Don’t Assign E/M Codes Based Solely on the Length of the Documentation

Coding an E/M visit based on the physician’s documentation is an art form -- but selecting a code simply based on the volume of documentation is just bad form. National Government Services (NGS), a Medicare payer in 26 states, recently published its "Post Pay Probe Results for Evaluation and Management Services" on its Web site.

The carrier noted that it downcoded subsequent hospital visit stays that several providers billed because the visits didn’t meet "policy documentation requirement guidelines." Interestingly, NGS indicated that some providers billed based on the amount of documentation rather than what the physician actually said in the documentation.

"The volume of documentation should not be the primary influence upon which a specific level of service is billed," NGS noted in its summary of findings.

The habit of coding based on the length of documentation is common. You should always base your code choice on the documentation’s content.

Transitional discounts for out-of-network patients

If you have recently terminated a contract with an insurance carrier and now have become an “out of network” provider, how best to deal with your affected patients? Of course you will need to notify them of your decision to do so but how do you structure an appropriate fee structure so that you minimize the potential loss of patients? 

 

Many practices in this situation have had success using the phrase “transitional discounts” when implementing a pricing structure for out-of-network patients. The concept helps keep the patients in the practice (i.e. they don’t bolt to an “in network” provider) but doesn’t permanently reduce fee schedules for out of network patients.  It will take a bit more management but financially this is a good idea in the longer run.  

Uncomfortable collecting patient copays?

There are many front desk people who are uncomfortable asking patients for copays even though it is part of their job description. Is there any easy way to overcome this apprehension? One idea is not to confront the patient directly with a request for money. When patients check in for their appointment, greet them, sign them in, and then ask with a pleasant smile if they happen to know what their copay is. You then quietly take out a receipt book from your desk and with pen poised and a warm, expectant smile on your face, waiting patiently. Most patients will pay on the spot……and if there's a problem paying by cash or check, be sure to tell them which credit cards you take.

And if the patient doesn’t know what their copay is, always request a payment of $25 – it’s easier to issue a refund that to try to collect copayments!

This Checklist Gets You Clean Claims

Has your office ever received a claim that was "denied due to insufficient initial reporting"? If not, consider yourself in the minority, because insufficient initial reporting is a leading cause of claim denials. What to do? Help your office get it right the first time by printing out this checklist as a guide to clean claims. Post it wherever claims are processed, so you can check the list before sending every claim to ensure accuracy:

So your claim’s ready for submission? Have you:

·         made sure the policy number and ID number are accurate?

·         obtained insurance eligibility verification?

·         verified other patient information (proper name, birth date, address, etc.)?

·         confirmed the information the provider gave you for posting charged entries?

·         checked that Current Procedural Terminology (CPT) and ICD-9 (diagnosis) codes are up-to-date and as specific as possible?

·         made sure that you have the referral authorization number on the form (if applicable)?

·         made sure that you included the referring doctor’s UPIN or HPI (if required)?

Ensure patient documents are legible and complete

Want to help keep your medical office’s documentation crisp, complete and legible? Use this checklist to make sure that your patient files pass muster if an auditor ever comes calling.

 

PATIENT DOCUMENT CHECKLIST

 

Before you file away that patient document or send it to an insurance carrier, take a minute to look at the file and ask yourself:

 

Is the documentation legible?

Does the documentation substantiate the patient service?

Does the documentation clearly identify the provider of the service?

Is the documentation complete and accurate?

Can you read the documentation?

 

If you can’t answer "yes" to all of these questions, don’t file or mail that document - fix it first!

Separate reception and telephone staff (If you can)

No matter what sort of technology you use to keep communications flowing efficiently, some days it seems the phones never stop ringing in your practice. Callers require appointments the same day they call, want to know about ongoing treatments or medications, or even need immediate emergency attention.

If your receptionist answers all these calls, how can she or he properly greet and register patients and parents? Different medical practices have different styles. In general, try to have separately dedicated telephone and reception staff. And resolve that never the twain shall meet.

Teach your telephone staffers how to answer the phone properly. Also, help them learn how to deal with more than one call at a time. Don't expect this phone person to sign patients in or out on top of that. Too much will fall through the cracks during harried times.

Hospital-Physician relationships – the Feds want to know more about them

The Centers for Medicare and Medicaid Services (CMS) has confirmed that it plans to proceed with plans to distribute the Disclosure of Financial Relationships Report (DFRR) to 400 private sector, for-profit and not-for-profit, general acute care and specialty hospitals throughout the Untied States. CMS' purpose for distributing the DFRR is to identify arrangements that potentially do not comply with federal self-referral laws, such as Stark, and to identify areas of non-compliance that will assist CMS in further rulemaking. To accurately complete the report, detailed information and support documentation will be required for disclosure including, physician investments in the hospital; physician joint ventures; and physician compensation arrangements with the hospital (i.e. medical directorships, service agreements and on-call arrangements).

Let’s get down and tweet

Okay, I’ve finally succumbed to all of those “pundits” that say you need a twitter account to further your communications with clients, colleagues, friends, etc………..like any gives a ^&*# what I’m up to. Really don’t know yet what my tweet “strategy” is going to be but I hope you’ll drop by and check out my postings from time to time.

The New York Times calls Twitter "one of the fastest-growing phenomena on the Internet." TIME Magazine says, "Twitter is on its way to becoming the next killer app," and Newsweek noted that "Suddenly, it seems as though all the world's a-twitter." What will you think? http://twitter.com

The dreaded favored nations clause

While you are in the process of renegotiating your contract with a managed care carrier, they want you to sign an agreement that states that the rate being offered will remain as favorable as those granted to other carriers (i.e. their competition).

 

Should you ever grant any other carrier a more “favorable” rate (i.e. a higher rate), you will need to notify the carrier within 30 days and the contract will then be amended to the more favorable rate, and all overpayments shall be refunded.

 

To make matters worse, the carrier tries to insert a clause that says it shall have the right to audit your books upon 90 days notice, to determine if the rate is favorable.

 

As experienced healthcare people know, this is the dreaded “favored nations clause” that many payers try to put in to their provider agreements. NEVER sign an agreement with this type of clause in it – seeing how it can shackle a practice should be painfully obvious.

HIPAA: Children in the office

Reproduced from [name of publication] © 2008 HCPro, Inc., 200 Hoods Lane, Marblehead, MA 01945. 781/639-1872. www.hcpro.com. Used with permission.

What if one of your employees on occasions have one of their children stop by the office and the child sometimes waits for the employee in his or her in her office – and this office contains patient charts. Is this a HIPAA violation? How would this pertain to a physician’s spouse who would wait in the physician’s private office where charts could be found?

This should not be a HIPAA violation, if reasonable steps are taken to protect patient privacy. Keeping patient records closed and out of the reach of small children is a good first step. Older children should be educated about patient privacy and the expectation that they will not access confidential information.