Medicare reform, risk adjustment, and the expanded role of medical coders in today’s physician practices were among the many topics discussed during HEALTHCON 2017 sponsored by the American Academy of Professional Coders (AAPC). More than 2,500 billing and coding professionals attended the event that took place in Las Vegas earlier this month.
This year’s agenda included a wide variety of sessions covering denial management, evaluation and management (E/M) challenges, auditing, HIPAA, practice management, and various specialty coding topics that went beyond coding basics to include anatomy, pathophysiology, and an in-depth discussion of procedures and treatments. An overarching theme throughout many of these sessions? The value that credentialed coders bring to physician practices—especially during the transition from fee-for-service to value-based reimbursement.
“The coding industry is at the heart of how we establish value,” said keynote speaker Mike Leavitt, former governor of Utah and former secretary of Health and Human Services. “There will be an enhanced need to figure out who is doing a good job. That’s going to require coding in some form and in some way.”
Strive for Coding That's "Truly Meaningful"
During a packed general session, Raemarie Jimenez, CPC, CDEO, CPB, CPMA, CPPM, CPC-I, CANPC, CRHC, manager of new product development at AAPC, told attendees that coding will be critical regardless of how payment models change and evolve. She cited several examples of why accurate and consistent coded data is so important:
- Coded data helps payers anticipate costs and assign value.
- Coded data helps physicians gauge efficiency and profitability.
- Coded data allows researchers to identify disease trends and develop proactive treatments.
“It all goes back to the coded data we’re collecting and the codes we’re reporting,” she said.
Jimenez said coders can help physicians improve their documentation so the coded data they report accurately reflects the quality care they provide. She encouraged coders to help physicians make the record a “truly meaningful piece of information.” Capturing the patient’s complete clinical picture helps physicians be successful in any and all value-based payment models going forward, she added.
For example, coders can leverage their skills to select quality measures that will be most advantageous for the practice, develop templates to capture relevant documentation, and provide ongoing feedback to physicians regarding coding and documentation compliance.
Coders Must Stay Informed and Partner With Physicians
During an equally packed general session, Stephanie Cecchini, CHISP, CPC, CEMC, vice president of products at AAPC, also encouraged coders to share their knowledge with physicians, many of whom she said are “drowning in documentation but dying of thirst for information.”
Coders must constantly strive to expand their skills and keep up with ever-changing regulatory requirements, said Stephani Cecchini, AAPC VP of products, adding: “If you’re not doing something to stay current, you’re going to be left behind."
One of the most popular sessions was a panel discussion about E/M ambiguities. The three-person panel, which included one healthcare attorney, a physician, and a payer representative, fielded a variety of questions from the audience pertaining to the role of electronic health records (EHR) in E/M compliance. For example, one attendee asked about the challenges associated with copy and paste functionality.
The record must always be a true representation of the work performed, said Michael Miscoe, Esq., CPC, CPCO, CPMA, CASCC, CCPC, CUC, panelist and founding partner of Miscoe Health Law, LLC. “If the record isn’t credible, then what have you got? You’ve got nothing,” he said.
Copy and paste can be useful when referencing a complex clinical description but that physicians should always be mindful when using it for other purposes, said panelist and osteopathic physician Michael Warner, DO, CPC.
Panelist Annie Boynton, COC, CPC, CPCO, CPC-P, CPMA, CPC-I, echoed this, saying payers are working on software that would allow them to easily pinpoint and flag repetitive phrases in physician documentation. Boynton is a payer expert and principal of Boynton Healthcare Management Solutions.
Another attendee asked about the potential for upcoding E/M levels when using an EHR. Boynton said upcoding is a real risk and that physicians must be careful when using templates. She encouraged attendees to remind physicians to use free text in the assessment and plan to substantiate any buttons they check in the template.
Legal Questions About HIPAA Compliance and EHRs
During an equally popular panel discussion about legal trends, six healthcare attorneys answered a variety of HIPAA- and EHR-related questions from the audience. Following are a few noteworthy ones:
- Can we use one EHR password for everyone in the office? Everyone in the office should have their own password, especially during this time of heightened medical identify theft, said Julie E. Chicoine, JD, RN, CPC, CPCO, member of the AAPC legal advisory board. “When you have a single password, you’re undermining the integrity of your privacy and security programs,” she added.
- How should we handle gray areas of medical-decision making (MDM)? Develop a consistent internal policy, and audit your records using that policy, said Miscoe.
- What responsibility do coders have to accept a physician’s code selection in the EHR—particularly when they know a code is incorrect? Coders should advise physicians about a potential code error, but they ultimately can’t control what the physician chooses to report, said Miscoe. Coders are legally at risk when they’re in collusion with the physician, he added. He urged coders to document their efforts to alert the physician about the error. Christopher A. Parrella, JD, CPC, CHC, member of the AAPC legal advisory board, agreed, stating coders should record what they tell the physician and when—and keep the file at home.
- Can we offer self-pay discounts to patients with high deductible health plans who prefer to pay out of pocket? It all depends on the contract, said Miscoe. Some insurer contracts don’t allow physicians to charge amounts that are lower than the contracted rate.
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