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AAPC 2014 Seattle Regional Conference Review. Documentation Concerns for ICD-10. Presented by Lori Dafoe, CPC. Focus Points From AAPC Seattle Regional Conference. Presentation drafted from information provided by: Documentation Concerns for ICD-10 - PowerPoint PPT Presentation
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AAPC 2014 Seattle Regional Conference Review
Documentation Concerns for ICD-10
Presented by Lori Dafoe, CPC
Focus Points From AAPC Seattle Regional Conference
Presentation drafted from information provided by:
Documentation Concerns for ICD-10
Presented by Peggy Stilley, CPC, CPB, CPMA, CPC-I, COBGC
Agenda
• Benefits of Documentation• Best Approach• Examples
Benefits of Documentation
• “Documentation is only good if the next physician who treats the patient can pick up your record and know exactly what happened.”
Benefits of Documentation
• Improves compliance• Improves patient care• Improves clinical data for research
and education• Enables proper reimbursement for
services performed
Best Approach
• “The only person that likes change is the baby with a wet diaper.”
Best Approach
* Positive Attitude
Best Approach
• Introduction of Information in Steps
Best Approach
• Offering Solutions
ICD-9: 692.9 Eczema NOSSUBJECTIVE: This patient was sent in for consult for initial evaluation of a eczema. The patient has been treated with Elidel cream b.i.d. for six months but apparently this has stopped working now and it seems to make her more dry and plus she has been using some baby oil on her skin. Overall health is good.
EXAM: The patient has eczematous changes today on her face, trunk and extremities.
IMPRESSION: Eczema
ICD-10: L30.9 Dermatitis, unspecified (Eczema NOS)
ICD-10 Documentation Assessment FormPhysician Name: Dr. Crabby Date of Audit: XXXX
Reviewer (Auditor): Lori Dafoe, CPC
Chart Patient ID ICD-10-CM Description
1 A1234 L30.9 Dermatitis, unspecified (Eczema NOS)
In ICD-10-CM, in order to assign a code for dermatitis to the highest level of specificity, documentation needs to include type and causation.
DermatitisSUBJECTIVE: This 10 month old, black female, sent in for consult for initial evaluation of a lifelong history of atopic eczema. The patient has been treated with Elidel cream b.i.d. for six months but apparently this has stopped working now and it seems to make her more dry and plus she has been using some baby oil on her skin. Overall health is good.
EXAM: The patient has eczematous changes today on her face, trunk and extremities.
IMPRESSION: Atopic eczema
ICD-10: L20.83 Infantile (acute) (chronic) eczema
Summary
• Emphasize the need to move away from usage of unspecified codes.
• Update Templates (EMR or Paper).• Educate on changes with enough time to become
familiar with them.• Perform documentation assessments to see where
improvements are needed.• Provide clear, concise education on noted weaknesses.• Re-evaluate after implementation.
The role of your Billing Department
Presented by: Barbara Parker, CPC
Hints from AAPC Regional Conference
• Adapted from two presentations given by• Charitie Horsley, CPC• Owner of a billing service• Yvonne Dailey, CPC, CPC-I, CPB• Owner of Dailey Billing Services
Objectives
• Identify resources available• Explain how these resources will improve
efficiency• List some technology that could make the
Billing Department more efficient• Explain the ways all staff affects claims denials
Does your Billing Department Look Like This?
