codingaid’s 2019 highlights from healthcon · 2019. 5. 21. · • 2009-hitech act of 2009 •...

CodingAID’s 2019

5.16.19

Highlights from Healthcon

Lynn Handy, Janae Ballard, Carrie Weiss, Kerri Larson

AGENDA

010203

Transforming Your Career Path

Auditors: Our Role As An Educator

CDI for the Physician Practice

04 EHR Templates: Past, Current and Future


Kerri Larson CPC

3

Coder vs. Auditor• Professional Fee Coders Primary Functions:

• Provide efficient quality coding of CPT, Modifiers, ICD 10 and HCPCS. • Act as a resource to the physicians and other healthcare providers to ensure appropriate

physician billing.

• Physician Auditor Primary Functions: • Validate coding.• Scrutinizes the content and quality of the record.• Provide explanations regarding the findings on content/quality review to fellow audit staff.• Create written findings and recommendations summary.

4


Get Ready• Set yourself apart from others.

• Continue growing and learning .• Remain a great positive communicator with your team and providers.• Make your leadership aware of your interest in the steps to becoming an auditor.

• What does a hiring manager look for? • Experience – most often in multiple specialties.• Quality research skills. • Candidates that have great attention to detail.• Willingness to collaborate.


Get Set• Create a powerful Resume!

• Assure it speaks to the specific job description and your qualifications. • Read the job description carefully to assure you have the qualifications. • Proofread • Include your references and accomplishments to help market yourself.

• Training and research experience detail• Presentations, articles and content creation experience

6


Go…Interview Ready• Focus communication on “wins”.

• Business office• Provider communication• Quality and Productivity

• Offer samples of research performed.

• If there is insufficient experience, focus on the willingness to learn. • Seek training and consideration of specialty credentials.

7


Hiring Manager Perspective• Start with the end in mind.

• Define what that Auditor will be doing long term. • Envision how the Auditor role will impact the organization as a whole. • Request sample work reports.

• If newer, request a research document they have created. • Discuss hot topics. • Discuss what the candidate has found to be effective in past experience with

documentation and coding education delivery.• Don’t rule out the “right” person for the position due to lack of experience.

• Audit skills can be taught where personality, work ethic and initiative cannot. 8


Continue on the Journey• Start reading job descriptions to assure knowledge of what an Audit position will look like. • Keep educating yourself within the coding field, writing and educating. • Consider specialty credentials and stay connected to your local AAPC chapter or AHIMA

group. • As you move through your day, focus on what you like about your career path.

• Coding – moving quickly through charts reviewing for coding accuracy. • Auditing – moving at a pace that allows for a deep dive into each chart to assure that everything is

done and reported on with 100% accuracy. • Education – Summarization of results and communicating to the provider to convey concisely the

improvements that will help them be more successful.

9


Auditors: Our Role as an Educator

Carrie Weiss LPN, CPC, CEMC

Why Do We Audit/Educate?• Compliance

oMonitor and identify errors or fraudulent activities (documentation, billing etc.)

oCreate and Implement policies oDesignate a Compliance Officer or contactoProvide Education oRespond and Enforce Offenses


Role as an Auditor/Educator• Perform Audit• Communicate Results

• Reports (accuracy scores, findings, recommendations and education)• Review results

• Re-Audit or Monitor


Obstacles with Provider Education• Creditability and Confidence• Clinical vs. Coder• Medical Necessity vs. Quantity• Doesn’t Understand the Guidelines or Doesn’t Want to Understand the

Guidelines• RVU Driven Providers


Tips for Overcoming Obstacles of Provider Education• Creditability and Confidence

o How do you look, sound etc.?o Do you know your skill set (i.e. guidelines, tools etc.)?o Do you know why your auditing?o Are you prepared?

• Clinical vs. Codero There is a difference….doesn’t mean it’s a bad thing.o Coders assist with getting paid properly and compliance.

• Medical Necessity vs. Quantityo Medical Necessity is the overarching criterion

• Doesn’t Understand the Guidelines or Doesn’t Want to Understand the Guidelineso Know the guidelines and be prepared to discuss with provider

• RVU Driven Providerso Be prepared to stand your ground



Lynn Handy CPC, CPC-I, COC, CCS-P, LPN

Clinical Documentation Improvement• Clinical Documentation Improvement (CDI) is the recognized process

of improving healthcare records to ensure improved patient outcomes, data quality and accurate reimbursement

Wikipedia.org


CDI Current State• When is CDI performed?

• Retrospectively • Based on denials• After an audit shows areas for documentation improvement

• Prospectively• During Prospective audits• Real time feedback during concurrent coding


Current State Challenges• Electronic Health Record

• Inadequate training• Did not provide the efficiencies promised• Copy/Paste/Cloned Notes• Inadequate resources within the EHR• E & M Calculator accuracy• ICD-10-CM Lists and look up functions• The Problem List!!!!!!!!


• Lack of Provider understanding of Coding & Documentation Guidelines• Medical Necessity• LCD/NCD• E & M Guidelines (95 or 97?)• HEDIS, HCC, MACRA, Quality Measures and more!!!!!

More Challenges• Staffing

• Do you have appropriate resources

• Charge Entry Process• Current Edits in place

• Are their too many or not enough?


SolutionsSolution #1

• 100% Review of all claims before billing

• Is that realistic?• If not, target areas:

• High Risk• High Dollar• Most impact for education

opportunities

Solution #2• Documentation Improvement

• Feedback/education to the providers• Feedback/education to the coders

• Realtime feedback is the best!!• In person• E-mails• In-basket• Audit reports• Shadowing (my personal favorite)

• Implement a Query process


SolutionsSolution #3

• Appropriate staff• “Coders look for what is there: Clinical

Documentation Specialists look for what is not there.”

