communication.

What I would recommend is participating in your closest local chapter group.

That's a good one.

Most of the local chapters are meeting remotely still.

They're offering the in person as well, and that's a great way to build those connections, particularly around different specialties that you're in with and you've got those direct questions.

On our AAPC website, we also have an ask an expert for a very, very small fee. You could post some some questions there as well.

And and thanks for bringing up the the AAC local chapters. A lot of times, those have, pretty reasonably priced CEU opportunities as well.

Just another way to save money on CEUs there too.

Okay. Next question. Do you think that there will be a trend on focusing quality over productivity in the future?

Can you say that one more time, Cordell?

Yeah. Do you think that there will be a trend moving from quality over productivity in the future?

I do.

I do believe so simply because I think the shift of payers and payment is going to be more well, we've kind of already seen it, quality based versus productivity based. And that's why I think there's so many, denials or a lot of rework being done, because coders may or may not be whipping through those charts really, really fast and might be missing some of those quality type type things that that should have been picked up.

So, yeah, I do I do think there is going to be a shift, in organizations, you know, like I said in in the presentation, there there there needs to be time built into a coders productivity to allow for some of that to slow down so that quality does improve over the productivity.

Steph, are you seeing the same thing on your side?

Whoops. Let me unmute myself. Yes. We're seeing the same, Melinda.

Okay. That's what I thought.

Okay. Next question. Can point of care testing like eight seven eight zero four be billed at a provider based billing clinic where the charges split bill?

So off the top of my head, I I'm not sure, but this is not provider base. This is a more facility, webinar about the pain points and and expressing it. But if you wanna send that question or if you have it, we can I can take a closer look at it, and we can get back with some, personal, feedback on that?

Okay.

On the LWBS patient patients, and you said we can code a facility charge. Can we use the chief complaint as the diagnosis for the claim?

It's gonna go back to your documentation and how how what you have for documentation.

Because I don't wanna say a blanket statement that that, yes, you can. It's gonna depend on, you know, how things are set up in your EHR.

If your provider, signed orders that have that diagnosis on it, you can use the diagnosis on that signed order.

So, theoretically, you should be able to, because you you should have an order in your system somewhere for what you've already done.

But I can't promise that your your particular record is set up that way or that your particular I'm not you know, every single EHR is different and set up different.

So it's just gonna depend on your documentation that you have for that die getting that diagnosis.

K. Thank you.

Next question. I work for an academic facility, and we charge for both pro fee and facility.

Is it possible to charge the facility or tech only portion of an image if the physician did not review the image? We do we do not want to lose out on the tech portion of our hospital charge.

Yeah. You can you can charge the the technical portion.

You would have to add the appropriate modifier to show that it's just for the technical portion.

Yeah.

Then someone asked, how do I find, my local chapter? I think Stephanie put, a link in the chat where you could find that.

Great.

Getting a lot of questions about, if this recording will be available. Again, it will be, along with the slide deck in a couple of days. Just keep an eye out, for that box.

Next, I'm receiving a lot of denials for incorrect revenue codes, code bill with bill with procedure code. Do you know, if it's book for revenue code?

I'm not sure. I'm Yeah. Understanding that.

I'll read it again and see if we can suss it out. I'm re receiving a lot of denials for incorrect revenue codes. Bill with procedure code. Do you know if it's booked for revenue code?

I I think the question, Cordell, is do you know if there's a book that that crosswalks to the revenue codes?

Oh, okay.

There is if you go online, in on the CMS web you can find the listing of revenue codes and the categories of things that fall into them. I don't believe there's, like, a one to one match. Like, this CPT code goes to this revenue code. But I think but there's a general you can get a general idea of what category you should be in, you know, and what what general idea of what revenue codes you should use.

So, yes, you can find that online.

Okay. For decisions to hospitalize, if a patient comes into the ER and the ER consults a hospitalist, the hospitalist either places in, OBS or admits, the patient is credit under risk to be given.

What was the last sentence, Cordell?

The hospitalist either places, in OBS or admits, to inpatient, is credit under risk, capital r, risk to be given?

I think this is a professional E and M question around the medical decision making risk component, I'm assuming. So, if if that's the case, if we if we could maybe restate the question, then we'll see if we can get a better answer for you.

Okay.

I'm gonna just ask one more question. We take before taking you off the hot seats, Stephanie and Melinda, and that is any advice on ASC billing for drugs that are k two indicators? In other words, paid separately when provided, integral to a surgical procedure on ASC list.

Any advice on getting them paid? That's the question?

Yeah. I'm billing. Yeah.

So I am not a billing expert.

I'll be the first to admit it. I don't, Steph. I don't I don't have any advice on that.

Do you, Steph? Yeah. So we we deal a lot with, insufficient documentation around these drugs because oftentimes, it's it's the documentation is very is very unclear if the patient brings those in, if it's supplied by the hospital pharmacy. And if so, you know, what what's the medical necessity, and is it billed on the charge master, or should a coder pick pick those up?

So I think to answer your question, there there isn't an all in one right answer. I think you've gotta go back and you've gotta do root cause analysis and find that that paper trail or the workflow trail of what's happened. How how are the those drugs obtained? Where are they obtained?

Who's using them, and how are they being documented.

Our experience, again, is is most often they're not being documented correctly, and that's that's kind of the crux of the denial.

Okay. I appreciate that. Thank you so much, Melinda and Stephanie, for the presentation today. Thank you everybody, for attending. As I mentioned, we will be sending out a copy of the presentation and the slide deck in a couple of days.

Also, if you're interested in learning more about Stephanie and Melinda's, auto encoding services, just let us know. There's gonna be a survey that pops up as soon as we close this webinar out. Thanks, and we hope to see you next time.