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Coding For RCM Managers
- 1. Coding for Radiology Practice Managers Brigette LaBar October 12, 2009
- 2. Disclosure: Nothing to disclose I’m not a coder, but I play one on T.V.!
- 9. “ How is it a write-off?” “ They just write it off.” “ Write it off what?” “ Jerry, all these big companies …they write off everything.” “ You don’t even know what a write-off is.” “ Do you?” “ No, I don’t.” “ But they do, and they’re the ones writing it off.” “ It’s a write-off for them.”
- 18. Non-Specific Finding Guideline to Improve Specific Clinical Indications MVA Document the clinical indication in addition to MVA Where does it hurt? List all OR What part(s) of body rcvd trauma? Date of accident Check for Dates Specify the reason a size-date discrepancy is suspected Large for date OR Small for date Complications of pregnancy - specify R/O Pneumonia Specify the reason pneumonia is suspected SOB, difficulty breathing, Cough, Fever Abnormal test results Pre-Op Specify the operation to be performed Fever, Back Pain Abnormal test results Smoker Document the clinical indication SOB, difficulty breathing, Cough Abnormal test results Follow-up Specify what is suspected and why Where does it hurt? Swelling, Abnormal weight loss Abnormal test results Cancer List specific primary/secondary site Where does it hurt? Swelling, Abnormal weight loss Abnormal test results DEXA Screen Once every 365 days Is patient post-menopausal? Suspect XX or Rule out XX or Evaluate for XX Document the reason XX is suspected Where does it hurt? Swelling, Abnormal weight loss Abnormal test results History of XX Do NOT use if condition still exists Be specific about the disease Document clinical indications that disease has returned
- 21. 2009 Denial Rates by Payer * Source: athenahealth Coventry Healthcare 9.3% Medicare-B 8.7% Champus/Tricare 7.7% Wellpoint 7.3% United Health Group 7.2% Cigna 5.9% Aetna 5.6%
- 26. Questions?
Editor's Notes
- Show of hands – how many certified coders do we have in the room?
- AAPC Interventional coder CACs by MedLearn and others
- Managed staff costs means being able to manage the allocation of staff – forecast for new/loss of procedures No loss of throughput for illness, vacations
- Throughput = total procedures coded, total docs/hour Output = coded docs per coder per hour
- Show of hands You can’t improve what you can’t measure Measure -- yardstick vs. computer Increase throughput -- by increasing the number of procedures that go directly to billing without coder review Increase output – if you’re trying to manage without data. “when coders count, they aren’t coding”, Linda Weideman Identify errors -- most CACs flag coding errors somewhere in the coding process, allowing for corrections before the charge is posted and runs through a claim scrubber and allows for a certified coder to make corrections
- Beat their personal and practice best
- Can anyone suggest other variables?
- Facility interface – usually happens after facility changes their RIS
- Rad-stats from OIG Eliminate the bottom 20% of infrequently performed procedures from routine audits, but these should be audited at least once a year
- DOING an audit is not enough, DO something with the results! Area of concern example: outliers like higher rate for a certain procedure, downcoding due to lack of documentation
- Meet with facility to eliminate them from the RIS
- Industry benchmark – two days, show of hands Another TAT that is usually tracked by the RIS is from the exam completion to when the report is finalized Another TAT is the time from completion to receipt You could also track by facility – what might drive that variance?
- Aetna and Champus are at the top of the heap for not correctly applying the CCI rules Other types of incorrect denials Wellpoint tops the list of payers that require documentation
- Discrepancy rate – 98% of the time the physician is right