The devil is in the details for effective coding, but the real answer to improving compliance and increasing revenues lies in communication and relationships. Although these areas are challenging to tackle, they are essential elements in improving the total patient experience and are critical to demonstrating high-quality care at lower costs. We’ve found the most significant improvements come from:
- Breaking down the barriers between the clinical/business staff and the front and back ends of the revenue process.
- Engaging the physicians and soliciting their leadership throughout the process.
- Educating physicians, clinical support personnel, and coding staff about their roles and partnering with one another.
- Introducing the revenue integrity “conversation” into the day-today business of the practice.
In our experience, unbalanced and poorly defined roles and responsibilities among physicians, clinical support staff, and coding staff create repetitive problems. By addressing the following issues, you will experience the most immediate and substantive impact:
Ensure Physician Engagement
- Physicians understand the importance of data accuracy on clinical outcomes. Ensure they also understand its importance to billing compliance, which typically leads to revenue improvements.
- Stress that the team’s role is to help the physicians get credit for the work they are already doing.
- Show the physicians examples of how their work is not being accurately reflected in their documentation and the financial implications. Once physicians understand the importance of a team approach to coding, they often become champions of the process.
Make Sure Employees Understand Their Roles
- Help the coders understand that sharing their expertise with physicians is more valuable than piecemeal coding work.
- Coders can’t get inside a physician’s head and understand what was involved in the patient encounter strictly by reviewing the notes. Redirect coders to focus on higher-risk areas and to mentor physicians to better understand the connection between documentation and coding rules.
- Ensure your teams understand that accurate documentation is important for many reasons: improving care, ensuring compliant, accurate billing and prompt payment, and creating a high-quality patient experience.
Teamwork Requires Two-Way Communication
- Some physicians have little role in the coding and documentation process, and often coders “enable” them by making communication either nonexistent or not taking a team approach. Physicians may be right in questioning coding results, but it must be done with a sense of teamwork.
- Physicians who understand and respect the coder’s role, the complexity of their efforts, and especially how their own documentation drives the ultimate coding are engaged and work as team members with their coders. Some might approach other physicians about coding.
- Clarified roles and improved communication create positive changes among coding staff. They no longer need to play mind reader; instead they become advisors and confidants to the physicians.
- More direct and focused educational efforts with continuing feedback to providers keep things running smoothly.
- After initial clinic-wide coding education and subsequent one-on-one discussions between physicians and coders, there is typically significant improvement in E/M coding.
- Physicians appreciate the coding staff’s ability to be more current in their conversation and become real partners in integrating documentation issues into day-to-day business discussions.
- Clinical staff members have better working relationships with coding staff and overall documentation clarity improves.
- When problems are identified, staff members have better processes and communication in place to resolve them. In conclusion, by focusing your efforts on these areas for improvement, you will make a positive impact on compliance, you will better serve your patients, and staff engagement will improve. Improved efficiency and revenues will be your rewards.