Practice Management Alert

So, you've performed yet another internal audit and are still finding the same documentation, coding and billing errors. What can be done to make it easier for you and your physicians to communicate necessary information quickly and efficiently?

"It's education, education and more education," says Lorraine Goupee, CPC, CMA, professor for the Health Information Technician and Medical Assistant programs, Duluth Business University, Minnesota. "Policies and procedures are constantly changing. For example, E/M documentation requirements for some payers have increased for higher-level office visit codes."

Many physicians are unhappy about supplying the extra documentation to warrant the use of level-four and -five E/M codes, and some are even insulted because they feel the diagnosis is self-explanatory. "However, we have been noticing an increase in level-four and -five denials as well as downcoded claims. Therefore, there is a problem and we need to figure out how to communicate the importance of this to our physicians," Goupee says. "One reason for the increase in denials is that many private payers have increased their staff of reviewers. We need to prepare." Education and Implementation Because physicians learn best when you provide empirical data, you should conduct periodic internal audits on outgoing claims. Take documentation from several charts and review it. Code the documentation separately without looking at the billing. Then compare what the audit revealed to what was billed. If you find that the claim should have been downcoded, then you owe the insurance company money. "You can use this as an opportunity for education and review the results with the physician to help make the guidelines clearer," Goupee says.

If you find that you have a trend in underdocument-ing, then all E/M codes should be held for complete documentation and reviewed before a claim is released.

Education on guidelines must be current to ensure everyone is up-to-date. Randomly quizzing staff on the new changes can suggest who has read your update. For example, ask, "What's your opinion on the new MRI codes?" This is a casual way of finding out whether the memo was read, Goupee says.

Address the changes in a memo to physicians. One of the keys to making sure physicians read the new changes is to keep written communication short and include bullet points and/or highlighted sections. This makes it easier to scan. If you have different-colored fonts on your computer, use them to section out portions of the notification. For example, use red for new codes and yellow for deleted codes.

"You should follow up on the memo with a one-on-one meeting between the 'trainer' and 'trainee' especially if a pattern of denials is showing up," says Catherine A. Brink, CMM, CPC, president of Healthcare Resources Management Inc., a [...]