ÿWPCá ê?Ÿ%]ƒù‘¹ï‡ ÞTìÿé­‘ôï¿/3´¯é­¸eá'¡éZ·m‚>±ªB?3 £GD“·†ª,µ»ÏŒ(ÍHewî¿°3}f¼’¡ØXB”¸ë=µ¯ t®¿9Ü3ø®mA$sò“zo F ÖÞ˜ Òvi^„±U¡Á•”¿”c¥G*4oì{ö1+ñ‹8á~ƒäýÈh¤è˯AãÄ¥+8Ž~Ý*ïë¼ÄÁñ¾ìdå² ½ã”í¼Øbe…6{ ˜ÿAvMt•7žýí¢ó¡ Mí%qž€ËÔæagÛ¼9·Úa bd­-PGøìœÛÝÝncD•ÙPÑ:äÀÒ¤ æD•¥Èá4‡‡í¼˜‡ˆØ*P²"±N 1Ù÷¿ Ï©òF¯,N³F߈"2Zxy§IÛ8>©Ö¥#q€JG9 ‰dÚšÃ9KÕû†£à$leݨ·ÚL*ÎÆàš¨IgRJâ›±Óõª†R}ZUŠgׯMÒÚUìø«Œzƒ¢å´"XéW‹ú€L3ð ó^‡¯.øãA#e¶˰ri•”¤f\´F ^˜þ{˜S]í‡ ØØ-د‡&p³v€»Á"=—fÅ\|¼èÔD7zkÊÄ\—©ß¯G~¢ #!¨UNÉ % 0(^ Ew@Q4‘¥´ m¶Í˜Lexmark ValueWriter 300ÈÈ,,,,ÈÈ0(ÖÃ9 Z‹6Times New Roman RegularX($¡¡  ¸&‰ ° ± D² ³ D´ µ E¶ · E¸ ¹ 8¢ @”„3|x¹ ÿU‹ÿÀÀÀ  CDRÝ ƒ!ÝÝ  Ý›Ô_ÔÑX°ÑÑX°ÑÒX°ÒÒX°ÒÔ‡èS½çXXÔÓ  Óò òÌÌÌÌPotential€Proposal€for€Formation€of€a€ÌCoding,€Documentation€and€Reimbursement€(CDR)ÏCommittee€Within€a€Medical€PracticeÔ#†X÷mXçèS½d#ÔÐ p   Ðó óÓƒÓÌÌÌÌÓ  ÓÔ‡¼œ»XX÷mÔò òÌó óÔ#†X÷mX»¼œi#ÔÓ]ÓÌÌÌÌÌÌà ° àGiven€the€growing€presence€of€managed€care,€medical€providers€are€under€ever„increasing€pressure€toÏscrutinize€how€their€patterns€of€diagnosis€and€procedural€coding€may€be€improved€to€most€effectively€recoverÏappropriate€reimbursement€for€services€provided.€€Additionally,€governing€organizations€threaten€to€disciplineÏthose€with€documentation€and€coding€practices€that€fail€to€comply€with€existing€guidelines.€Ì€€Ìà ° àAny€Practice€stands€to€benefit€substantially€from€efforts€to€refine€issues€related€to€chart€documentation,Ïreimbursement€trends,€and€procedural€coding.€€Fragmented€attempts€to€address€these€issues€can€yield€positiveÏresults,€but€an€organized€approach,€with€attention€to€priority,€would€be€far€more€effective.€€This€is€a€€proposal€toÏcreate€a€Coding,€Documentation€and€Reimbursement€(CDR)€Committee.€ÌÌà ° àFollowing€are€several€examples€of€potential€actions€by€the€proposed€committee.€€Many€suggested€actionsÏmay€already€be€in€full€or€partial€effect.€€The€proposed€committee€allows€improved€organization€and€oversight€ofÏissues€related€to€coding,€documentation€and€reimbursement.€€Additionally,€suggestions€are€made€regardingÏpossible€composition€of€the€committee,€and€potential€obstacles.ÌÌÐ  %¼"! ÐÔ‡ dã!XX÷mÔò òÓ  Óà0 @° àà @X àÔ#†X÷mX! dã³#ÔÔ‡èS½çXX÷mÔPotential€Actions€of€the€Coding,€Documentation,€andÐ X ÐReimbursement€CommitteeÔ#†X÷mXçèS½#Ôó óÐ Ü„ ÐÓÕÓÌÌò òà ° àDevelopment€of€Expertise€within€the€Practiceó óÐ 8à ÐÌà ° àà  àà0 ` àà  àIndividuals€with€particular€interests/abilities€could€be€designated€as€resident€experts€in€specificÏareas.€€The€Practice€could€foster€the€development€of€those€personsðð€skills€and€utilize€theirÏknowledge€for€the€benefit€of€the€entire€organization.Ð ` €%` €% ÐÌÌò òà ° àDetermination€of€Needed€Resourcesó óÐ ¬ T  ÐÌà ° àà  àà0 ` àà  àPractice€sites€utilize€unique€resources€(reference€books,€computer€software,€etc.)