May 27, 2022 | By Sonal Patel, CPMA, CPC, CMC, ICDCM
I have been privileged to make my entrance into the world of healthcare and medical coding, specifically after my first career as an art historian dissolved way back in 2008 due to the recession. Mind you, I have taken all my research skills, writing, communication, and critical thinking strengths along for the ride as well. To be honest, I believe so much of the work I perform as a consultant today benefits from my past knowledge, skills, and abilities in the humanities. And of course, it helps to have an ornery physician-now-retired-internal medicine father serve as my biggest advocate on tough days. I am a physician champion to this day because of what I saw growing up: a committed dedication and passion to serve others.
So then, when it comes to my everyday business of protecting physicians, I do so with my passion for language, the written word. I advise providers to adhere to policies and guidelines as published by both commercial and government payors alike. Of course, this is preferable on the front-end, with proactive compliance. But I have also helped develop reactionary corrective action plans, compliance programs, and internal compliance policies to ensure that medical practices and their physician leaders are defended moving forward.
I believe compliance is the backbone of coding integrity. Unfortunately, this is not the focus or primary goal when starting a career in medical coding. Rather, newly certified medical coders are guided by performance metrics and production-level standards. If instead, medical coders were impressed upon the larger ideology of coding compliance, alongside the nuances of researching clinical policies and reimbursement policies before coding claims, medical practices could be better served overall.
There are a plethora of tools I utilize (or develop) when I perform pre-payment or post-payment audits for various providers, from MDs and DOs to NPs and PAs in a mixed bag of specialties and sub-specialties. Of course, two of my favorites over the years have come from the Office of Inspector General (OIG). First, the monthly OIG Work Plan is instrumental in outlining the pending work performed by the Office of Audit Services, as well as the Office of Evaluation and Inspections. The reports that result are beneficial to many of the practices I serve when it comes to notorious disclosures involving modifier -25 abuses or Incident-To errors, just to name just two. Second, the OIG’s website also discloses a laundry list of enforcement actions that involve criminal, civil, or administrative legal actions that afflict alleged violators of fraud laws and other alleged violators of specific laws. Hand in hand, these types of information allow me to inform my providers of how to better avoid these types of egregious outcomes or to simply see how the monthly work may impact their practices.
Despite the splashy headlines in the news, the vast majority of our nation’s medical practitioners render quality care and strive to improve patient outcomes. To this day, I see my father’s prior patients say, “Hey, Dr. Patel” and jog up to him in parking lots and excitedly tell him about their improved diabetes mellitus; marked weight loss; or smoking cessation because of his decades serving as their doctor; they always say he made a positive impact on their well-being, with a dash of great bedside manner.
I, too, like many of my compliance colleagues, strive to make an impact on the business side of medicine. The fine art of language complements the science, the wizardry of our providers. It is our job to ensure that the adage “document, document, document” remain intact. But to remain vibrant and vital in this space of healthcare, it’s all in the delivery, isn’t it?