“Billing has morphed into a monster,” stated Kathi Carney, CPC, senior coding auditor for STAT Solutions, a division of Crosslin & Associates.
For practices trying to get a handle on coding and billing, it often feels like battling the mythical hydra … every time you think you are getting somewhere, another issue rears its ugly head.
In mythology, Hercules ultimately defeated the monster by settling on a methodical process for attacking and eliminating each head. In practice management, a similar disciplined approach helps conquer billing and coding woes. “It’s all about process and accountability,” said Rhonda Sides, principal, Healthcare Services & Forensic/Valuation Services at STAT Solutions,
“Right now, a lot of what we’re being sought out to help physicians with is the financial impact of various decisions they face,” Sides continued. While there are many areas that impact profitability … from recruitment to M&A decisions to patient engagement … perhaps no area is so directly linked to the bottom line as billing and coding. Closely akin to that is the need for a robust internal auditing program to evaluate compliance efforts and billing efficiencies.
“Money is being left on the table because things drop through the cracks,” Sides said of what they discover when asked to audit practices. “Sometimes what we find is documentation that is not ever captured in billing. They did the work and didn’t get paid.”
But it doesn’t have to be that way. “There are controls and processes that many, many practices could really improve … simple processes that create accountability all the way through the trail from the patient walking through the door to posting money received,” she continued.
Both Carney and Sides agreed that technology is a double-edged sword. “Technology is not making it easier … it’s making it more difficult,” Carney said. In part, she continued, because it’s easy to assume the technology has all the answers. “People are letting the system do the work, but it still requires a human,” she noted. Verifying the amount received matches contracted prices, following up on denials, and checking fee schedules all need the human touch.
Carney added, electronic records often sort entered items into different pockets, which can make it easier to miss a piece of documentation or billable action. She said practices have to be particularly vigilant when first switching to an electronic system. “With EHR conversions, it’s imperative to do a pre- and post-coding and chart review,” she stressed. “The doctor is used to documenting a certain way on paper, but it’s different in the EHR so you have to make sure the documentation is captured appropriately.”
Sides added, “EMR systems have changed the way that documentation is done, but it also, by default, has changed some of the coding patterns.”
Another place where the consultants have seen technology make practices somewhat lax is in reconciling books … particularly when payments come into the practice electronically. “There are so many things you have to check and balance to make sure you are tying your actual cash received to what you posted to the billing system,” Sides said. “Basic, simple things are missed all the time.”
Sides and Carney said one of the best ways to find and correct those ‘misses’ is to engage an outside consultant to review charts, coding and billing, and compliance. Sides pointed out, “Independent eyes pick up a lot of things you don’t see.”
Carney added, “By having their coding looked at, it can improve the bottom line.” She went on to say that although auditors might find inappropriate reimbursements that could cost money in the short run, ultimately those catches could help the practice avoid future fines by correcting processes. Additionally, an audit could highlight billable services that aren’t being captured.
Without a firm grasp of the complicated coding and billing process, which will only get more complex with ICD-10 implementation, the two-headed hydra could quickly become a practice manager’s worst nightmare. Carney summed up, “You can end up with a monster of a mess in your computer system … and no money.”
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