Don’t cheat your practice: Improve coding techniques
Improper codes can mean less revenue
When the Platte Medical Clinic in Platte City, MO, conducted an audit of its coding practices, the staff were surprised to learn that the practice was missing out on revenue because physicians were undercoding.
"Most of the time, we found the physician did not give himself full credit for the work done. He could have selected a higher code," says Lori Norris, FACMPE, former practice manager who is now employed by North Kansas City (MO) Hospital, the owner of the practice.
However, she adds, physicians are not always comfortable with coding and fear being audited and accused of fraud. "They may be so afraid, that they cheat themselves out of money by not billing for what was performed."
To avoid the appearance of trying to collect more than they are due, some physicians tend to undercode. But in the long run, this isn’t any better idea than coding for a higher level of care than you provided, the experts say.
"Physicians can cheat themselves if they don’t code properly," points out Rita Scichilone, of Woodbine, IA, practice manager for coding products and services for the American Health Information Management Association.
And the problems created by undercoding go further than just receiving less for the services you perform. For instance, a managed care plan may look at your practice and decide that you don’t treat patients with a high level of intensity. As a result in a capitated plan, the insurer may cut the per-member-per-month payment your practice receives, she adds.
Undercoding gives the appearance of something not being right if too many services receive a low-level code, Scichilone adds. "In a normal practice, you see a wide variety of levels because the physicians see a wide variety of patients with different needs." Some physicians get stuck on level 2 or level 3 codes and don’t use any others, she adds. "Unless physicians are familiar with how the systems work, they may check off the same code every time."
If your practice exhibits an unusual pattern, the insurer or the Health Care Financing Admini-stration (HCFA) may decide to conduct an audit to see what’s going on. This is a time- and labor-intensive process.
Here’s an example of how undercoding can hurt your practice: If you are a cardiothoracic surgeon and give every patient a low-level office visit code, yet you do open-heart surgery, HCFA could conclude that you are doing open-heart surgery on patients who are not sick, points out Todd Welter, MSM, CPC, a coding consultant for the Medical Group Management Association in Englewood, CO.
After Welter conducted a coding audit for one physician group practice, the practice manager wrote out fake "checks" to each physicians for the money the practice would have received had he or she coded properly. "Some of them got checks for $12,000 or more. It made quite an impression," he says.
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