I am going to talk to you about leading and teaching a coding team and talk to you a little bit about how to get the right fit for your practice as far as your coders, billers, kind of what to look for once you have some coders and billers in place, how to look at accuracy, productivity. We're also going to talk a little bit about compliance plan. So having a compliance plan in place, the references and resources that you need for your practice at all times. And then the last thing, and I'll probably stress this a lot, is communication. I think that is the biggest when it comes to everybody in the group plays a role in the revenue cycle process. Everybody wants that claim to get paid the first time around, but we also have to make sure that we have the right staff in place to get those things done. And so communication is very key and critical to your practice. And so we're going to talk a little bit about communication as well. So I have a question. What coding materials should your practice purchase each year? ICD-10 books, ICD-10 CPT and HCPCS books, none. We use the internet. ICD-9 CPT and HCPCS books. This is perfect. Okay. So 80% of you say you need to have an ICD-10, a CPT book and a HCPCS book. And that is correct. You know, that's kind of should be a part of your compliance and your compliance plan. They should also be current, not, we're not talking about CPT from 2015. We need CPT from 2024, 2025, et cetera, et cetera. So making sure that we purchase these every year, again, making sure that everybody knows where they are is another one. And another one is make sure that you take the cellophane off the books. Make sure that they, you know, appear to be used. I know we use, we have lots of coding software out there. We've got the internet and that's completely fine. But if, you know, you're not 100% sure of that answer or that source online, you always should look to your coding books. So let's talk about hiring the best fit coder. And I can tell you probably some of you listening and are thinking, it's hard to find a coder. And it is, and it can be challenging. It's definitely hard to find a coder that has GI specific experience. If you do, if you get ahold of them, try to keep them, okay? So here are some of the common certifications that you look for. I think CPC is probably the more popular one. So that's a certified professional coder and they would be certified through the AAPC, American Academy of Professional Coders. You also could look to see if one has a specific GI coding certification, CGIC, which is the certified gastroenterology coder, and that's again through AAPC. We also have CCS, certified coding specialist, but that would be through AHIMA, American Health Information Management Association. And then there's also another GI specific certification, QMGC, which is certified through QPRO, qualified professionals. So just kind of to start on, you know, square one, that's really those, those are the more common certifications you'll see when you start, you know, getting resumes and hiring your coders. Okay, so do they have to be certified? What about work experience? So you don't technically have to have a certified coder. Yes, it looks better with your compliance. It's best practice recommendations. That's what Kathy and I would recommend. But again, it's hard sometimes to find coders. You might have a, you might have someone fill in an application and let's say they've been working with a GI practice for years. Let's say they check in patients or they're a medical assistant, or maybe they just did the denials and they didn't do the coding. So they may not necessarily be certified, but it's good that they at least have that knowledge base. If you find a coder that isn't certified, but has that GI coding experience, they can be given a timeframe to complete and pass a coding certification. And that's kind of what I would recommend, you know, if you're having a hard time finding a coder, that's actual certified coder. That's something that you can do is you can hire them and say, well, within a year, you need to have your, you need to practice and take your coding certification and pass it. You could even hire a CPC and then require them to become a certified GI coder in the next year or whatever. So that's all dependent upon what you do, but that's our best practice recommendation. Also one thing that I think is critical and very, very important is hire some, hire someone that has provider education experience or has worked with providers. That way they know that they're not afraid to communicate with providers. And I've worked with coders before I've met, I've supervised coders that they had that like white coat syndrome. It's just, I'm scared they're going to yell at me because I'm telling them they did something wrong and blah, blah, blah, blah, blah. So if you have someone that has experience already working with providers, that's a plus as well. And hire a team player that works well with others. You know, if you've got a coder that, that found out from Medicare, that Medicare is not covering X, Y, Z anymore or whatever it is, and they just keep it to themselves and they don't communicate that out with the practice, that's really not a good employee to have. You've got to have someone that's a team player. If you do, when you're doing coding accuracy and productivity, you should have a compliance manager, preferably someone with a CPMA, the certified professional medical auditor. So we should be checking, you know, double checking ourselves and performing those coding audits. Typically a coder should be at 90% accuracy or above. You know, if there's, obviously there's room to improve. There are, you know, situations where you might have someone that's a little lower than that. That's fine. Work with them, et cetera. We always say book chapter versus key. And that was that kind of that polling question that we gave you is that we always, always, always want to have those current guidelines and policies. And I know a lot of providers listening in, you might've asked a question and, you know, one of your coders or billers said, this is the answer. And you're like, well, where'd you find that? What was your source? What are you referencing? And that's very important to have that piece of information in case they want that information to read it. Set productivity standards in your practice as well. Productivity can vary by the types of reports that are audited. So typically what I would, and these are just numbers I kind of like, you know, this sounds, this sounds, you know, like a thing to do. 15 to 20 basic endoscopy reports per hour. Okay. So