R-E-S-P-E-C-T: Find Out What It Means to Providers
Improving communication with providers starts with mutual respect.
by Melissa Caperton, RHIA, CPC, CPC-I, CFPC
Physicians have an inherent need to treat their patients well. Coders have an inherent need to translate the physician work into a series of numbers. Such divergent needs can create disastrous communication failures. But if you respectfully apply a few simple tips, the communication path will become much smoother and exponentially reduce stress in the workplace.
Respect Is Key
The key to good communication is respect. Participants should enter the conversation respecting one another, if only because each side has taken the time to meet with the other. For example, coders should thank the provider for taking time out of his or her busy schedule to discuss these important issues. By demonstrating respect, you allow the provider to reciprocate and establish rapport as a foundation of communication. Note that actions are as important as words. For instance, don’t just thank the provider for his or her time: Come prepared so as not to waste time.
Respect of Time
Coders: Be concise and get to the point as quickly as possible. Unless the provider wants to hear all of the history leading up to the latest rule change, don’t share the details. Although the information may be fascinating to you, providers usually are interested only in knowing how the change affects them. Give your provider enough information to communicate the importance of your topic, but resist the urge to overwhelm him or her with your knowledgebase.
Providers: Even if your coders aren’t good communicators, keep in mind that they really do have your best interests in mind. They know you are the medical expert; it’s not necessary to wow them with your wisdom and send them away more confused than when they came in. Help them to help you by explaining your process and what is important to the medical care of the patient. That information will always be at the heart of what the coder needs in the documentation.
Respect of Knowledge
Coders: The provider has spent many years in medical school and is constantly learning. It really is OK if you don’t know everything the provider is saying to you. On the other hand, it’s not OK to pretend you understand. Show respect of the provider’s knowledge by acknowledging a hole in yours. Ask the provider to describe the issue as simply as possible in layman’s terms. It’s OK to say, “Explain how you do this so I can better understand.” The more you know about your provider’s job, the better equipped you will be to do yours.
Providers: Although coders may not have all your medical knowledge, they are well versed in coding and documentation rules. Your focus is on providing quality patient care; their focus is on ensuring you are paid and can successfully pass an audit. Respect their knowledge of the rules by working with them to find a solution you can live with, and to meet the needs they have presented.
Respect of Workflow
One recurring theme from the providers interviewed for this article was that you must understand the provider’s workflow. One provider summed it up this way: “One of the requirements [for good communication] is having a coder who truly understands what you do as a provider; it is the responsibility of the provider to share as much information with the coder as possible to ensure proper coding and documentation.”
The most successful coder/provider communications take place when there is intentional learning from each other. These relationships are not comprised of “hit and run” exchanges in the hall between patients, but rather result from a dedicated time set aside for exchanging information. This could be handled by way of a scheduled time each month to meet and discuss issues. You could use the time to hear from the providers about their workflow or medical treatments, while providers could hear from you about how their work is translated into code, what words trigger different codes, and how that translates into money.
Respect of Personality
Consider how differing personalities might affect communication, and tailor your approach, as necessary.
Do you ever feel like you’re talking to a brick wall?
It’s possible the individual you’re addressing feels as if he or she has lost control, and wants to regain it. When communicating with such an individual, ask open-ended questions that require more than a “yes” or “no” answer. Be attentive to what the other individual is saying. Resist the urge to fill in the silence during a conversation. There’s a lot of “activity” going on behind the wall, and allowing the individual time to gather his or her thoughts is the best way to foster open communication.
When dealing with someone who complains about everything, that person likely has a need to be taken care of. Listen closely to figure out the true need. Let him or her feel important by acknowledging what is said. Ask open-ended questions and avoid accusations, which will put the individual on the defense. Don’t allow someone to complain in generalities: Gently push for specifics, which will allow you to work together to find the facts and solutions.
Does the other individual have a response for everything?
It’s likely that he or she needs attention or acceptance. Your role is to help the individual to understand other views without antagonizing. Validate his or her points, when appropriate, but be sure you’ve done your research and know the facts so you can disseminate fact from fiction. Present the facts as an alternative viewpoint, which will give the person an opportunity to “save face” if he or she has stated things incorrectly.
One provider I spoke with gave this great example of communication related to an evaluation and management (E/M) topic.
Coder: “I need XXX elements in the HPI.”
Provider: “That is meaningless and frankly annoying to me so I am going to ignore it.”
Coder: “As part of your usual exam for XX condition, what HPI questions are important to the clinical visit and your history?”
Physician: (Gives examples of usual workflow.)
Coder: “I understand. As you do your usual history for the chief complaint, make sure to document what makes it better/worse and what treatment they did before arrival.”
This puts necessary information into a context the provider can understand and respect. The information is relevant to patient care, so documenting it makes sense.
If the individual gets angry, the most important thing to do is help him or her regain control. This means being patient and letting him or her “get it out.” As long as it isn’t interfering with others in the area, let the individual rant until he or she runs out of things to say (with reasonable limits, of course). Displaying patience and demonstrating a sincere desire to talk will help you get past the war zone and into diplomatic discussions. You may have to interrupt to join the conversation, and it’s OK to do so, as long as you do so in a calm manner.
Take the time to look around personalities and to reach the people with whom your work. Address the topics the provider has, not just your own, and you’ll be amazed at how much further you get in your communications.
Melissa Caperton, RHIA, CPC, CPC-I, CFPC, is manager of reimbursement and quality improvement, University of Florida Jacksonville Physicians, Inc. With over 20 years’ experience in the healthcare industry, her areas of expertise include fee analysis, budgeting, and quality improvement activities. Caperton enjoys presenting on teamwork and communication. Toastmasters International awarded her its highest honor, Distinguished Toastmaster (DTM). Caperton served as co-director of the annual “Coding on the River” conference in Jacksonville, Florida, for several years, is a member of the Jacksonville River City, Florida, local chapter, and is a past chair of the AAPC Chapter Association board of directors.