€for€assistance€inÏdocumentation€and€coding.€€Maintenance€of€these€materials€can€be€costly,€making€itÏpossible€that€some€sites€may€be€utilizing€outdated,€inaccurate€or€incomplete€information.€ÏCDR€could€assist€the€survey€of€individual€sites€to€determine€their€needs.€Ð ` €%` €% ÐÌÌà ° àò òCentralization€of€Resourcesó óÐ  ´ ÐÌà ° àà  àà0 ` àà  àCDR€could€investigate€whether€it€would€be€in€the€Practiceððs€best€interest€to€create€a€centralizedÏset€of€materials€that€could€be€utilized€by€every€site,€preventing€redundancy€and€ensuringÏthat€information€is€current€and€complete.€Ð ` €%` €% ÐÌÌò òà ° àDissemination€of€Informationó óÐ €( ÐÌà ° àà  àà0 ` àà  àRequirements€for€documentation€and€coding€are€ever„changing.€€It€would€be€helpful€to€have€aÏcommon€method€to€distribute€information€to€each€Practice€site.€€A€newsletter€could€beÏdeveloped€with€the€purpose€of€circulating€important€coding€and€documentation€updatesÏthroughout€the€organization.Ð ` €%` €% ÐÌÌà ° àò òDevelopment€of€Formal€Policiesó óÐ à"ˆ " ÐÌà ° àà  àà0 ` àà  àEach€site€uses€its€own€protocols€to€guide€documentation€and€coding€practice.€€Most€are€likelyÏappropriate€and€effective,€but€some€may€benefit€from€informed€direction.€€CDR€couldÏdevelop€policies€or€guidelines€to€represent€Practice€standards.Ð ` €%` €% ÐÌÌò òà ° àMastery€of€Common€Proceduresó óÐ T)ü&) ÐÌà ° àà  àà0 ` àà  àIt€is€likely€that€a€majority€of€the€Practiceððs€charges€are€generated€by€a€limited€number€of€services.€ÏSince€it€is€not€realistic€to€expect€providers€to€perfect€their€skills€of€documentation€andÏcoding€for€all€procedures,€it€makes€sense€to€pay€attention€to€those€services€of€greatestÏimport.€€CDR€could€identify€these€high„impact€services€and€provide€guidance€on€how€toÏmost€appropriately€manage€them.€Ð ` €%` €% ÐÐ È/p-0 Їò òà ° àDocumentation€Guideline€Educationó óÐ X ÐÌà ° àà  àà0 ` àà  àCDR€could€assist€the€continued€education€of€providers€in€becoming€more€proficient€in€the€use€ofÏ¢HCFA£€documentation€guidelines.€€The€primary€goal€would€continue€to€be€enhancement€ofÏguideline€compliance,€improvement€of€documentation€practices€and€reduction€of€risk€forÏboth€the€individual€providers€and€the€organization.Ð ` €%` €% ÐÌÌò òà ° àDiagnosis€Codingó óÐ ¸ ` ÐÌà ° àà  àà0 ` àà  àCDR€could€conduct€investigations€to€determine€which€procedures€or€services€are€problematicÏwhen€it€comes€to€diagnosis€code€selection.€€Third„party€¢payor£€requirements€for€diagnosisÏcoding€could€be€reviewed.€€Educational€materials€could€then€be€prepared€in€order€toÏeducate€providers€how€to€most€appropriately€select€diagnosis€codes.