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September/October 2021

Evolving Education: Follow These Guidelines to Optimize Coder Education
By Shannon DeConda, CPC, CEMC, CEMA, CPMA, CRTT
For The Record
Vol. 33 No. 5 P. 10

2020 confirmed that within the world of coding and billing, change is inevitable. Therefore, each organization must have a design on how to stay current, be cognizant of trending topics, and stay ahead of impending changes. Being current ensures that the organization is maintaining compliance to the best of its abilities, including issues surrounding billing and coding.

What are “trending topics”? For the most part, they’re the current issues that carriers are looking to audit. Staying on top of the latest trends is not easy. Here, networking can be a boon. What are other organizations being audited for on the regular? Attending local chapter meet-ups and addressing pressing topics in organizational roundtables are excellent forums for staying on top of matters.

Being prepared for possible change is difficult, mainly because it’s not that easy to prognosticate what’s next on the auditing firing line. For example, the pandemic shook every organization, including the coding and billing departments. Oddly enough, 2021 was supposed to be the year when substantial changes occurred. However, many providers have not been affected at all, proving that all of that ramp up–training and worry was of little need.

Organizations must take the ideas of staying current, knowing trends, and planning ahead and adapt them to their specific processes, which can be difficult because most providers are structured to run lean and mean. Therefore, it seems impossible to take on duties outside of day-to-day operations. Matters such as compliance, audits, and preparing for future changes are duties that tend to skirt and shift. While these seem like tasks that could be pushed down a priority list, the cost of doing so could lead to fines and penalties, not to mention a potential sanctioning from billing.

Let’s consider each situation.

Staying Current
Take the example of a practice that has recently onboarded a new physician. The physician notifies the practice that his previous practice recently began billing the extenders services as incident-to and split-shared due to the Centers for Medicare & Medicaid Services relaxing some of its billing guidelines. Is the physician’s new practice on top of these (hypothetical) changes? In other words, is it staying current?

Knowing Trends
During a recent lunch and learn for practice managers, Lauren hears that another ear, nose, and throat group in town was recently audited by XYZ carrier for the use of 25 modifier and scopes. During the discussion, other practice managers share their experiences with similar audits for modifier 25 in other specialties and how they were affected. Based on this “intel,” Lauren is able to create an internal audit plan targeting these services to ensure that should they be audited, they are proficient in these areas.

Planning Ahead
Given 2021 brought about the first changes to evaluation and management (E/M) services in 25 years, most organizations probably planned ahead. However, planning ahead for E/M 2021 did not end with training providers on the guidelines. To truly be effective, organizations must test applicability and ensure retention to plan ahead for audit proficiency. This can be accomplished through mock audits, which can be conducted internally or through a third-party audit review.

Know the Facts
Staying current, in the know, and well prepared has more challenges than obtaining buy-in from others and constructing a plan. Accuracy challenges also must be addressed. Rumors, opinions, individual interpretations, and “fake news” plague the industry. Deciphering the differences is harder than one might think.

Case in point are the 2021 changes to E/M billing. Prior to the March release of the technical changes, there were many “industry-leading experts” who were presenting specific information on their websites about the American Medical Association (AMA) rules; however, they were not stating that it was their interpretation of AMA’s ill-defined statements. These leading authorities were inferring that their own interpretation was the AMA rule, failing to note that it was not written guidance. This was later authenticated as point in fact when AMA published the technical corrections update in March. As a result, many experts were forced to update their interpretations.

In these situations, the best policy is to go to the source and find the rules. If you read information from someone who is not the source, submit an inquiry and ask questions. Find out what is their interpretation and opinion as opposed to what is the actual published guidance. Also, always ask for site and source.

It’s a Team Effort
It’s important that when one member of the team receives education that it is shared with colleagues. This can have a layering impact on the team—especially the team member who received the training.

When it comes to training, keep the following guidelines in mind:

• No member should be allowed to attend training without understanding the expectations of reteaching the content to the team. This sets the expectation of attendance and attention at the event and, knowing that they will be required to share their knowledge, helps the attendee retain what they have learned.

• The team should provide the attendee with thoughtful questions and specific scenarios to present to the educator. Take full advantage of the time of each training event.

Learning Methods
Individuals retain and learn in different ways. For example, I enjoy audible books, but I would not say that I retain all of the information presented. My personal learning method is hearing and seeing. Having something read and reading myself at the same time helps me absorb and retain the content. Otherwise, my mind wanders and is easily distracted. Consider giving your team members a quiz to find out what type of learning modality is best for them, but be sure to specify this is for learning as opposed to hobby or pleasure learning.

A simple five-minute exercise could help. Gather everyone around a conference table. Tell them that this will seem a strange exercise, but it has to do with concentration and staring at computers all day. Have them close their eyes while you read the following passage:

Connie came into the office last week to see Dr. Greenjeans. She was running late for her appointment that day because her kids had been playing with her mobile phone the night before and accidentally turned off the alarm. They had a late start that morning and after dropping the kids off to school, she rushed right over to the office. She was upset to see that her weight had increased by 4 lbs. After all, she has been taking yoga classes at the YWCA and eating a low-calorie diet for the past week.

What was the patient’s name?

What was she wearing?

This is not a scientific exercise; you can make up your own version. The idea here is to see who on your team may need to be a visual learner. Obviously, this is not a valid test. You could Google one, but the trick here is—the patient’s name was stated only once, and what she was wearing was never mentioned, but the physician’s name could be a distraction.

Something as rudimentary as this exercise may give you an idea as to what tools work best for your team.

Spend Wisely
Make sure there’s a purpose behind the continuing education dollars your organization spends. These funds should be an investment into sustainable compliance but that works only if they are used appropriately. If team members are allowed to use and abuse their continuing education dollars and attend “conf-acations,” then little will be gained. In health care, there should always be an avenue for return on investment, and continuing education is no exception.

— Shannon DeConda, CPC, CEMC, CEMA, CPMA, CRTT, is the president and founder of NAMAS, a division of DoctorsManagement, in which she is a partner with 25-plus years in health care.