Change in healthcare is continual, and many of the ongoing changes result in corresponding modifications to coding and billing practices. Hospitals and physician offices cannot afford to relinquish any appropriate payments, nor can they afford the penalties and potential risk associated with inappropriate coding and billing. We believe hospitals that dedicate the necessary time, energy, and resources to ensure accurate and appropriate coding will be well positioned to make the best of the uncertain healthcare financial environment.
When considering strategies to ensure accurate coding and billing practices, we recommend the following:
Invest in staff education and training–Procedure coding can only be as accurate as the knowledge and understanding that the staff possesses. The time and cost associated with adequate education and training for the coding staff is no doubt well spent! Codes are continually added, deleted, bundled, unbundled, or modified in other ways… Education for the staff must be ongoing with, at minimum, annual update sessions related to the intricacies of what has changed. For key hospital service lines, a subset of “dedicated” coders who are adept at the nuances in that particular specialty may be worthwhile.
Provide up-to-date coding references and resources, along with regularly-scheduled internal Chargemaster reviews – Hospitals should have the most current references related to DRG, CPT, and HCPCS coding readily accessible via online versions or in bound hard copy. We often recommend retaining past versions as well (a year or two) in order to have a reference of “old codes” should an issue arise from charts previously coded. Beyond the annual published references, codes will, at times, be altered throughout the year, so it is essential to receive quarterly updates from CMS and review and disseminate as appropriate to areas where codes are affected. Quarterly updates can be obtained from several websites such as http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets/HCPCS_Quarterly_Update.html
Perform regular internal documentation audits –In order to ensure accuracy, especially in procedural areas, regular internal coding and billing audits can assist in identifying any degradation in coding accuracy. This is critical if changes have occurred to either the codes or to the staff. In many organizations, clinical personnel may code procedures and the associated supplies, thus the responsibility for coding is spread across a large, diverse group of personnel, which may lead to inconsistencies. Regularly-scheduled or impromptu audits can identify areas where additional education or support is needed.
Understand the industry trends – Keeping abreast of current coding trends will help identify areas requiring additional resource materials or staff education. For example, RAC audits are closely scrutinizing implantable cardiac defibrillators (ICDs); thus, hospital leaders are wise to implement strategies that ensure physicians are aware of the appropriate documentation required to justify implantation. Further, the coders need to know the correct procedure and device codes to assure accurate payment for the care delivered.
Use solid documentation to validate billing – The value of detailed documentation cannot be underestimated as a means to corroborate billing codes. When revisions to codes occur, providing education or printed materials to physicians can help ensure that they are aware of what they need to provide relative to accuracy with documentation. Templates or examples can be distributed so they are aware of changes, and also clearly understand any new actions necessary on their part to support correct coding.
Corazon believes accurate coding and billing practices are critical to the organization at large and likewise to specific service lines, especially cardiovascular, neuroscience, and orthopedics, where the coding complexities can be difficult and multifaceted. Our experience across the country proves that constant monitoring of procedure and device codes for changes or additions—and providing education related to those changes—will only become increasingly important as the industry moves towards not only an ICD-10 system, but a bundled payment structure as well.
Marsha Knapik RN, MSN is an Account Manager with Corazon. Corazon offers consulting, recruitment, interim management, and physician practice & alignment services to hospitals and practices in the heart, vascular, neuro, and orthopedics specialties. Find Corazon on facebook at www.facebook.com/corazoninc or on LinkedIn at www.linkedin.com/company/corazon-inc. To learn more, call 412-364-8200 or visit www.corazoninc.com.