ENGAGEMENT Whether you're discussing a new protocol for op notes or clarifying a claim, involve your docs in your coding and billing process.

Most surgeons make no secret that coding, billing and entering their notes into an electronic record are at the bottom of their priority list, because — naturally — patient care is at the top. But just because surgeons would rather care for patients than push papers doesn't excuse them from providing the documentation your coders need to bill procedures correctly and compliantly. If your surgeons' eyes glaze over anytime you mention coding and billing, here are 7 tips to get them to be more engaged with the business side of surgery.

Never ambush your docs with surprise demands
If you're starting a new policy stating that op reports must be turned in within 24 hours of the procedure, instead of 48 hours, make it a point to schedule a meeting with the surgeons to explain the new demand and why the change is necessary. Stress that you'll receive quicker reimbursements if your coders can get claims out the door swiftly and correctly. If you set aside a time to talk — instead of just haphazardly telling them the next time they're around — your surgeons will be more receptive.

Shorten the message
Want to explain a new coding or billing process to your docs? Forgo the standard all-day training session. The recommended time for a lecture on these topics is short — 10 to 20 minutes short. For information that you would cover in a daylong seminar, consider condensing it into hour-long meetings.

Make sure the information is relevant
Let's say the government decides to mandate that all ASCs must enter their notes into electronic patient records. You call in your doctors for a meeting to go over the new requirements. Instead of boring your physicians with the trivial background knowledge about the new law, focus only on what they need to know. Explain how the mandate will impact their patient care, since that's their focus day-in and day-out, and how the EHR will make claims more accurate and bring in more revenue. Coding and billing processes can be a dense subject, so give them the information in a way that's digestible and tangible.

Encourage your doctors to interact with you
Whether you're introducing new demands or clarifying an existing problem in your revenue cycle, make sure that you allow for physician interaction. For example, if you're introducing a new way to record right shoulder arthroscopies in op notes, gather the surgeons for a short meeting, break them into smaller groups and let them ask questions. Better yet, give them case examples during the meeting so they can practice recording the procedure properly. Not only does this reinforce the right way to document the case, but it also lets you proactively fix any problems.

Avoid being too general
If your group of ophthalmologists is not recording cataract cases correctly and causing claims mistakes, don't just gather all of your physicians for an overview on how to improve op notes. Instead, meet with just the docs who perform cataract cases, show them what they're currently doing, what you want them to do and explain why. It may seem obvious, but overgeneralization is a big reason why many physicians tune out coding and billing information.

Be precise about questions
Even with the best instruction, your coders are going to need clarification from your physicians occasionally. Too often, though, surgeons ignore these requests. Instead of asking a general question, tell your coders to phrase their questions in a multiple-choice format, when possible. For example, if Dr. Jones performs a procedure and indicates there are complications, but doesn't specify what they are, the coder could send a message saying something like, "I see there were complications in Ms. Smith's case, but could you clarify? Was there an infection, post-op fever, respiratory complication or another issue?" By providing options, you're more likely to jog their memory and quickly receive a helpful response.

CT COLONOGRAPHY
Will CMS Finally Pay for Virtual Colonoscopies?

VIRTUAL REALITY Lawmakers are proposing a bill that would require CMS to cover computed tomography (CT) colonography.

A proposed bill (S. 2262) would require Medicare coverage for seniors who choose computed tomography colonography (CTC), so-called virtual colonoscopy, over traditional colonoscopy as a colorectal cancer screening option.

Given to patients who can't or won't undergo a colonoscopy, a CT colonography is a minimally invasive imaging procedure that produces 2-D and 3-D images of the colon. It uses low-dose radiation CT scanning to obtain an interior view of the colon that is otherwise only seen with a colonoscopy.

CT colonography doesn't require sedation, injections or the insertion of a camera into the colon, and the procedure takes less time than an optical colonoscopy. CT colonography can also visualize certain parts of the colon that are difficult to see during a traditional optical colonoscopy. In addition, patients can drive themselves home or return to work immediately following their exam, which is not the case with the traditional optical colonoscopy.

The American Cancer Society recommends CT colonography as a screening test for colorectal cancer, and several national insurers, including CIGNA, UnitedHealthcare and Anthem Blue Cross Blue Shield, currently cover it, according to the American College of Radiology (ACR). However, CMS has historically refused to pay for the procedure, citing its higher cost.

Patient advocacy groups say that studies show that virtual colonoscopies are comparably accurate to traditional colonoscopies in most people, though some GI groups note that they aren't as effective at catching smaller polyps.

"One-third of those who should be screened for colorectal cancer can't have or won't get a colonoscopy," says Eric Hargis, chief executive office of the Colon Cancer Alliance. "CT colonography increases screening rates where offered. Medicare coverage would provide seniors with insured access to an exam that may appeal to them. This would jump-start screening, catch more cancers early and save more lives."

— Kendal Gapinski

Don't challenge the doctor's knowledge
Coders and billers should never assume a condition without proper documentation or clarification from the physician. It's a common problem in a lot of facilities. The coder reviews the op notes and sees that the doc failed to document a key component of the procedure. He sends her a message saying, "You failed to establish the connection between hypertension and heart failure in the notes. I'll go ahead and change it, if that's correct." The coder could be right, but the doc may resent his tone and ignore or delay response.

Instead, the coder should send a message simply saying he wanted to clarify whether there was a connection between the hypertension and heart failure. It's to the point, requires a yes or no answer and doesn't seem like he's pointing fingers.

Partners in success
Surgeons are focused on patient care — rightfully so — and as a result may over- or under-code, provide coders and billers with incomplete information, be slow to answer queries or simply be unaware of coding rules. And they sometimes show outright contempt for what we do, treating us as annoying paper-pushers rather than the strategic partners in practice success we really are. By following these tips, you'll pave the way for physician buy-in for your coding and billing process. You'll also cut down the number of inaccurate claims, get those reports completed and signed, and put a stop to overcoding and a million other headaches. OSM