Just as we have changed professionally post-COVID, our work environments also may have changed or may need to change. In Today’s Take, I’d like to discuss the structural changes that need to take place post-COVID. Recently, Stephanie Allard did an amazing job presenting a NAMAS webinar addressing the organizational structure of your internal audit teams. To continue this, I’d like to discuss an approach that may seem radical at first glance, and I want to be sure you understand precisely what I mean when I suggest taking away a coding validation job. Now, I’m not meaning to take away a coding validation job. Let me say right up front that we should be taking coders and improving their skills, and moving them into auditor roles! Instead, maybe moving from 100% coding validation more into audit for proficiency.
In many organizations, providers perform their functions, and coders then do 100% validation of those services. During a patient encounter, no one knows what went on in that room better than the provider, and they don’t necessarily understand the coding functions and the requirements of those E&M services as well the coders and auditors. It is our job to train them and provide them with the knowledge of how to choose their E&M code. The initiative behind 2021 documentation guidelines and the 2023 expansion was to empower “patients over paperwork” to make it easy for physicians and providers to quickly and efficiently move through paperwork and know what their levels of service are for those patients. We should be able to efficiently and easily help our physicians and providers determine their level of service when seeing and treating patients, code the levels of service, and then we should be able to audit those encounters and give them that level of feedback.
So, in order to move from a model that would be 100% coding validation, you will have to do some serious training for those providers, and you will have to audit them and do 100% coding validation and feedback to ensure they are proficient and maintain that proficiency before just saying “OK, we’re good, we did our education, we did our due diligence, and now we can remove 100% coding validation”. That’s not how this will work. You will need to do training, and 100% validation until you are sure that providers maintain a precision error rating of 90-95% for two or three weeks, or whatever your window of precision is. This should not be my window of precision or what I deem appropriate. That should be your window of precision and your time frame. So that should be up to your organization… your C-suite’s expectations.
Once this is put into play, and once that window is maintained for a certain length of time, then pass that provider off of proficiency and monitor that provider. There’s no rule that says providers have to be on 100% coding validation. So again, this is a great way to not only increase a coder’s strength, and move them into a path of going from coder to auditor but also to streamline efficiency within your organization and look at a restructure post-COVID.
Do you have questions on this process? Do you need some help? I’m here to help! Contact me with your comments! Again, coders -this is simply a way to increase your skill set.
Your next steps:
- Contact NAMAS for information about customized staff and provider training.
- Read more blog posts to stay updated on the 2023 Revisions to the 2021 E&M Guidelines.
- Watch the YouTube video on this topic and be sure to subscribe!
NAMAS is a division of DoctorsManagement, LLC, a premier full-service medical consulting firm since 1956. With a team of experienced auditors and educators boasting a minimum of a CPC and CPMA certification and 10+ years of auditing-specific experience, NAMAS offers a vast range of auditing education, resources, training, and services. As the original creator of the now AAPC-affiliated CPMA credential, NAMAS instructors continue to be the go-to authorities in auditing. From DOJ and RAC auditors to CMS and Medicare Advantage Auditors to physician and hospital-based auditing professionals, our team has educated them all. We are proud to have helped so many grow and excel in the auditing and compliance field.
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