Practice Management: What You Don’t Know about Coding Could Hurt You

What do coding and popular Farmers Insurance commercials have in common?  They share an old adage: “What you don’t know can hurt you.” Coding is a fact of life in health care today, and physicians and their teams need more than the basics to be truly effective in maximizing reimbursement. There are a number of items that can make a difference when documenting patient care and services provided, including assigning the most appropriate codes. In fact, what you don’t know about coding can certainly cost you money.

While pretty much universally understood that physician reimbursement is based on codes that are submitted to the payer, here’s what you may not know:  Physicians benefit more financially when they select their own codes, understand the coding process, and are involved in the reimbursement cycle. “Don’t let your electronic medical records system code automatically. You will lose money that way,” says Emily Hill, PA, president of Hill and Associates, Inc., and a highly rated ACOG coding workshop instructor.

Codes not only document the reasons why a patient requires care and the care that was provided, but they also have important financial and evaluation implications. These include:

  • Payers using codes to create a profile of a practice and determining whether the provider is in synch with others’ standards of care or if it is considered an outlier; Outliers may incur increased payer scrutiny.
  • Employers using coding practices as a basis for physician performance evaluation in employment situations.
  • Regulators using coding practices in outcome studies.

The nuances of modern medical practice are captured in the current coding classifications schema. Medical practices are well advised to understand these nuances so that coding is thorough and accurate, which helps to ensure fair payment for services and avoid false claim allegations. All of the following can impact your reimbursement:

  • Differences between consultations, transfer of care, and referrals.
  • The definition of new vs. established patientsit isn’t as clear as it may seem.
  • Differences between inpatient and outpatient consultation coding—some payers still reimburse for these codes!
  • Key components in selecting the levels of service such as time factors.
  • The critical role of medical record documentation specificity.
  • The difference between risk factor reduction and behavior change interventions when practicing preventative medicine.
  • Concurrent care by physicians. 

    The timing is right to take a keen interest in your own coding practices. After some delays, the Department of Health and Human Services announced in the August 2012 final rule that the ICD-10 implementation date will be October 1, 2015.

    The Centers for Medicare and Medicaid Services has announced some flexibility in claims auditing and quality reporting process for the ICD-10 transition, for up to one year. But, there is no guarantee that payers will grant the same flexibility.

    With the October 1 deadline approaching, are you ready for the change to ICD-10? ACOG still has great training opportunities this year. Hurry to sign up, as most of ACOG’s coding workshops are already sold out:

    August

    Just added!  ACOG Coding Workshop – ICD-10 Hands-On Module 
    August 3, Washington, DC

    Just added! ACOG Coding Workshop – ICD-10 Hands-On Module SOLD OUT. NO ONSITE REGISTRATION PERMITTED 

  • August 21, Washington, DC
    More Information

    November

    Join ACOG for a coding workshop in Tampa, Florida, November 5-8. SOLD OUT. NO ONSITE REGISTRATION PERMITTED 

  • If you are unable to attend a coding workshop, take advantage of ACOG coding resources and free coding webcasts.  

    ACOG’s coding resources provide tools and guidance needed to code claims faster and more accurately. You can prepare for a successful transition to the new ICD-10 coding system with the latest Ob/Gyn Quick Reference ICD-9 to ICD-10 Crosswalk.

    To help you even more, ACOG offers the following ICD-10 webcasts at no cost:

Get ahead of the curve on coding so your practice can thrive and you can receive the reimbursement you deserve.

 

 

American Congress of Obstetricians and Gynecologists
409 12th Street SW, Washington, DC  20024-2188 | Mailing Address: PO Box 70620, Washington, DC 20024-9998