Automation
• Don’t underestimate the value of one minute
Times per day
Day Week Month Year Total Hours
1 minute 1 5 20 260 4.3
5 minutes
5 25 100 1300 21.7
10 minutes
10 50 200 2600 45.3
Communications
• http://www.televox.com/wellness-preventive-reminders/additional-resources/
• Great resource that Charitie referenced in her presentation
• Research showed:
• 85% of patents said that e-communications are more helpful than in-person or phone conversations
• 88% of patients want to receive digital reminders for preventive or follow up care
• More than 35% of patients who don’t follow treatment plans exactly said they would be more likely to do so if they received e-mail, voicemail, or text reminders
Examples
• Automated patient collections process• Utilizing Clearinghouse services for denial
corrections, appeal solutions and to analyze data
• Internet freebies such as WHO, AMA, and CMS• MGMA (Book: The Physician Billing Process:
12 Potholes in the Road to Getting Paid)
Key Items to Measure
• Timely filing loss• Working Productivity• Coding• Accounts Receivable• Workflow• Denials
One Resource
TITAN-a real-time, web-based application that provides comparative healthcare analytics on reimbursement, utilization and productivity for practices, service providers, and health systemswww.remitdata.com
Sample Analytics
• Denial management• E & M procedure code profile• Payer performance• E & M utilization with analysis• Clearinghouse analysis
Hire the Right People
Pre-Employment Skills Assessments Writing Spelling Basic math Keyboard 10-key Special Skills (coding, accounting)
Denials
• Documentation• Missed charges• Carrier policies determine billing codes
Common Billing Errors
• Patient cannot be identified• Address for the place of service, including a valid Zip
Code• E/M procedure code and place of service do not match• NPI missing or invalid• Diagnosis codes invalid• Procedure code/modifier invalid• Information needed when Medicare is a secondary
payer
Claims follow-up
• Don’t set to auto rebill every 30 days• Run reports from PMS• Assign staff for claims follow-up and make
them responsible
Other items to watch
• Payment posting• Denial management• Proof of timely filing• Appeals• Reports
Cost for NOT Working Denials
• 90 claims per day at $90 per claim = $8,100• If 10% denied = $810 in denial per day• If only 1 in 10 denials are appealed it = $729
per day• 52 weeks X 5 days – 20 days (vacation, etc.) =
240 working days• 240 working days X $729 = 174,960 lost per
year
In conclusion
Why Compliance?
Presented by: Marisa Clauson, CPC
Focus Points From AAPC Seattle Regional Conference
Presentation drafted from information provided by:
Dan Schwebach and Katherine Abel with AAPC Physician services
Michael D. Miscoe, PA, CPC
Agenda
• What Is Compliance?• Elements of Effective Compliance Programs• Legal Issues to Consider
What is Compliance ?
• It is Creating a Culture in your Organization:– A Culture of commitment to Correctness– A Culture of commitment to Consistency– A Culture of commitment to Communication
Effective Compliance Programs
• Helps to prevent erroneous and fraudulent claims submission resulting in :– Minimizing billing mistakes– Reducing chances of audits– Avoiding conflicts with laws such as Anti-Kickback
and Self-Referral.– Education
Effective Compliance ProgramsThe OIG has defined 7 elements that should be included1) Written Policies and Procedure2) Designate a Compliance Officer 3) Conduct Appropriate Training &
Education4) Develop Open Lines of
Communication5) Conduct Internal Monitoring and
Auditing6) Respond to Detected Offenses 7) Enforce Disciplinary Standards
Legal Issues to Consider
Our Biggest Challenge?? KEEPING UP WITH ALL THE CHANGES!
• Coding (CPT, ICD-9/ICD-10, HCPC)• Carrier specific rules with regards to codes and
policies.
What is Coding?
Coding Defined• Coding is essentially a short hand method of letting the
payer know what happened by providing alpha numeric codes to translate what occurred during the encounter.
Correct Coding• For a code to be correct it must be legally accurate
based on the code set we are given to follow. It must not mislead the recipient into a false belief of what services were provided.
What is Coding?
Legal Accuracy• The representation made must be accurate in the eyes of
the recipient based upon their rules.Legal Falsity • must not only contain a misrepresentation, but the
misrepresentation must be material to the decision to pay.Coding Rules• The individual coding rules (AMA/WHO/Payer) establishes
how a service must be represented so that it is properly understood.
Fraud or Abuse That is the Question
The False Claims Act -31 U.S.C 3729 identifies that the Government only has to prove that you were wrong - not that there was intent to defraud the government.
Mistakes are not fraud as long as your interpretation was reasonable as viewed by the court.
What If You Have Concerns Within Your Own Organization?
• Keep your resources updated• Address mistakes that are made• Identify Concerns – prove them by using binding
guidance.• Listen to alternate justifications objectively• Seek formal guidance if needed• Take the more conservative approach• Document efforts to resolve