Practice Management Alert

Idea: Visual aids such as bell-curve charts can help problem providers see the big picture

Your job isn't finished once you have the final results of an internal audit - the next step is to identify key problem areas and eliminate them by training physicians and billers.

Last month we told you how to best prepare for an effective internal audit (see "Chart a Course for Ultimate Audit Success in 4 Easy Steps" in the May issue) by using benchmarking data to focus your efforts. Now our experts tell you how to examine audit findings and implement the necessary changes in your billing process.
 
Correct your audit-revealed coding blunders with these three expert guidelines:

1. Use visual aids to illustrate problems. Generating an E/M bell-curve chart for each provider and comparing it to their specialty-specific national-average curve is helpful because you can easily identify any overcoding or undercoding and know which codes to address with each physician, says Mary Falbo, MBA, CPC, president of Millennium Healthcare Consulting Inc. in Lansdale, Pa. In addition, showing a provider his coding mistakes in such an easy-to-read format will help convince him the problems are real and require his attention and cooperation to fix.

2. Organize education and feedback sessions. If your internal audit identifies erroneous coding patterns, you should use case notes from the audit to guide education and feedback, Falbo says. If several providers and billers need training on the same topics, you may want to arrange a group training session. Individual sessions are better for providers or billers who have unique coding problems, or who require more attention.

Strategy: Suppose one of your providers is consistently reporting level-two established patient visits when she should be using level-three codes. Your first step should be to show the provider her personal billing bell-curve chart so she can clearly see her undercoding. Make sure she understands the results of her specific audit and recognizes that she needs an education session, says Catherine Brink, CMM, CPC, president of HealthCare Resource Management Inc. in Spring Lake, N.J. Arrange a time when you can sit down together and review the principles of E/M coding and how she can apply these to her typical patient visits.

For example, you can go through the documentation for a few of the provider's audited E/M claims and explain why the provider selected the wrong level. For instance, she may have underdocumented the patient's history, risk factors, ordered tests or the plan of care. Another audit-revealed problem area could be that the provider is using nonspecific diagnosis codes when the documentation indicated more specific codes, Brink says.

You should also give providers a take-away tool that will help remind them of key billing elements. In this situation, a checklist of necessary elements to select the appropriate E/M code would be appropriate.

Follow-up: "Education is very important," Falbo says, and "feedback is essential." Remember to check on your trainee's documentation and coding routinely and tell her when she improves. In addition, you should arrange a problem-focused audit and at least one formal feedback session several weeks after the training to assess the provider's progress and give any additional pointers or recommendations.

Always: Be sure the provider or biller you're training has a clear understanding of why he must change his  billing behavior. If undercoding is the problem, stress the fact that the practice is losing deserved reimbursement because of these mistakes. If overcoding is the problem, remind your trainee that compliance is a must to keep the practice out of legal hot water.

3. Conduct another audit. Some time after your postaudit compliance session, you should reaudit the problem areas revealed during the first audit. You may want to just focus on the problem providers whom you trained, Falbo says. Consult your compliance plan for specifics on when and how you should follow up on an audit that reveals problems.

Reaudit and retest your providers and billers at given intervals to ensure no one is backsliding. "Individuals learn at different paces," Falbo says, so "consistency in the audit/education cycle" is what will eventually produce results.

Last resort: If some providers persist in noncompliant coding, you need to consider corrective actions - such as a fee for education sessions, Falbo says. Consult your compliance plan to see if specific guidelines dictate how you must handle a chronically noncompliant physician. If you don't have a compliance plan, you need to have some guidelines in writing to dictate your actions in this situation.