Clinician/Coder Communication is Key in Correct Claim Submission

Original story posted on: July 10, 2017

The key to any successful relationship is communication, and that applies to the relationship between physicians providing services in a practice and the hospital, coders, and billers.
Maintaining communication between physicians and coders often is a challenge because both parties are so busy. However, again, communication will make a big difference to both the physician and hospital to ensure accurate reimbursement.
Interactions between physicians and coders are key when coding and billing medical claims. Both parties should exhibit a mutual respect for each other’s skill and expertise.

Many times, unfortunately, physicians don’t even communicate with coders. I have heard many physicians tell me many times that coders don’t relay information about coding changes, regulations, modifier issues, or changes in national or local coverage determinations (NCDs or LCDs). Practitioners should always be kept informed regarding what is going on in the world of coding and reimbursement so they can comply with the various changes.

A coder should be comfortable advising a physician on medical documentation or requesting clarification via a query on a procedure, service, or diagnosis code.

At the same time, a physician must be willing to accept advice. Proper documentation leads to increased reimbursement, while incorrect or inadequate documentation will lower reimbursement and possibly raise compliance issues. It is the coder’s responsibility to make sure that the practice is in compliance and is not at risk, and that the rules and regulations are communicated to all members of the practice.

Physicians and coders should be trained together. It is important for the physician to understand bundling issues, E/M leveling, diagnosis coding guidelines, and carrier rules. By working together in a training session, the coders can see the physician’s perspective and the physicians can understand what the coders need in the documentation to support medical necessity. The first thing you must do is figure out the best way to communicate with practitioners – it may be in person, via email, through online queries, or phone calls, depending on the setting. Keep it consistent, though. Physicians like consistency.

Another good way to keep physicians and billers working together is to hold monthly or quarterly meetings involving coders and clinicians. These meetings can be used to address significant issues, such as having physicians explain a new procedure or having billers explain a change to a code. Coding and billing staff should deliver regular feedback to clinicians about the reasons for denials.
These discussions are extremely important because they illustrate to physicians how vital it is that they communicate with coders. If a physician doesn't understand why the documentation does not support medical necessity, he or she probably won't be able to document appropriately to support an appeal.
Another effective communication tool is reports. Frequency reports outlining the most common codes used and denial reports help address why claims are denied. It is a good idea to report on the procedures and diagnoses being used to see if there might be issues with lack of specificity, for example. Practitioners seem to really appreciate reports that give them financial or statistical data for their medical practice and/or hospital services.

Quality indicators and data analytics are causing coding roles to change tremendously. One aspect of this change has been substantially increased email communication with other health information teams (CDI, or clinical documentation improvement, QA, or quality assurance, and case management) related to clinical documentation and coding accuracy. 

Ultimate responsibility is being placed on coders to interpret clinical documentation and ensure coding accuracy. When questioned, coders should be able to communicate logical answers backing up their assessments. Coders are relearning time management and organizational skills in order to better manage productivity and email communications in their work day.  

Here are a few tips for clinicians and coders alike:

Tips for Clinicians 

  • Standardize your workflow. Create and follow standardized chart documentation to allow coders to understand the diagnosis and care provided for each patient encounter. Then, educate the coders on that process, making sure they understand it.

  • Ensure that you have two-way communication established with the coders. Coders must have a way to communicate with you directly. A formal system should be developed in the hospital and in the physician’s office for submitting and receiving chart queries. It might work best for your facility if all questions flow through the coding or health information management (HIM) manager to the physician.

  • Use a standard communication method. This will allow you to establish a standard flow of communication. Some software programs allow the coder to comment on charts, query practitioners, and put such matters in a holding queue for review.

  • Ask for feedback from your coders. Coders often have ideas for ways to improve collaboration between themselves and  other facility staff or physicians. Regularly ask them for feedback on improving processes, and take their ideas into account.
Disclaimer: Every reasonable effort was made to ensure the accuracy of this information at the time it was published. However, due to the nature of industry changes over time we cannot guarantee its validity after the year it was published.
Deborah Grider, CPC, CPC-H, CPC-I, CPC-P, CPMA, CEMC, CCS-P, CDIP, Certified Clinical Documentation Improvement Practitioner

Deborah Grider has 35 years of industry experience and is a recognized national speaker, consultant, and American Medical Association author who has been working with ICD-10 since 1990 and is the author of Preparing for ICD-10, Making the Transition Manageable, Principles of ICD-10, the ICD-10 Workbook, Medical Record Auditor, and Coding with Modifiers for the AMA. She is a senior healthcare consultant with Karen Zupko & Associates. Deborah is also the 2017 American Health Information Management Association (AHIMA) Literacy Legacy Award recipient. She is a member of the ICD10monitor editorial board and a popular panelist on Talk Ten Tuesdays.

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