Establish a Great E/M Education Program
by Kim Harper, MBA, RHIA, CPC
Since the 1995 and 1997 Documentation Standards implementation, physicians have been made aware of history of present illness elements, review of system bullets, physical exam components, and medical decision making issues which constitute an evaluation and management (E/M) level of service. The big question most physicians have is, “How am I ever going to remember this?” The answer to the question is not easy. The best solution is to implement a great education program to provide on-going education for your physicians.
I emphasize the words great and program for several reasons. You must have a great educator to identify issues, communicate those issues to physicians, and offer solutions to the issues. Identifying the issues is the easy part. Offering solutions to a group of physicians who are frustrated with government billing regulations can be a challenge. Establish a program comprised of a series of lectures to help the physicians focus on one issue at a time to keep the physicians interested in E/M coding. If you bombard the physicians with an overabundance of criticism all at once, it will overwhelm and the information won’t be retained. The education session should not convey the message, “You are a bad doctor and you are going to jail.” The education sessions should cover both negative and positive aspects of physician documentation. Your program should implement an accuracy goal to help physicians see where they stand and what improvement is made since the last review. With this system, they will rise to the challenge of being “graded” and strive for the best.
The first step in establishing a great education program is to perform a quarterly or monthly audit. The audits will determine your issues and what the education session should focus on. The audits should reflect your documentation accuracy and show where you need to improve. Remember: both over-coding and under-coding lead to financial burdens. If the group is over-coding, you risk paying fines, and if the group is under-coding, you deny the physicians money they work hard for.
The second step is preparing and presenting great education sessions. Education sessions should be held at least once a month. The more face-to-face time you have with physicians to discuss the importance of documentation, the better. If you are in a multispecialty group, it’s important each group has its own education session as each group’s patients and services differ. Your education session should allow your physicians to ask a lot of questions. This helps the group stay interested in the discussions. For instance, if the education session is scheduled to last an hour, plan for a 30 minute presentation and use the remaining 30 minutes for questions. When the physicians ponder different real life scenarios, the questions start flowing. If you feel uncomfortable allowing your physicians to ask questions because you don’t like being put on the spot, remember a great educator is not afraid to say “I don’t know but I will look that up and get back with you.” This provides you with a chance to research the correct answer. Take time to research prior to the education session to help alleviate the stress of presenting and the pressure of being put on the spot. To be a great educator, it’s necessary to be knowledgeable and comfortable presenting the information. Physicians love examples and they may have a hard time believing they make mistakes. Seeing their documentation and its shortcomings can help get their attention. However, be careful in presenting this in a group session because no one likes to be singled out for bad practices. These issues should be addressed in a one-on-one session. One-on-one sessions are great for struggling or new physicians.
To have a great education program, all physicians should be aware of the expectations and the importance of proper documentation. Once the audit process and education program is implemented, the physicians should understand excepted accuracy rates and the importance of attending education sessions. For example, if you have an 80 percent coding accuracy rate, the physicians should be informed if this accuracy rate includes both under and over coded claims. If it does include both and the audit consists of 10 charts, the physicians must have eight records documented to the correct level of service submitted. If the physicians have consistently poor audit outcomes, the plan may need an incentive program to reward physicians for scoring above the accuracy goal and discourage physicians from incorrect documentation. If this seems extreme, consider the impact on a physician’s practice when the documentation isn’t taken seriously. It is important physicians realize the importance of compliant documentation.
The final step in having a great education program is to get support from your hospital administrator and your physician director. The educator must be a person the physician feels comfortable asking questions to and feels is acting in their best interest. For the program to be successful you need an “enforcer” of accuracy rates and the incentive program. The best enforcer is usually another physician.
Establishing a great education program is beneficial as it provides a layer of defense from an outside audit and also ensures the group is billing for all services provided. Both lead to financial success and a good night’s sleep.