Ð ` €%` €% ÐÌÌò òà ° àProcedural€Codingó óÐ À ÐÌà0 ° àà  àà0` °€%°€%àà  àIt€is€common€for€care€providers€to€misunderstand€documentation€and€coding€issues€related€toÏsome€services€such€as€fracture€care,€global€billing€for€procedural€care,€dermatologicÏprocedures,€care€plan€oversight,€professional€and€technical€components€of€procedures,€andÏmultiple€services€performed€on€the€same€day.€€Inappropriate€handling€of€these€services€canÏlead€to€denied€claims,€and,€in€some€instances,€even€be€interpreted€as€abuse.€€CDR€couldÏdevelop€guidelines€to€help€manage€these€services€most€appropriately.Ð ` €%` €% ÐÌÌò òà ° àNon„Provider€Educationó óÐ Pø ÐÌà ° àà  àà0 ` àà  àCare€providers€are€ultimately€responsible€for€documentation,€diagnosis€and€coding.€€HoweverÏthere€are€many€instances€when€nurses€or€other€staff€members€are€also€involved.€€It€is€notÏunusual€in€any€practice€for€supporting€staff€to€assist€in€selecting€codes€for€medications,Ïtests,€vaccinations€and€supplies.€€Additionally,€nurses€often€contribute€to€documentation,Ïand€individuals€entering€charges€serve€as€important€checkpoints.€€CDR€could€assist€theÏdevelopment€of€educational€materials€or€protocols€to€help€ensure€that€supporting€staffÏmembers€receive€appropriate€training€in€areas€that€affect€coding€and€documentation.Ð ` €%` €% ÐÌÌà ° àò òAnalysis€of€Third„Party€Reimbursementó óÐ t$"% ÐÌà ° àà  àà0 ` àà  àCDR€could€examine€the€reimbursement€patterns€of€various€insurance€carriers.€€Attention€could€beÏpaid€to€whether€the€Practice€is€being€appropriately€compensated€for€services€according€toÏestablished€fee€schedules,€and€whether€the€practice€abides€by€the€regulations€of€MedicareÏand€other€carriers.€€Incongruities€could€be€brought€to€the€attention€of€the€carriers€forÏexplanation.Ð ` €%` €% ÐÌÌÌÌÌÐ „/,-1 Ðà ° àò òIssues€Related€to€Capitationó óÐ X ÐÌà ° àà  àà0 ` àà  àIn€some€¢capitated£€plans,€the€rate€of€payment€(per€patient€per€month)€may€be€influenced€by€theÏcomplexity€of€the€population€served.€€Diagnosis€code€selection€to€the€greatest€level€ofÏspecificity€(as€opposed€to€nonspecific€codes)€can€sometimes€demonstrate€a€ð ðsickerððÏpatient€population,€justifying€a€higher€capitation€rate.€€CDR€could€assess€whetherÏdiagnosis€code€selection€is€a€significant€factor€and€accordingly€develop€materials€to€furtherÏeducate€providers€on€appropriate€diagnosis€coding.Ð ` €%` €% ÐÌÌà ° àò òAnalysis€of€Denied€Claimsó óÐ  8  ÐÌà ° àà  àà0 ` àà  àA€significant€number€of€any€practiceððs€submitted€charges€are€denied€every€day.€€CDR€could€directÏa€review€of€denied€claims€in€order€to€guide€future€coding€practices,€possibly€resulting€inÏfewer€denials.Ð ` €%` €% ÐÌÌò òà ° àIssues€Related€to€Auditsó óÐ ¬ ÐÌà ° àà  àà0 ` àà  àCDR€could€help€conduct€internal€audits€of€documentation€and€coding€practices€to€determineÏpotential€concerns€that€might€surface€in€the€event€of€a€formal€audit€conducted€by€anÏoutside€organization.