Health Information Management

Improve coding quality and reimbursement

Briefings on APCs, March 26, 2010

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Coders know that, with few exceptions, they may not report something that a physician has not ­documented. Queries are necessary to obtain clarity and specificity. They take time and delay processing of the record, thereby increasing the unbilled balance on the discharged-not-final-billed list. Coders often know which physicians will respond to queries and which will not. And if coders query for specificity on every possible account, physicians may have more queries to which they must respond than records they must complete.

Queries are not as effective as face-to-face discussions with physicians. Coding managers must assess queries being formulated, the physicians to whom they are directed, and the reasons. Coding managers should then arrange to meet with individual physicians privately to review coding nuances or rules of which they may be unaware. Providing physicians direct face-to-face time and focused education will yield much better results than written queries that don’t explain what is lacking in the documentation.
 

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