In an article written by Deborah Hale for the April 2010 issue of ACP Hospitalist, Deborah discusses how a diagnosis of acute respiratory failure can affect documentation and payment.

With average cost, length of stay and mortality rate comparisons so much a part of today’s health care delivery system, it is important that a patient’s diagnosis be recorded to the highest level of specificity. Hospitalists should always document the most severe form of the disease process that accurately explains the circumstance of an admission. Read the full article.

As the demand for hospitalists continues to outstrip supply, one route to enhance the hospitalist workforce continues to gain currency: hiring midlevels. As either physician extenders or as niche providers, the thinking goes, physician assistants and nurse practitioners will go a long way toward helping hospitalists treat the swelling ranks of inpatients. Read the full article.

Ever wonder what it takes to maximize patient collections? Is it offering flexible payments plans or even accepting credit cards? Maybe it’s putting up a sign explaining the rules regarding co-payments? These are just a few questions that you may want to ask yourself when it comes to maximizing patient collections. Read the full article.

The Centers for Medicare & Medicaid Services communicated to Medicare carriers last month that consultation codes (99241-99245 and 99251-99255) have been removed from the Medicare Claims Processing Manual. Effective, Jan. 1, 2010, consult codes will no longer be recognized for Medicare Part B payment.

In an article written by Phyllis Maguire for the January 2010 issue of Today'sHospitalist, Phyllis discusses how Hospitalists will be affected by this change.

“the coding change could have a ripple effect on hospitalists’ role vis-a-vis subspecialists. Even as hospitalists take on a growing number of admitting services, some experts wonder if subspecialists might be tempted to reclaim a larger role as attendings so they can bill more complex admissions.” Read the full article.

Written by Kathy Cramer, CEO of Professional Practice Resources

 

While physicians may worry about being audited because they’re overreaching when it comes to coding, recent data reveal that hospitalists face the opposite problem: They consistently undercode their work.

 

To get an idea of the scope of undercoding, you need look no further than the Centers for Medicare & Medicaid Services (CMS). In the late 1990s, the CMS established the comprehensive error rate testing (CERT) program, which audits more than 100,000 claims each year to determine how many Medicare payments were incorrect.

 

You’ve no doubt seen the results of this program in news stories that highlight how much money Medicare is overpaying physicians and hospitals. But the program also tracks underpayments, and CERT analyses consistently find that many E&M services are undercoded. Not surprisingly, codes that hospitalists use are on that list.

 

According to the latest CERT findings, for example, inpatient follow-up consults (CPT 99261) are undercoded 17% of the time. And as a group, subsequent care inpatient codes (99231-99233) make the list of the top 20 claims that are consistently undercoded.

 

While national studies estimate that physicians lose up to 9% of the revenue they should receive because of undercoding, one hospitalist practice that we worked with was taking a 20% hit in reimbursement for subsequent care days because the physicians rarely used the highest level of coding. The group instead opted for 99232 in almost every case, regardless of the patient's condition. After reviewing their documentation practices and showing the physicians their CPT productivity reports each month, the doctors began coding more accurately.

 

Why do doctors undercode? While it may seem counterintuitive that physicians would bill Medicare for a penny less than what they’re owed, there are some basic explanations. For one, many physicians lack a true understanding of E&M coding, a system that even the CMS allows can be subjective.

 

Some physicians try to be conservative with their coding to avoid scrutiny by insurers and auditors. They may think that downcoding or using the same level code for all visits is playing it safe.

 

One physician we worked with went so far as to use subsequent visit codes rather than the critical care codes he was entitled to. Why? He said that he wasn’t sure how to properly document critical care services, even thought he was actually doing a good job documenting not only the time he was spending, but other key factors like the patient’s medical condition and his own decision-making.

 

Other physicians, particularly those working in larger institutions, may be using an electronic medical record system. While this technology can be a huge time-saver, these systems often suggest CPT codes without taking into account factors that would warrant using a higher code.

 

One EMR system we reviewed, for instance, used an outdated diagnosis system, leading to downcoding visits. Another system didn’t include the physician's remarks or notes, which also resulted in significant downcoding.

 

What can you do to make sure you are correctly coding your visits? Here are some suggestions that have worked for our clients:

 

1. Analyze your coding patterns. A good start is to make sure that your billing company provides you with a CPT productivity listing each month that shows how many of each CPT codes are being billed.