if they're upper, lower, that's about it, 15 to 20. But if you're an advanced endoscopist coder, you might only get 10 to 15 an hour. And that can include your ERCPs because ERCPs, those reports are long. And again, when their providers are doing multiple methods, it could be a little challenging to get all those codes reported. For visits, visits are a little different. I would say 20 office visits per hour or 15 hospital visits per hour, because sometimes hospital visits can slow us down just for the fact that we look at a little bit more things when we're looking at hospital visits, you know, we, we want to make sure there's no cloning. And I'll talk about that later on today when I have a talk on electronic medical records and all that good stuff. But, you know, we're watching out for cloning. We're making sure we didn't order the tests that are being reviewed. It was the hospitalist. So it slows us down just a little bit. Compliance tools, assign appropriate member of your staff to review your billing process and develop that compliance plan. Include step-by-step processes for responding to an audit. Review internal billing data to identify patterns that may trigger an audit. And again, conduct frequent coder training and provider education. You should, again, perform regular internal coding audits. Determine how frequent your practice will perform those audits as well. Most practices do quarterly basis. At least once a year, you need to do your audits once a year. Whether you're auditing coders or providers just depends on your scenario and if you have coders in your practice. Determine the type of review so you could focus on EGDs or you can focus on snare polypectomy or you can focus on a specific level of visit. Or you can just do a random mixed review of procedures and visits as well by across multiple providers. So what should be part of defining the scope of your review? Is it prospective, retrospective? So prospective before it's billed out, retro after. A lot of people, so when we do reviews for practices, we do mostly retrospective. So they're just having us take a look at post-payment. And there's some, obviously, retrospective is better financially in a way, in a way, because you're not holding on to a bunch of claims for someone to do an audit on you. But the good thing about prospective is you can fix it before you bill it out. So if I do an audit on your practice and I find all these things were billed wrong, and they've, then you, then you have to correct it. Then you have to send in, you know, corrected claims and refund and then it gets a mess. But that's, it's up to you. Best practices to perform that prospective review. Create spreadsheet of findings. That's another important thing. One area should contain the coder selection and another for the auditor's results as well. So we do reviews, we document, you know, we comment on, is it over-coded? Is it under-coded? What is the financial impact? And comment section. Then give your coder that preliminary copy and the explanation or the provider, whoever it is that you're doing the review for. A final report should be submitted and appropriate meetings and training should be scheduled. Okay. So you can't just audit one of your coders and then say, okay, here's your results. Bye. You know, you should meet, you should go over those results. Maybe they have comments back. Maybe you found out that you were wrong. Document efforts to improve coding and billing processes. So this should include staff training, ongoing education, as well as provider documentation training. You know, our providers don't know they're doing something wrong if we don't tell them. And then explaining why. Identify your problem areas in your practice. You know, do you have a bunch of coding errors? Or is it more of a billing error? So keystroke errors, data entry errors. Or is it poor documentation? So provider errors. So who's accountable? And then move forward with that education. Understand what corrective actions should be taken to avoid improper payments. Track and search denials. All right. Research your denials. Track them. Don't just, and we hear this a lot too, is we don't have enough staff to work every single denial that comes through. And I get it. Holds true. But don't put them on the back burner and don't look at them. Or don't just, you know, not take a look at them now and again. Again, it might be something that you're doing internally that you didn't know you were doing wrong. And one little easy fix could lessen a significant amount of denials that come through your practice. Keep up to date with CMS policies and your local Medicare contractor guidelines. CMS is actually a good source. I know sometimes when you look at things through CMS, you go down this long winded, you know, spiraling staircase that you'll never come out of. But there are local coverage determinations. I also talk about MedLearn Matters MLNs. Those are the updates that Medicare publish. You can sign up for them. It's free. And if there's any kind of compliance coding billing issues or nuances, they, you know, might have a policy on it. Print your local coverage determination. So for example, if you are under a certain Medicare contractor that has a medical policy for upper endoscopy, that should be distributed to everybody in the practice. All right. So if Dr. Sun orders upper and lower endoscopy all the time for anemia unspecified, and nobody tells them that it's not a covered diagnosis on Medicare's policy, then that's a big disadvantage. Okay. But if we tell them, hey, iron deficiency is, anemia is not, then he can move forward with his orders. Okay. So just giving you an example. If we don't tell them that, they're not, providers are not going to know if we don't tell them that. Review the OIG annual work plan. So the office of inspector general. And I'll talk about that in my next talk, kind of go over some of the things that they're looking at for potential audit areas. Monitor your recovery audit contractor progress and updates on their websites. And I will give you that in the next talk as well. And like I said, I think the biggest thing here is communication. Billing managers should communicate pair of policy changes to the staff. Coders and billers need to communicate with each other to ensure consistency and coding accuracy. And everyone must communicate back to that provider. They cannot fix mistakes if they don't know about them. All right. And I think this takes me to my next talk, which is auditing providers within your practice.

coding team leadership

GI coding

compliance plan

coding audits

effective communication