PHOENIX – While the importance of procedure coding in U.S. healthcare is often maligned, it can hardly be overstated. Insurance and Medicare payments are contingent on the proper coding of all procedures performed, and few factors can drain a facility’s finances faster than inattention to its changing complexities.
So in light of last year’s introduction of ambulatory payment classifications (APC) for Medicare reimbursement, Christina Melnykovych’s presentation Friday at the American Healthcare Radiology Administrators (AHRA) Changing Workforce conference was both timely and encouraging. Melnykovych offered a hands-on strategy called point-of-service coding that promises to increase compliance as well as paid claims.
Reimbursement has traditionally been dependent on the assignment of current procedural terminology, fourth edition (CPT-4) codes and the Health Care Financing Administration (HCFA) common procedural coding system (HCPCS. Then last August HCFA implemented the APC payment scheme for Medicare reimbursement of services provided to patients who have not been admitted to a hospital.
Melnykovych, CEO and president of Tucson-based Coding Continuum, explained that APC codes were created to more precisely define outpatient services and treatment. "The APC codes are supposed to encourage healthcare providers to provide services more efficiently and, supposedly, better control costs," she said.
In addition to CPT and HCPCS codes, international classification of diseases, 9th revision, clinical modification (ICD-9-CM) codes, are also ingredients in defining payment. Thus, although one APC code may include multiple CPT and HCPCS codes, ICD-9-CM codes are still required to ensure a claim gets paid Melnykovych noted.
For healthcare organizations, piling another APC coding layer on an already Byzantine reimbursement structure means having to retool their claim and record keeping procedures. "Healthcare is, at times, an onerous environment of pressing regulatory issues that can adversely impact an institution," she said.
Melnykovych advocates point of service (POS) coding -- whereby a reimbursement coder remains in direct contact with the environment where procedures are performed -- as the single best coding strategy for an institution. She believes that a POS infrastructure consolidates workload, enhances communication, improves documentation, assures compliance, and can improve revenue.
In order for POS coding to work, Melnykovych said that executive management must be brought into the process early and often. "Millions of dollars are annually lost by institutions due to rejected claims, held claims, and write offs," she said. A commitment to a POS approach will require staffing, space, and new systems – commodities that are in short supply at most facilities.
Melnykovych suggested that administrators begin with a thorough review of coding activity in a high-revenue area of their organization, such as interventional radiology.
"These are areas where facilities commonly leave a lot of money on the table," she said.
The review should include the who, what, where, why, and how of charge entry functions; the charge entry; the order to claim process; and the claim to collection process.
"Once you can show the chief financial officer (CFO) a dollar figure of lost revenue due to coding errors, it’s a lot easier to get budget approval for implementing POS coding," she said.
POS coding is not a "slam-bam" instant gratification coding strategy, she cautioned. Implementing it one department at a time ensures proper oversight, and can help overcome an institution’s intransigence in adopting a new workflow methodology. The rollout of POS coding should take a year to be successful.
A key factor for its success is identifying personnel in an institution that can be trained as APC coders. Due to a current shortage of trained professionals, a coder with two-years experience can command $40 to $50 (U.S.) per hour as an independent contractor, she said. Thus, the onus falls on the administrator to train staff for the new role.
Melnykovych said administrators might consider starting an APC and CPT training program at their facilities. The program, taught by an accredited American Academy of Professional Coders (AAPC) instructor, can be accomplished in two three-hour training sessions over 10 to 15 weeks. Even training can be a revenue source for an institution, she said, if it’s marketed to other healthcare organizations in the area.
"In addition to being good business, it’ll keep your competitors from poaching your employees," she noted.
Finally, POS coding requires constant vigilance by administrators, Melnykovych said. Quality monitoring is an ongoing process that requires feedback to the individual coder of claim denials. The institution must commit to educating employees and following up on claims, preferably via a monthly accounts receivable review.
"A clean claim is a paid claim," she said.
By Jonathan S. BatchelorAuntMinnie.com staff writer
February 5, 2001
Related Reading
Offensive strategy may be mammographers’ best bet in reimbursement war, October 9, 2000
Hospitals can develop strategies to cope with HCFA's new outpatient payment scheme, August 1, 2000
Radiology awaits arrival of HCFA's new APC payment system, June 5, 2000
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