July 28, 2023 | By Jill Young, CPC, CEDC, CIMC
I have been a consultant for over 20 years and have worked in the medical field for over 40 years. When I first was in a position that required me to research the rules and policies of both documentation and compliance issues, there was no internet. There were no online search engines. If you were lucky, you had copies of manuals on paper. More importantly, you also had updates from payers that were sent monthly, quarterly, or perhaps yearly. But you had to search through those to see if any changes had been made by the payer since that manual had been published say, 5 years ago. If you were really lucky you might have an index of the changes to the original policy made to help you search.
There was a lot of paper involved in the past and not a lot of organization of it most times. It made pinning down specific details difficult. I still remember calling a major payer in our area to ask what their policy was regarding anesthesia time. I asked if they used minutes or units. The provider representative on the other end of the phone line said to me “What do you have in your records that we do?” Not only did she not know the policy for the company she worked with, but she was also asking ME what I showed theirs was. I had to laugh at the incredulousness of that conversation.
Now we have online policy manuals. Ones that are updated and maintained. Ones that are indexed and, oftentimes, searchable. I am not saying that all payers have good or even great information on their websites, but many do. CMS/Medicare has reasonably good information, as do their Medicare Administrative Contractors (MAC).
As a consultant, I am often asked by clients, prior students, and friends of friends, “I don’t know how to code for —, can you help me?”. Sometimes, it is more specific like “I can’t find where it says how to —. Can you help me?” I am astonished when a simple search of a payers website, or even a search using Google or Bing finds a listing under the payer and the specifics they were asking about. I always wonder, where did they look?
This brings me to the point of this article, which is: know and use your resources. Learn how to search on CMS.GOV’s website along with your MACs. Understand that if your MAC doesn’t have a policy, try searching the Frequently Asked Questions (FAQs) on the topic. If that doesn’t elicit the information needed, try searching another MAC’s website. Theirs may have material for you on the topic. Referencing another MAC is a reasonable alternative resource, which is better than having none at all.
Know what your search words and parameters should be. When you are searching for information, let’s say for Critical Care services and documentation of time, ask just that. But you can also be a little vague. For example, if you only search the words “Critical Care Time “, you may get articles written about the subject. Read them because there may be information you find valuable and there also may be references listed. The very reference you were looking for perhaps. Plus, you are reading on the topic, and that depth of knowledge is always good to have. Always look at the source of the article and the author. You may find it’s someone you have read before.
If you are looking for diagnosis information, have a PDF of the current year’s ICD-10-CM Guidelines in your files. You can download the most current version at the CDC.gov website. Having an electronic copy to search is extremely helpful. As is easily printing the section that addresses the guidelines from your common areas of diagnostic coding. After the conventions section, there are guidelines by chapters in the ICD-10-CM book. So a chapter regarding Neoplasm coding, one for Obstetrics and one for Diseases of the Digestive System to name a few. I was elated several years ago when someone told me about the amazing search tool hitting “Control” and “F” elicits. If the document is searchable, it will display every instance of the word(s) you are looking for in the document. Invaluable – especially when searching 2700 pages of a CMS Physician Fee Schedule Final Rule in the Federal Register (PFS Final Rule)!!
In June or early July, CMA releases a document that has the proposed rules for the Physician Fee Schedule (PFS) for the upcoming year in the Federal Register. The final rule is released in November or December and is a phenomenal source of information. The document contains the actual rules and policy changes that will take effect on January 1st of the upcoming year. It also has comments that are published in response to questions and remarks submitted to CMS after the proposed rule is released earlier in the year. These in-depth comments offer invaluable insight into the rules as authored by those writing the rules.
Lastly, I would mention networking. Attending conferences, whether in person or virtually allows you to meet professionals who are both like and unlike you. Local chapter meetings and other professional organizations give you peer-to-peer relationships that are invaluable when you have questions.
Look at the resources you have at your fingertips and then look beyond. Look at what can you reach for a grab to add to your arsenal of information that you need to efficiently, effectively, and compliantly complete your job.
Your next steps:
- Become a NAMAS Member to earn those CEUs and take advantage of learning resources, products, and resources!
- Read more blog posts to stay updated on the 2023 Revisions to the 2021 E&M Guidelines.
- Subscribe to the NAMAS YouTube channel for more auditing and compliance tips!
- Subscribe to the NAMAS YouTube channel for more auditing and compliance tips!
- Check out the agenda for the 15th Annual NAMAS Auditing & Compliance Conference and register to attend!
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.
Looking to start up a medical practice or grow your existing practice? Contact our parent company, DoctorsManagement.
