PRESENTED BY: JOHN STIMLER, DO, CPC, CHC, FACEP BSA HEALTHCARE AND BSA HEALTHCARE ADVISORY GROUP
CRITICAL CODING REPORTS E/M Code Distribution Reports All Payers Medicare Procedure Code Analysis Report Volume and % Admissions Report(s) Provider Down-coding Reports Denial Reports: Not an emergency Not medically necessary 2
HOW SHOULD CODING REPORTS BE UTILIZED? (1) Coder comparison Trending analysis for coders and providers Recognition of: Coding methodology issues Provider documentation issues Potential compliance issues Revenue loss 3
HOW SHOULD CODING REPORTS BE UTILIZED? (2) To impact: Coder training Focused QA programs One-on-one training with chart examples 4
HOW SHOULD CODING REPORTS BE UTILIZED? (3*) Ensure more consistency and less coding variance Help better prepare for audit defense for all payers Establish E/M distribution averages and expectations 5
E/M CODE DISTRIBUTION REPORT: WHAT IS IT? Volume and comparative percentage for 99281 through 99292 All Payer vs. Medicare alone Trending important Enables evaluation of: Total practice Each facility Every coder and provider 6
E/M CODE DISTRIBUTION: HOW DO YOU USE IT? Estimate revenue loss or future upside potential Recognize coders in need of remedial education (using example charts) Balance reimbursement with compliance Isolate providers needing training due to documentation deficiencies (using example charts) 7
FINANCIAL DIFFERENCE BETWEEN
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