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sherin

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Our company is using Allscripts EHR for our electronic medical records. We will be installing the Allscripts practice management component along with it. Our providers have the option to use an E&M calculator once they complete their documentation to determine the level of service. I am seeing that this option over codes the visit. Is anyone using this option of an E&M calculator and how is it working for you?
 
sherin said:
Our company is using Allscripts EHR for our electronic medical records. We will be installing the Allscripts practice management component along with it. Our providers have the option to use an E&M calculator once they complete their documentation to determine the level of service. I am seeing that this option over codes the visit. Is anyone using this option of an E&M calculator and how is it working for you?
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We have Allscripts, also. When you say it's over-coding...what are you seeing that makes you think this? The physicians do have the option to override the E/M calculator. The physician can also copy and paste which may add unnecessary/unrelated information; based on the nature of the presenting problem and this will/can increase your level of visit. These are the most common scenario's I see.
 
Thank you! It was good information for me to share with my providers. It was information I was looking for.
Sheri
 
Sorry, I wasn't very clear. My providers are totally relying on the calculator to be correct. I know they have the ablility to override it but I think the way they are looking at it is if they are doing all this work/documentation that justifies a higher level then it needs to be billed for. I am trying to explain to them that their level of service needs to be driven by their medical decision making/complexity of visit rather than just relying on all the buttons they selected throughout the visit (I guess that it is what I meant by overcoding the visit). I know the provider is ultimately responsible the documentation, I just need feedback from other people using this product, like you and your office, that can share information with me on how it is working and not working for them. Do you have guidelines set up for them that the level of service billed is driven by the medical decision making which goes back to the chief complaint?
Any examples of policy or guidelines you can share with me, as well as web sites you use, would be appreciated.
Thanks again for all your help,
Sheri Naccarato, CPC, CFPC
 
sherin said:
Sorry, I wasn't very clear. My providers are totally relying on the calculator to be correct. I know they have the ablility to override it but I think the way they are looking at it is if they are doing all this work/documentation that justifies a higher level then it needs to be billed for. I am trying to explain to them that their level of service needs to be driven by their medical decision making/complexity of visit rather than just relying on all the buttons they selected throughout the visit (I guess that it is what I meant by overcoding the visit). I know the provider is ultimately responsible the documentation, I just need feedback from other people using this product, like you and your office, that can share information with me on how it is working and not working for them. Do you have guidelines set up for them that the level of service billed is driven by the medical decision making which goes back to the chief complaint?
Any examples of policy or guidelines you can share with me, as well as web sites you use, would be appreciated.
Thanks again for all your help,
Sheri Naccarato, CPC, CFPC
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No problem! I wish I could tell you how our program is working, but it's still in the development phase :)eek:Scary, right?)...anyways, if you go here: http://www.ttuhsc.edu/billingcompliance/
You can find all of their policies and procedures for their billing compliance (Look under the 'Plan and Policy' tab on the left)- we're modeling ours off of theirs, because it's really comprehensive. I especially like the point system that they use to decide what actions to take if providers' documentation doesn't make the cut. I assume that it works pretty well, since it's been in place for so long, but I don't know how well it works outside of the teaching-hospital setting. Guess I'll find out soon!:D
 
Sheri,

Unless your carrier has something different in writing, then I will refer you to CMS' policy on the volume of documentation and medical necessity, not medical decision making.

"Medical necessity of a service is the overarching criterion for payment in addition to the individual requirements of a CPT code. It would not be medically necessary or appropriate to bill a higher level of evaluation and management service when a lower level of service is warranted. The volume of documentation should not be the primary influence upon which a specific level of service is billed. Documentation should support the level of service reported. The service should be documented during, or as soon as practicable after it is provided in order to maintain an accurate medical record."

When you audit your physicians, make recommendations to the best of your ability based on the documentation requirements. When I conduct an audit and meet with the provider to go over the results, they are required to sign a "feedback form". I record the topics of our discussion and my "recommendations". All you can do, ultimatley, is provide sound recommendations/suggestions and the provider is responsible for the rest.

Page 38

https://www.cms.gov/manuals/downloads/clm104c12.pdf
 
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