Opportunities for performance improvement vary greatly among practices and billing offices. Therefore, vendor provided edits built into enterprise software are insufficient for superior performance. Likewise, human auditing continually correcting coding errors without building in coding edits can prove costly and does not address the issue at the root cause.
Coding edits should be triaged and then follow a course of corrective action with proper routing – either reworked based on staff who created the original error, staff who can best rectify the problem, or by a custom designed coding edit.
To properly work coding edits, two pathways should be followed (1) triage accounts that need to be worked by staff who are best able to address them – eligibility, registration, medical necessity and other errors. This targeted feedback prior to bill drop helps identify patterns and directs training efforts. (2) Customized edits are built to focus on payer-specific billing requirements, known front-office process deficiencies, and should be evaluated and revised on an ongoing basis. Top performers have thousands of customized edits.
Traditional coding audits rely on concurrent review. However, this approach is not viable for most ambulatory settings since the patients are generally seen for a short period of time and physician practices can be dispersed across large geographical areas.
Since concurrent review or coding specialists on-site may not be an option for many practices, it is important to conduct routine coding audits with focused education sessions to ensure charge accuracy.
HWS can conduct regularly scheduled retrospective audits, which will allow revenue cycle leaders to identify sources of revenue leakage and help physicians with their coding needs from a training and revenue optimization perspective. Audits can identify outliers by specialty.
An audit can do the following:
1. Ensure accurate code selection and use of modifiers
2. Ensure complete capture of charges
3. Monitor compliance issues
4. Identify documentation improvement opportunities
5. Provide benchmarking to physicians and their practices.
As physician practices implement Electronic Medical Records (EMR), a transition is taking place from coding staff to physicians entering codes and ultimately charges. While this complete transition may represent a long-term goal, short-term challenges exist such as decrease in physician productivity and an increase in charge lag time. Additionally, many physicians struggle in accurately and completely capturing charges.
Typically, EMR design has been vendor and IT driven, with minimal physician involvement. Revenue cycle objectives have not been included in the design, which contributes to lack of physician acceptance.
HWS can assist in medical staff training, EMR template design and usage rollout across physician practices and can provide continual, incremental design improvements. Additionally, HWS can assist in reallocating charge entry staff, coding your backlogged accounts and providing charge entry audits to make sure your staff is accurately accounting for all charges.