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