Deciding Whether Use of ED Superbill Will Improve Billing
Published on Wed Mar 01, 2000
By Caral Edelberg, CPC, CCS-P, president of
Medical Management Solutions Inc. in Jacksonville, Fla.
With compliance concerns at an all-time high, emergency physicians are attempting to control potential errors from coding staff through use of a superbill or coding charge sheet. Although this concept is not new to emergency medicine, its resurgence bears discussion of the pros and cons of using such a short-cut method to determine codes and charges.
How Physicians Can Address the Issue
Having physicians involved in the code assignment through ongoing coding training can be beneficial. Many groups believe that by assigning the actual billing code, physicians are reminded about how charts should be documented and can easily clarify any code options by assigning the code that most closely reflects the procedure or service that was performed. However, coding must be performed on the service that is documented, not the service they think the physician feels he performed.
Unless physicians understand that the coding system works that way, assigning their own codes may place them at a higher level of risk of charges of fraud or abuse.
Physicians who choose to do their own coding through use of a superbill form should be aware of these eight points:
1. All coding should be reviewed by a trained coder to
ensure the documentation supports the code assigned.
2. Coders should assign the modifiers prior to billing.
3. Coders should assign the ICD-9 diagnosis codes to
assure that the CPT and ICD-9 codes match and demonstrate medical necessity.
4. Coders should provide routine feedback to the
physicians when codes are assigned incorrectly.
5. Physicians should be clear that their code assignment, if incorrect, will be changed by the coder.
6. Physicians should be expected to maintain a
minimum number of hours of orientation to correct coding.
7. Physicians should be advised of how codes are paid
and/or denied by major payers. This can be accomplished by a routine review of payment remittances.
8. External quarterly audits should be required as part
of the compliance program to identify coding errors
made by either physicians or coders.
Physicians should be aware that, from a compliance perspective, it is advantageous to have codes and charges assigned by someone with no incentive to upcode. If physicians are indeed paid by what they code and audit problems occur, it will be more difficult to demonstrate that a clear division between coding and revenue exists. In other words, when physicians are removed from the coding process, there can be no suggestion of involvement in upcoding for monetary gain.
This does not mean that when a trained coder performs coding, the physician should ignore his or her responsibilities. On the contrary, no matter who performs the [...]
