An academic medical center added 15 adult hospitalists over the past 2 years. Many of the new faculty did not have prior experience with billing. Over the same time, the Department of Internal Medicine recognized That many charges were not being captured because of poor communication with coders. Despite faculty orientation presentations, many hospitalists did not fully grasp the requirements for attestation documentation or visit levels. The goal was to improve documentation and coding accuracy to meet compliance standards and develop relationships with assigned coders.
To develop an individualized coding education process for hospitalist faculty.
The Implementation of a provider coding process was announced In March 2009. Before that announcement, physicians with community hospitalist experience were enlisted for support. Four separate presentations on documentation improvement were given over 10 months by the coding educator and designated physician. A standardized format, charge drop‐off site and submission verification checklist was explained to providers. To meet the billing group compliance standard of 90% accuracy, physicians were scheduled lo meet individually wilh a coder, coding educator and designated physician twice over a 14‐day ward attending block. Coders entered a minimum of 20 charges submitted by physicians over the first 7 days into Intellicode, audit software that provides objective feedback reports on coding accuracy. Itemized discrepancies were identified. All identified errors were reviewed with physicians. Those who achieved > 90% coding accuracy on initial audit “graduated.” All others met with the same group at the end of the 14‐day attending block for reaudit. Thee of 9 audited providers scored > 90% coding accuracy on the first week. The other 6 faculty members ranged from 53.3% lo 87.5%. All 6 of Ihem scored grealer than 90% on follow‐up audit. All 9 providers reported feeling comfortable contacting coders or the designated physician wilh questions. This process resulted in a dramatic increase in the hospitalists' clinical collections and work RVUs without significant changes in inpatient census; a 127% increase in monthly collections and a 121% increase in monthly wRVUs (suggesting an increase in collections per wRVU). Hospitalists' proportion of Department of Internal Medicine collections has increased from 4% to 8% and RVUs from 7% to 11% over this time, despite an overall departmental increase
A coordinated charge entry and individualized provider billing education process can develop physician competence in coding, improve coder relationships, and lead to a dramatic improvemenl in clinical collections.
L Noronha, UNM, employment