Wiki Issue with employer!

[em2177]

Hello everyone, I was just wondering if you can help me put together a list of why it is important for me as a "certified coder" to go out and perform HCC chart reviews. My employer is changing things around for me and wants our Marketing Dept to go out and scan all the patient notes from the chartandbring them back to me for review. My problem with this is who will educate the physicians if there is a problem with the documentation? Our Marketing Dept knows nothing about coding and I have a problem with this. They say they want to save me a trip to the physician offices and want to keep me in the office to perform data entry which does not include anycoding. I will be staying in the office to input copays for the different health plans. What a waste of a coder's time in my opinion. I certainly am thankful for having a job but I think that they dont realize the importance of a chart review and its purpose!!!

 

[Anna Weaver]

issues

If you are doing a complete chart review, are they going to copy the complete chart? You don't just look at one or two pages, you have to check everything. Unfortunately, not all offices are the same. This would be a waste of time, effort, and money. You are using 2 people to do the job of one, and using up extra resources (paper, toner etc) when it's unnecessary. When we review the charts, we look from front to back, where is all the documentation located? If they only document on one page, no problem, have the office copy and send. BUT, I know of no office who documents an entire visit on one page, our offices have papers all over the chart that refer to a single visit. Also, what about the transport of copied charts, HIPAA is a major issue, I really wouldn't want my medical record being transported by someone to somewhere I didn't know about. That puts a major red flag out there for me, and with the red flag system in play, that's scary.
These are my opinions only, but I agree, it's a waste of manpower!

 

[JSimpson]

I am a auditor for a billing company and a CPC. You marketing person has no business making copies of a physicians patients that is not his/her employer and transporting from point A to point B. If they want you to do an audit, they should send you to the physicians office to review documentation in the medical record. You should have strick guidelines that discribes your audits, it's reason and function. In the guidleines it should be spelled out how the physicians will be notified of all findings and how they will be corrected, who will do refunds and resubmission of corrected claims. From a compliance standpoint someone in a "marketing" position has nothing to do with clinical care nor billing and is not in the "need to know" position to have access to medical records.

Are you a billling company? What type of service does your marketing staff market?

The skills of a CPC coder should never be used for lower level positions, check in/out filing. Auditing experience is a great skill to gain and should be known by a coder however this should never be done as a selling point for a service. If you are audited by the OIG or CMI your compliance plan will be reviewed and that is where you findings should be and how you corrected them. Doesn't make good fiscial sense as well. I think your mamangement team should let you audit correctly or code.

 

[em2177]

I totally agree with you both! Last year I was able to schedule the chart reviews and visit the offices for the audits myself. This year they want to switch things around which make no sense to me. Why would they hire a coder to do data entry??? I have given my opinion to my Supervisor about this today but I really dont think they will listen to me. I pointed out the HIPPA issue and how it would be double the work if it turns out that I have to go to one of the offices myself to clarify any documentation. We are an IPA and what we do here is process claims, authorizations, marketing, contracting, eligibility, etc. I am the only Coder in the office and my supervisor knows nothing about coding herself. When they get audited, I hope it does not come back and get me. I am saving all the emails and documentation that I have sent them regarding this just in case.
Thanks for you input!