• Hire staff that do more than just code and can interact with the providers

• This is an investment!

Solution #4

• EHR Clean-Up• Diagnosis code descriptions• Templates and Smart Phrases• Problem Lists• Review the providers ICD-10 Favorites list


EHR Templates: Past, Current and Future

Janae Ballard CPC, CPMA, COC, CEMC

Past• S.O.A.P Note

• Subjective• Objective• Assessment• Plan


• Created by Dr. Lawrence Weed, MD

• 1970’s• Retell the story• Anyone could read the note

and know what is going on

• Paper Charts, Handwritten notes, Dictation

• Illegible• Too short/vague• Notes could be lost or

destroyed

Past• 2009-HITECH Act of 2009

• $25.9 billion paid to providers/health systems for the adoption of EHRs

• 2012- 78% of providers/health systems had transitioned to EHR

• 2015- financial penalty for providers/groups not using an EHR


Current• 1995 and 1997 E/M Documentation Guidelines

• 24 and 22 years old• Don’t support EHR work flow and current documentation

• History and Exam are over documented, pre-populated, auto added to templates• Det or Comp History and Exam-could drive the E/M level higher• Medical Necessity

• Assessment and Plan• Copied• Problem Lists• No associated Plan• Contains past and current info

• Smart set phrases• Canned notes• Incorrect info


Current• Lack of detail/specificity of the visit,

patient, status, treatment• Wrong Data• Templates• Long notes• Preset Negatives

• Overdocumentation• Copy/Paste• Cloned/Canned notes• Contradicting documentation• Irrelevant information• Female ROS/Exam in a Male patient chart

and vice versa


Current• 2019/2010 Update to E/M Guidelines• CMS – updating E/M policy to include documentation, coding, and payment changes to reduce administrative

burden and improve payment accuracy effective 1/1/2019• Continue to use 1995/1995 E/M Guidelines but with modifications• Elimination of the requirement to document the medical necessity of a home visit in lieu of an office visit;• For established patient office/outpatient visits, when relevant information is already contained in the medical record,

practitioners may choose to focus their documentation on what has changed since the last visit, or on pertinent items that have not changed, and need not re-record the defined list of required elements if there is evidence that the practitioner reviewed the previous information and updated it as needed. Practitioners should still review prior data, update as necessary, and indicate in the medical record that they have done so;

• New and established E/M office/outpatient visits, practitioners need not re-enter in the medical record information on the patient’s chief complaint and history that has already been entered by ancillary staff or the beneficiary. The practitioner may simply indicate in the medical record that he or she reviewed and verified this information; and

• Removal of potentially duplicative requirements for notations in medical records that may have previously been included in the medical records by residents or other members of the medical team for E/M visits furnished by teaching physicians.


Future• 2021 Proposed Updates to the E/M Guidelines

• CMS will further reduce burden

• CMS believes these policies will allow practitioners greater flexibility to exercise clinical judgment in documentation, so they can focus on what is clinically relevant and medically necessary for the beneficiary

• Payment for E/M office/outpatient visits will be simplified


Future• Reduction in the payment variation for E/M office/outpatient visit levels by paying a single rate for E/M office/outpatient visit levels 2 through 4 for

established and new patients while maintaining the payment rate for E/M office/outpatient visit level 5 in order to better account for the care and needs of complex patients;

• Permitting practitioners to choose to document E/M office/outpatient level 2 through 5 visits using medical decision-making or time instead of applying the current 1995 or 1997 E/M documentation guidelines, or alternatively practitioners could continue using the current framework;

• E/M office/outpatient levels 2 through 5 visits, we will allow for flexibility in how visit levels are documented— specifically a choice to use the current framework, MDM, or time. For E/M office/outpatient level 2 through 4 visits, when using MDM or current framework to document the visit, we will also apply a minimum supporting documentation standard associated with level 2 visits. For these cases, Medicare would require information to support a level 2 E/M office/outpatient visit code for history, exam and/or medical decision-making;

• E/M time -practitioners will document the medical necessity of the visit and that the billing practitioner personally spent the required amount of time face-to-face with the beneficiary;

• Implementation of add-on codes that describe the additional resources inherent in visits for primary care and particular kinds of non-procedural specialized medical care, though they would not be restricted by physician specialty. These codes would only be reportable with E/M office/outpatient level 2 through 4 visits, and their use generally would not impose new per-visit documentation requirements; and

• Adoption of a new “extended visit” add-on code for use only with E/M office/outpatient level 2 through 4 visits to account for the additional resources required when practitioners need to spend extended time with the patient.


New Services that match current/new technology

• Brief communication technology-based service, e.g. virtual check-in (HCPCS code G2012)

• Remote evaluation of recorded video and/or images submitted by an established patient (HCPCS code G2010)

• Chronic care remote physiologic monitoring (CPT codes 99453, 99454, and 99457)

• Interprofessional internet consultation (CPT codes 99451, 99452, 99446, 99447, 99448, and 99449).

• Prolonged preventive service(s)HCPCS codes G0513 and G0514

• RHC/FQHC Virtual Communication Service HCPCS code, G0071


Thank YouNew coding webinars the first Thursday of every month.

Next webinar on May 30 on Achieving and Protecting Sepsis Reimbursement from Maggie DeFilippis, JD, RN, CPC, CCS, CCDS, CDIP

Next Coding Webinar on June 6 on Preventive Services from Lynn Handy and Janae Ballard

codingaid’s 2019 highlights from healthcon · 2019. 5. 21. · • 2009-hitech act of 2009 •...

Documents