"Practices are just so gun-shy and afraid they'll be called on the carpet," says Judy Allen, practice administrator with Advanced Surgeons. "But they're just causing themselves to lose money."
Though the charts may support a higher level of coding for visits for both new and established patients, practices still hold back. "The difference per visit is pretty small between levels, but it does add up when you multiply that coding per patient per week over 52 weeks by three doctors," says Mary Elliott, CPA, with Warren Averett Kimbrough & Marino.
To overcome that reticence to claim the full reimbursement, physicians should compare their office level coding quantities to Medicare's posted national average. "We don't want anyone to overcode, but if your physicians are in sync with that national average, then undercoding only means they're doing the same work for a lower reimbursement level," says Jim Stroud, CPA, with Warren Averett Kimbrough & Marino.
Practices have become so timid, they even strive to place themselves below the bell curve. But Allen says there's no need. "Every code has bullet points that are necessary to be able to qualify for that code," she says. "Just make sure you're covering all the bullet points during the time spent with the patient."
Training the doctors falls high on the list for ensuring accuracy. "When we see that office coding error, we educate the doctor," Allen says. "CPT codes change all the time. You have to keep the doctors up on them."
Allen says practices cannot underestimate the value of regular oversight by certified coders either. "We have three coders for our practice, and we're a five-physician practice," she says. They're about to add a fourth.
With the advent of electronic health records (EHR), practices will find greater coding accuracy, "but they're not foolproof," Stroud says.
One physician who thought he was documenting his work accurately had missed out on several coded reimbursements. He was clicking on the same button to record having viewed three perspectives of an injured shoulder. But the EHR required a different entering process for the second and third views, so they were never charted. "And that work goes uncoded with no reimbursement," Stroud says.
"The info on your EHR system is only as good as what you put into it," Allen says.
Beware of cloning, adds Elliott, where the EHR auto-fills certain fields for the physician. "It makes it easier, but you need to do some planning on the medical templates, especially for each specialty, to attain that accuracy," Elliott says.
Auditors stress that knowledge and oversight of coding can conquer any hesitancy to claim full reimbursements. They add though physicians feel frustrated over having no control over the dollar amount of their reimbursements, they can control whether they're gathering every reimbursement they deserve.
For their Blue Cross Blue Shield (BCBS) patients, primary care physicians can qualify for an extra five percent on their reimbursements for new and established office visits. As part of BCBS's Value-Based Payment Physician Quality and Transparency Program, physicians must meet certain criteria, including a specific ranking on their patient feedback, to qualify for that incentive.
"You need to be doing surveys yourself at point of service, so you know what those problems are. Solve it before it has time to populate the physician score card being done by payers and affects your reimbursements," Stroud says.
E-prescribe offers another reimbursement bonus. Though the June deadline for submitting the initial 10 claims with the appropriate G-code to avoid a reimbursement penalty has passed, the end-of-year deadline still affords an opportunity. Qualified physicians who submit 25 appropriate e-prescribe claims by December 31 can receive a one-percent incentive in their reimbursements.
"So if you missed the first deadline and face that one-percent reduction, you still could get the 25 prescriptions incentive by the end of the year and break even," Stroud says.
With reimbursements being set without physicians' influence, Stroud and Elliott emphasize that other options exist to offset that lost income. "If you book one more patient in the morning and one in the afternoon, the annual bottom-line results you achieve will be amazing, because it's all profit with no additional overhead," Stroud says.
Lowering no-shows is another prime source revenue. "It crosses all specialties. We know a cardiologist who had five no-shows in one morning. It's epidemic," Stroud says. "But if you can win that no-show battle, you can make a lot more money."
