Kareo - Your Medical Office Software: Coding Pitfalls and Promises

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Your Medical Office SoftwareCoding Pitfalls & Promises

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Your Hosts Today…

Betsy NicolettiMS, CPC

Lea ChathamContent Marketing Manager, Kareo

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Our Schedule for Today…

1 Introduction & Welcome Betsy

2 Your Medical Office Software: Coding Pitfalls & Promises

3 Discover Kareo’s Role

4 Answer Questions

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Betsy Nicoletti, MS, CPC

Speaker, writer, and consultant in coding education, billing, and accounts receivable

Author of The Field Guide to Physician Coding

Founder of Codapedia.com

Developer of The Accurate Coding System

MS in organization and management

20 years experience in medical coding

Member of MGMA & the National Speakers Association

Betsy Nicoletti, MS, CPCwww.betsynicoletti.com

[email protected]

@BetsyNicoletti

http://www.codapedia.com/

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4 Answer Questions

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Agenda

Use coding functions in software to improve accuracy

Describe key audit functions in EHRs that support compliance

Develop a copy/paste policyDiscuss the pros and cons of Evaluation and

Management calculators in the EHR

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Use Software to Improve Accuracy

Complete coding descriptions reduce errors Incomplete CPT code descriptions can lead to

incorrect codes selected

Discourage users from changing descriptions of ICD-9 and CPT codes

ICD-9 codes that are changed are often least specified

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Set Coding Edits

Modifier use Edits that remind user when modifier

needed Pre-adjudication edits

Medical necessity editsLinking For vaccines, preventive medicine service

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Verify Eligibility, Coverage

Use these functions prior to patient arrivalAllows you to collect patient due amounts,

discuss finances with patient

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Templates for Procedures

Can be very helpful, save typingCan be tied to CPT codesPitfall: can be too generic and non-descriptive “IV was removed and pressure applied for 3-5

minutes or until bleeding stopped”

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In the beginning, was the stimulus

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“Robert Burleigh was overbilled for an emergency-

room visit because the hospital’s electronic records included examinations he

had not been given.”

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Letter from HHS and Attorney General

“Troubling indications…game the system… potential cloning”Katherine Sebelius and Eric Holder in a letter

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Protect the Integrity of the Medical Record

Purpose is clinical Other providers must be able to treat from the

recordMisleading, inaccurate entries must not be

tolerated by physician leadersBilling is secondary!

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Key Audit Functions

OIG recommendations are described on coming slides as “required” in their report but are not mandates

These are their recommendations, not current requirements

These are suggestions to CMS and the ONC CMS developing guidelines

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OIG report: OEI-01-11-00571

“CMS and its contractors have adopted few program integrity practices to address vulnerability in EHRs”

January 2014

Contractors not looking for this

OIG recommends CMS develop policies

CMS agrees “We will.”

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From the New York Times

19

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OIG report: OEI-01-11-00570

“Not all fraud recommended safeguards have been implemented in Hospital EHR Technology”

December, 2013

Audit trailCloningOverdocumentation

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OIG Audit Recommendations

Have an audit logMethod of entry should be logged (direct,

copy/paste/import)Track original author when info entered by

someone else (e.g., medical assistant) Changes tracked by addendum, original saved

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OIG User Access Recommendations

Use user IDs and passwordsUse provider National Provider Identifier to

restrict access “Auditor” class user to have read only access

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OIG E/M Recommendations

Requires that EHR technology not prompt an EHR user to add documentation but be able to alert a user to inconsistencies between documentation and coding.

“Just add family history and you get a four!”

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OIG Patient ID Recommendations

How do you know the patient is really Betsy Nicoletti?

Prior relationship Picture ID Photo then imported into medical record


Overdocumentation is the practice of inserting false or irrelevant documentation to create the

appearance of support for billing higher level services. Some EHRs auto-

populate fields when using templates. Other systems generate extensive

documentation on the basis of a click of a checkbox, which if not

appropriately edited, may be inaccurate. Such features can produce information suggesting the practitioner preformed

more comprehensive services than were actually rendered.

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Templates & Copying Notes

Is using a template any different than copying from previous note?

