Physicians Who Code: Or Maybe Not

Blog post by Jack Duffy   Date: July 14, 2015

As the healthcare industry counts down the last hundred days until the coding convention changes forever, it might be useful to reflect on where we are and are we ready. The history of mandates, delays and more mandates would fill a shelf with millions of words. Training and software budgets have been created, spent, deferred and spent again. Hospitals, insurance companies claim processing software and other tools should be tested and ready for go-live. However one significant participant has resisted these changes for the past ten years. Many physician organizations would still like to see the whole thing go away. To the extent that they have supported this position with massive non-action, problems will surface in a few weeks.

Specific areas of concern include:

1. The continued use of “super bills” or any type of paper input document that is tasked with recording the diagnostic code. These forms struggled with the presentation of modifiers and will be overwhelmed by the new code sets.

2. The number of available professional coders and their training is another variable. Some sophisticated group practices have taken steps to increase their coding staff, many have not. Some specialty practices will just create a new list of codes to use and run the risk of lacking the required coding specificity.

3. Physicians will rely on the hospital to create the required codes. This will lead to an endless loop of requests for additional information and further suppress cash flow buy creating additional billing delays. Hospitals often have less than fully staffed coding departments. Additional work will further stress this scarce resource.

4. Finally both hospitals and physicians may believe that expensive electronic medical record systems will be sufficient to produce accurate, complete codes. The problem with that strategy is the quality of the coding will never exceed the quality of the supporting documentation. Incomplete records will by definition lead to under payments, continuous audits and loss of income for all parties.

Little can be improved in these last 100 days; however an honest appraisal of potential risks can produce a continuous improvement plan that develops into a contemporary coding process. The key will be a focused dialogue with the physician community to support the need for improved documentation, if not accurate coding.

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