 

Understand that insurers want you to bill the appropriate level of care and that any one code that is used exclusively will raise a red flag. You should be reporting fewer highest level and lowest level codes, using middle level codes most often. For subsequent care visits, for instance, use the mid-level code of 99232 at least half of the time, and then use either 99231 and 99233 for the other half of patient visits.

 

Some insurers give physicians quarterly or yearly reports showing how their coding patterns compare with their peers and norms. If your statistics are significantly different, you need to figure out why.

 

2. Don’t blindly trust codes suggested by a computer. Be wary of EMR systems that promise to take care of all the coding for you, because many of your patients can’t be neatly categorized by a computer program. If the system uses a template, for example, review it for completeness and accuracy. And make sure the system includes the contents of any freeform notes that you provide when it chooses a code.

 

The software’s ICD-9 listings need to be updated each year, and all conditions that apply to the visit should be noted. If you can’t review codes that the system is choosing each time, at least review a sampling each month. Make sure the system properly documents any consults, notes any referring physicians and generates a report.

 

3. Invest in a coding audit. Make sure that any audit includes subsequent education for all the physicians in the practice. Discuss audit findings and make sure physicians are aware of any coding irregularities. This corrective action will more than pay for itself with better documentation, fewer demands from insurers for refunds and maximized collections.

Number 8 on the Oprah Winfrey “Smart Patient Checklist” is “Get To Know Your Hospitalist”.

“Your regular doctor is your go-to gal for the coordination of all your illnesses and treatments. But, they aren't around when you're in the hospital. That's where a hospitalist steps in.”

"They know all the programs and the protocols. They're going to work closely with you to make sure you get what you need done," Dr. Oz says. "Find that person, learn who they are and work with them. That's the person that's going to help you get out of there quickly." … a quote from Dr. Oz on the Oprah Winfrey show.

Dr. Oz's Smart Patient Checklist, 8 Ways to Avoid Medical Mistakes. Read the full article.

It’s funny; yesterday I was just having a conversation with someone about twitter and healthcare. Now I find an article about hospitals using social networking to educate and market to patients. I probably should not be surprised about this because it seems that everywhere I turn now I hear about “twitter”. The only thing I am upset about is that I did not think of it first – I will add it to the list…

So, with that said – If you ever wanted to know what twitter is, I will tell you:

Twitter is a free social networking and micro-blogging service that enables its users to send and read other users' updates known as tweets.

Tweets are text-based posts of up to 140 characters in length which are displayed on the user's profile page and delivered to other users who have subscribed to them (known as followers). Senders can restrict delivery to those in their circle of friends or, by default, allow anybody to access them. Users can send and receive tweets via the Twitter website, Short Message Service (SMS) or external applications. The service is free to use over the Internet, but using SMS may incur phone service provider fees.

Now that you know what twitter is  – Its time to sign up for your own account and get started with social networking for you and your practice: www.twitter.com

Good Luck!

Everyone can agree that preauthorization in healthcare is the process of obtaining advance approval of a treatment plan proposed by a medical professional. The disagreement begins when deciding whether preauthorization is about providing patients with the best possible quality of care or reducing healthcare costs…

Radiology Today has an article in the April 2009 issue discussing the mixed results of preauthorization in the field of Radiology. The article is written by Kathy Hardy and is also available online. Read the full article.

Because we are a billing company that specializes in billing for hospitalists... I could not pass up this article I found on Today's Hospitalist website. This is becoming my go to resource when it comes to updates in the industry. In an article written by Tamra McLain, Tamra discusses how to split up billing when sharing care with multiple physicians. Read the full article.

In an article written by Kathy Hardy for Radiology Today, Kathy discusses the use of speech recognition in radiology. The article is supported by a few good case studies, especially one on The University of Mississippi Medical Center.

“We recognize that speech recognition technology is not perfect, but neither was the old transcription method”, Timothy McCowan, MD, radiology department chair at the University of Mississippi Medical Center.

The article does not just cover the positives but also the negatives of rolling out a new speech technology.

The article titled “Talking It Through” is the cover story for Radiology Today's March 2009 issue - It is definitely worth a read.

Read the full article.