Templates: can encourage documenting elements that aren’t needed

“Sameness” about notes Need enough variety of templates to accommodate

different types of visits and problems


Copy-pasting, also known as cloning, allows users to select information from one source and replicate it in another

location. When doctors, nurses, or other clinicians copy-paste information but fail

to update it or ensure accuracy, inaccurate information may enter the

patient's medical record and inappropriate charges may be billed to

patients and third-party health care payers. Furthermore, inappropriate copy-

pasting could facilitate attempts to inflate claims and duplicate or create

fraudulent claims.

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Develop a Policy

“Just say no?”Policy: who imports PFSH, how do we know the

clinician reviewed itMedical director input into policyParticularly troubling for inpatient records

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Hospital Visits

This note looks familiar

Entirely copied from previous day, and “edited”


With copying and pasting notes in EHRs, the rule is that you should

not document it if you did not ask it, review it, examine it or

consider it. If you copied from a previous note, read your new note and see if it contains any details that do not meet one of those

criteria. If so, delete that element.

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What Makes Sense?

78 y.o. m. w/COPD, pulmonary nodules…

45 y.o. f w/stage 2 breast cancer, tx’ed…

7 y.o. w/ADHD who… Update ages and add

detail as needed

“Since our last visit, he reports feeling increasingly SOB, unrelieved by inhalers,…”

Yes, copy the clinical summary

Always new: “Since last seen”


Clinical summary

Pleasant 58-year-old with a past medical history of coronary artery disease,

previous acute coronary syndrome. He had bypass surgery. His last cardiac

catheterization was June 2011. At that time bypass grafts were patent. The third obtuse marginal demonstrated 80 percent

stenosis in the proximal third. The RCA demonstrated 100 percent proximal

stenosis. The mid RCA was supplied by collaterals. There was diffuse coronary

disease. Ejection fraction was 55 percent. There was no intervention at that point in

time.

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“Since last seen…”

Now, the HPI elements that describe patient’s condition

This is the new work and part we will credit for the elements of the HPI

Status of three chronic diseases: yes, if new and updated

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Assessment

Should contain only problems addressed at this visit

Avoid listing all of the patient’s problemsUpdate status of patient’s conditions

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Use or Not Use E/M Calculators?

Do they work?Will they result in coding higher or lower than

note audited by an auditor?Will they result in coding higher or lower than

code selected by the clinician?

Goal: Accurate Coding!

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History in the E/M Calculator

Can only read structured fields: HPI is often free texted

ROS, PFSHMake sure fields have information when clinician

checks “Reviewed, no changes”

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Exam

Easiest part of note for EHR to auditBut, find out which guidelines are used: 1995 or

1997Probably doesn’t have 1997 single specialty

exam in system

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Medical Decision Making

Complexity: hardest part for an auditor, hard for a machine

New or established problem to examiner?May over count dataTable of risk—probably needs physician input

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Check Accuracy

Physician is responsible for coding submitted under his/her provider number

Coder who is experienced auditor should review sampling of notes if using E/M calculator

Should allow for override by physician in both directions: “It just wasn’t that complicated”

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Audit Strategies: New Patients

Select three common conditions for new patients Specialty specific: frequency, headache, shoulder

pain

Select three encounters for this service Review the notes What is the level of template? Does the HPI tell the story? Do they look eerily the same?

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Audit strategy for established visits

Select patients followed multiple times in a year for chronic conditions

Do not include acute visits in this sample Review sequential encounters Look at HPI and A/P for identical documentation

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Engaging Physician Leadership

Print out and review both OIG reportsPrint out Documentation Guidelines Research your EHR’s audit functions (who

entered data, time stamp)

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Show Results of Audit

Save audit results as part of compliance activities

Celebrate

Review problems with managing physician

Review with clinical staff

Develop a plan that emphasizes patient care

No problems Problems

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4 Answer Questions

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Discover Kareo’s Role

Cloud-basedMedical BillingPatient Payment ServicesInsurance Billing & RemittanceScheduling & Practice ManagementElectronic Health RecordsMedical Billing ServicesEducation, Training, & Support Included

20,000 Providers Nationwide

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Educational Resources

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•Kareo EHR• Built-in templates• Template editing• Set user

permissions• Superbill

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permissions• Superbill & E/M

Code Assistant

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permissions• Superbill

• Kareo PM• Eligibility

verification• Code scrubbing• Set user

permissions

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4 Answer Questions

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Kareo - Your Medical Office Software: Coding Pitfalls and Promises

Health & Medicine

Transcript of Kareo - Your Medical Office Software: Coding Pitfalls and Promises