€€If€any€problems€are€identified€by€an€audit,€CDR€could€suggestÏmethods€to€promptly€rectiñ° ñfy€themñ° ñ.€€Familiarity€with€auditing€procedures€may€also€enableÏthe€Practice€to€best€cooperate€with,€and€potentially€challenge€the€findings€of,€a€formalÏaudit.Ð ` €%` €% ÐÌÐ  Pø Ðò òÓ  ÓÔ‡èS½çXX÷mÔComposition€of€Proposed€CommitteeÔ#†X÷mXçèS½Ø##Ôó óÐ X ÐÓÌ#ÓÌÌà ° àThe€documentation,€coding€and€reimbursement€of€services€involves€numerous€individuals€in€assortedÏpositions€throughout€the€Practice.€€Involvement€by€any€of€the€following€groups€may€be€beneficial.ÌÌÌò òà ° àCare€providersó óÐ d  ÐÌà ° àà  àà0 ` àà  àSeveral€physician€and€non„physician€providers€would€be€an€asset€to€CDR.€Ð ` €%` €% ÐÌÌà ° àò òAdministrationó óÐ ¨  ÐÌà ° àà  àà0 ` àà  àThe€actions€of€the€committee€may€so€directly€affect€organization€policy€that€effectiveÏcommunication€with€administrators€would€be€imperative.Ð ` €%` €% ÐÌÌà ° àò òBilling€Personneló óÐ ˆ0 ÐÌà ° àà  àà0 ` àà  àPersons€with€detailed€knowledge€of€the€billing€system€would€be€invaluable€when€investigatingÏissues€that€pertain€to€charges,€reimbursement€and€claims€denials.Ð ` €%` €% ÐÌÌà ° àò òNursing€Staffó óÐ ¸ ÐÌà ° àà  àà0 ` àà  àGiven€that€actions€by€nurses€often€impact€documentation€and€coding,€representation€from€theÏnursing€staff€would€be€useful.€Ð ` €%` €% ÐÌÌà ° àò òLaboratory/Radiology/Procedural€Staffó óÐ ˜@ ÐÌà ° àà  àà0 ` àà  àSince€many€coding€issues€revolve€around€laboratory€testing€and€procedures€such€as€x„rays,Ïparticipation€of€staff€performing€these€services€may€be€helpful.Ð ` €%` €% ÐÌÌà ° àò òPersons€Entering€Chargesó óÐ  $È!$ ÐÌà ° àà  àà0 ` àà  àIndividuals€who€submit€charges€serve€as€the€most€important€checkpoints€for€each€site.€€They€areÏable€to€recognize€potential€mistakes€before€charges€are€submitted,€and€(whenÏappropriately€trained)€may€substantially€reduce€the€ñ± ñpercentage€of€denied€claimsñ± ññ² ñnumber€of€errorsñ² ñ.Ð ` €%` €% ÐÌÐ  ¨)P'* Ðò òÓ  ÓÔ‡èS½çXX÷mÔPotential€ObstaclesÔ#†X÷mXçèS½ ,#Ôó óÐ X ÐÓ,ÓÌÌà ° àò òLeadershipó óÐ ´\ ÐÌà ° àà  àà0 ` àà  àThe€organization€and€direction€of€any€group€requires€considerable€effort,€with€this€committeeÏbeing€no€exception.€€Capable€and€motivated€individuals€would€be€vital€to€making€CDR€aÏsuccess.€Ð ` €%` €% ÐÌÌà ° àò òRecruitment€of€Participantsó óÐ ( Ð  ÐÌà ° àà  àà0 ` àà  àIssues€related€to€documentation,€coding€and€reimbursement€do€not€ñ³ ñoften€ñ³ ñgenerate€much€interest,€as€theyÏare€often€viewed€as€hurdles,€and€do€not€directly€relate€to€patient€care.€€It€may€be€that€thereÏare€not€enough€interested€individuals€to€fashion€an€effective€committee.