A practice management consulting and training firm working for and with physicians since 1985

A Simple Plan: Making Coding Compliance Painless

Practice Administrator Yvonne Currie and the physicians of Casper Orthopaedic Associates in Casper, Wyoming, have found a simple and very effective way to handle compliance issues. Thanks in part to the advice of KarenZupko & Associates, Yvonne put together a simple, workable compliance plan that has helped the practice "straighten out its bell curve" and stay on top of coding compliance.

The Plan

Casper Orthopaedic Associates' compliance plan works like this: Yvonne and her team attend three KZA/AAOS Orthopaedic Coding Courses annually, and two physicians from this team volunteer to review coding. Each month, Yvonne pulls two recent E&M notes before they are submitted to insurance, from each of the practice's eight physicians. This is called a prospective audit. The reviewing physicians downcode notes that are coded too high, note where procedures are undercoded, and return the reports to the physicians who saw the patients. Yvonne runs the practice's physical therapists through the same procedure on a quarterly basis.

Simplicity and Accountability: Essential Ingredients

Two of the most important reasons for the success of Casper Orthopaedic Associates' compliance plan are its simplicity and its use of random variation. The plan is less than two pages long, simply describing the process above. As Yvonne says, "The more rules you make, the more you have to follow,” and the more likely the plan is to cause tension rather than to help physicians improve.

Tips for an Effective
Compliance Plan

Less is more.
Coding is complicated, but a good compliance plan is simple.

Make sure all of the physicians are on board from the beginning.
One way to do this is to demonstrate if the doctor compares positively or negatively with state and national code utilization averages.

(See KZA’s E&M Profile Analyzer)

Timeliness is important.
Prompt prospective reviews to avoid late filing.

A physician should never review his/her own notes.
Along with random variability, this step helps ensure accountability.

Keep the lines of communication open.
Communication is one of the most important elements of a successful group practice, especially when implementing a new procedure or taking corrective action.

Randomness ensures the physicians and therapists aren't tempted to be on their best behavior for the review, then slack off the rest of the month. Physicians and physical therapists don’t know when during the month the reviews will take place, and they don’t know which notes will be pulled.

Stronger Communication, Stronger Practice

Casper Orthopaedic Associates' physicians and therapists have increased self-awareness and improved communication as a result of this simple compliance plan. The physicians—who voted unanimously for the plan in 2000—appreciate the monthly reviews for the assistance in dealing with complicated coding issues. They now dictate E&M notes in a more logical format, making later communication of the notes easier. One of the most effective uses for the compliance plan has been integrating new physicians into practice protocol and the complex world of coding compliance.

E&M Profile Analyzer

Is your practice losing revenue? At risk of being audited? Get KZA’s powerful new E&M Profile Analyzer—customized for your specialty in your area—today!

Also available for 11 specialties and multi-specialty practices!

What the Profile Analyzer will show you:

If your practice’s coding pattern is in line with the state and national averages for your specialty, your Profile Analyzer graph will look something like this:

Graphs skewed to the left (as in the example below) signal a higher utilization of low-level codes, which may result in potentially lost revenue.

Graphs skewed to the right show a more frequent use of higher-level codes. Practices displaying an unusual number of higher-level codes may be at risk for an audit.

The E&M Profile Analyzer can be ordered from our website at: http://www.karenzupko.com/products/e&m.html, or by calling Chris Cantelmi at the KZA office at (312) 642-5616.

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