Meeting the challenge of new coding requirement
Physician education, communication are key
By Kandy Swanson, Patient Access Manager
Brant Campbell, Patient Accounts Manager
Morton Plant Mease Health Services
Dunedin, FL
The Balanced Budget Act of 1997 requires physicians and nonphysician providers, when ordering diagnostic services, to provide the ICD-9 diagnosis code on all Medicare referrals. To meet this challenge, Morton Plant Mease Health Services, a provider of diagnostic and surgical/ endoscopic services, has developed an action plan.
The challenge for the Morton Plant Mease team of representatives from patient accounts, marketing, and patient access services was to take what could be perceived by physicians and patients as a negative mandate and turn it into a positive outcome without jeopardizing quality of care and customer service standards.
The patient accounts department received notification Dec. 23, 1997, from the Florida Medicare intermediary of the new mandate to take effect Jan. 1, 1998. Their first response was to create a fax form, requesting the ICD-9 diagnosis code from the referring physicians after the service had been performed.
Response to the form was positive, but the time involved in managing this process put a severe strain on patient accounts' resources. It was realized quickly that this process would not meet the team's needs. By the end of January, just 5% of the Medicare revenue had been billed.
To remedy this, the Morton Plant Mease team developed a plan to fully educate the referring physicians and implement a new process with the objective of reducing the growing Medicare accounts receivable. The plan consisted of a letter to the referring physicians' offices, revision of the prescription pad, and implementation of a new screening process by patient access services.
The letter highlighted three points: the new Medicare requirement, the specific information that is now required, and the new process Morton Plant Mease was implementing. Specific references to the Medicare written documentation were made.
During the first two weeks of January, several members of the physicians' office staffs had objected to patient accounts' requests for ICD-9 codes, believing that this was just a new Morton Plant Mease requirement. After all, it was the holiday season, and not everyone keeps current on the "Florida Medicare B Update."
The letter was sent in a mass mailing to the referring physicians' offices. Copies also were placed in the physicians' hospital mailboxes and sent via courier along with result reports. The team wanted to be sure the referring physicians' offices got the message.
The marketing team was charged with redesign ing the prescription pad. They added a line for the referring physician to write the ICD-9 diagnosis code. The text now reads "ICD-9 Code Mandatory." A large proportion of our patients are insured by Medicare. The word mandatory was added with the expectation that other payers may adopt the same guidelines. The team also believed that being consistent with requested information would make the changes simpler to implement.
Flag Medicare paperwork
Once the marketing team completed its initial task, it was up to the patient access services teams to put together a process that would help them collect the needed data in the most efficient way possible. Before the team agreed on the process, each team member was briefed on the revised regulation and informed of the Morton Plant Mease policy on the subject.
The first step was to devise a system to flag all Medicare patients' paperwork. Because a flash card (scheduling information) prints each time a patient is scheduled for a diagnostic study, the team agreed that the best way to flag the paperwork would be to have the volunteer team highlight the flash cards belonging to Medicare patients. By flagging the flash cards, the registration team is able to easily determine which paperwork requires the coded script.
The next step happens during the preregistration process. The patient representative is charged with informing all Medicare patients, via the preregistration phone call, of the need to present on the day of their exam with a prescription noting the ICD-9 code. If the prescription has been faxed to the center before the patient's arrival, the patient representative is responsible for ensuring that the ICD-9 code is present on the script. If the code is not present on the script, the team member will contact the physician's office and ask that a completed script be faxed to the center before the patient's arrival.
The final step takes place the day of the patient's scheduled appointment. The patient is checked in upon arrival and his or her prescription is checked for completeness. If the prescription is complete, the scheduled exam is performed. If not, the patient is referred to the physician so the appointment can be rescheduled. The patient representative also takes note of the physician offices sending noncoded prescriptions. This information is forwarded to the marketing team for follow-up.
"Educating the physician offices is key to expediting the entire reimbursement process and thus helping to meet the needs of all involved, including the most important - the patient," says Vicky Zagorski, marketing coordinator for Morton Plant Mease.
Strict implementation of the process was delayed for a one-month grace period. Patients presenting without a diagnostic code continued to be seen at all outpatient sites during this time. Patient access services followed up with the referring physician offices via fax. The fax states that a patient was seen without a diagnostic code, asks the office to supply the code, and references the letter stating that patients will be rescheduled.
Since implementation of this process, compliance by the referring physicians has increased significantly. The team believes its action plan was successful in meeting the business need without compromising customer service to the patient and/or the physician.
(Editor's note: Swanson is a member of the education committee of the National Association of Health care Access Management in Washington, DC.)
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