€€Anything€lessÏthan€a€team€effort€would€be€unproductive.€Ð ` €%` €% ÐÌÌà ° àò òSuspicion€by€Providersó óÐ ˆ0 ÐÌà ° àà  àà0 ` àà  àSome€Practice€providers€may€justifiably€be€fearful€that€the€committeeððs€efforts€would€result€inÏadditional€intrusive€regulations.€€It€is€essential€that€the€actions€of€CDR€be€directed€atÏproviding€valuable€services,€interfering€as€little€as€possible€with€the€providersðð€practices.Ð ` €%` €% ÐÌÌà ° àò òPotential€Liability€if€the€Committeeððs€Recommendations€are€not€Observedó óÐ ü¤ ÐÌà ° àà  àà0 ` àà  àCreation€of€Practice€standards€serves€no€benefit€if€guidelines€are€not€embraced€by€providers€withinÏthe€organization.€€In€fact,€such€a€situation€could€be€detrimental.€€In€the€event€of€an€formalÏaudit,€providers€with€misguided€documentation€and€coding€practices€could€not€claimÏignorance€if€a€formal€Practice€standard€exists.Ð ` €%` €% ÐÌÌà ° àò òAvailable€Supportive€Resourcesó óÐ \!! ÐÌà ° àà  àà0 ` àà  àAny€effective€committee€requires€the€availability€of€supplies€and€secretarial€support.€€If€theÏnecessary€resources€do€not€exist,€or€cannot€be€assembled,€the€feasibility€of€such€aÏcommittee€should€be€questioned.Ð ` €%` €% ÐÌÐ  ä&Œ$' Ðò òÔ‡èS½çXX÷mÔÓ  ÓÌÌÌConclusionó óÔ#†X÷mXçèS½Ð4#ÔÐ äŒ ÐÓï4ÓÌÌÌà ° àThere€is€always€one€easy€solution€to€growing€financial€pressures„„providers€can€see€more€patients€perÏday.€€Unfortunately,€there€are€limits€to€this€approach.€€Greater€volume€eventually€erodes€either€providerÏsatisfaction€or€patient€care,€and€rendering€additional€poorly„reimbursed€services€does€nothing€to€improve€theÏsituation.€€At€some€time,€the€Practice€must€look€to€see€how€it€can€most€effectively€recover€ñ´ ñapproñ´ ññµ ññ´ ñrñ´ ññµ ññ¶ ñpriateÏñ¶ ñreimbursement€for€services€that€are€already€provided.€€Concomitantly,€it€must€make€sure€that€services€areÏñ· ñappropriateñ· ññ¸ ñnecessaryñ¸ ñ€and€that€documentation€practices€do€not€confer€undue€risk.€€ÌÌà ° àBenefits€of€improved€documentation€and€coding€can€be€realized€by€both€the€organization€and€theÏindividual€providers.€€The€challenge€is€determining€which€actions€are€likely€to€be€most€helpful,€at€the€same€timeÏminimizing€effort,€expense,€and€hassle.€€ÌÌà ° àWhile€it€may€be€desirable€to€hire€the€areaððs€most€knowledgeable€experts€to€examine€current€practices€andÏprovide€educational€services,€such€expenditure€is€not€realistic€for€more€than€a€limited€duration.€€A€structuredÏlong„term€plan€would€be€more€advantageous.€ñ¹ ñ€While€the€Practice€does€not€have€individuals€with€all„inclusiveÏknowledge€regarding€coding,€documentation€and€reimbursement,€there€are€likely€enough€interested€persons€withÏevolving€talent€to€assemble€a€successful€committee.ñ¹ ñœ