CDI for professional billing?

bmurphy@hcpro.combmurphy@hcpro.com
in CDI Talk Archive
Hi everyone, Brian here. I had a question from Tricia Truscott
(Tricia.Truscott@carle.com).



She was wondering if any other organizations or individuals have ever
rolled out a CDI program or have conducted limited CDI efforts for
professional fee (physician based) coding and billing. They are
currently looking into this.



If you have, you can reply here and/or I have also included Tricia's
e-mail address above.



I'm interested in this question as well!



Thanks,

Brian

Comments

  • Unknown
    edited May 2016
    Brian,



    I was approached by the manager of the physician based billing office
    regarding physician documentation substantiating the E/M coding.
    However, my manager preferred my efforts remain focused on obtaining
    documentation related to the hospital coding/billing needs. And since I
    am the only CDIS at my facility I agreed. I do see their needs for more
    thorough documentation related to their coding and billing.



    Thank you,

    Lisa Taylor, RN

    Wooster Community Hospital






  • mannb1mannb1
    edited May 2016
    The consulting company that worked with us here also did 1:1 for physician professional fee coding & billing. Of course, they are consultants, so this would not be inexpensive to have them work w/your physicians. Our CDI program is strictly inpatient focus, but I think the consultant worked w/several individual MDs and groups while they were on-site with us - like OB/GYN, the anesthesiologists, some other Internal Med docs, I think even Cardiologists.

    It was Navigant Consulting, Inc., sorry as I know this forum is for non-commercial use, but wanted to share the info.


  • digardskdigardsk
    edited May 2016
    As did ours (JATA). Kim


  • robert.hodges2robert.hodges2
    edited May 2016
    I've started doing a little of that. It's not a statistical sample (10
    charts per provider per year). My focus is on reviewing for
    "opportunities" for improved documentation by provider and I send them a
    "report card" once I finish their reviews. We have about 100 outpatient
    providers here and it constitutes over 90% of our business and facility
    revenue. Because of volume of visits it would be impossible to do more
    reviews than I am doing without stopping everything else.



    Robert



    Robert S. Hodges, BSN, MSN, RN

    Clinical Documentation Improvement Specialist

    Aleda E. Lutz VAMC

    Mail Code 136

    1500 Weiss Street

    Saginaw MI 48602



    P: 989-497-2500 x13101

    F: 989-321-4912

    E: Robert.Hodges2@va.gov



    "Anyone who has never made a mistake has never tried anything new."
    -Albert Einstein




  • stacy.vaughnstacy.vaughn
    edited May 2016
    Working the HIM field, I do consulting work for professional billing. If
    you are going to start auditing the documentation in the clinic notes,
    etc. make sure you are versed with the E&M codes and guidelines. There
    are two separate guidelines to use depending on if there is a specialty or
    the type of examination the physician does. There are also caveats within
    these guidelines. I would audit a nice sample for the provider, then give
    him the results along with education on how to improve. It is a job in
    itself. There is always wonderful opportunities on the office physician
    side for documentation improvement.

    Stacy Vaughn, RHIT, CCS
    Data Support Specialist/DRG Assurance
    Aurora Baycare Medical Center
    2845 Greenbrier Rd
    Green Bay, WI 54311
    Phone: (920) 288-8655
    Fax: (920) 288-3052




  • dbutlerdbutler
    edited May 2016
    When we first implemented (with JA Thomas), they offered a free limited review of Part B billing and documentation for any physician office willing (about 6 charts per provider in the office as I recall). I personally believe this was part of their strategy for physician education, awareness, buy-in, etc. to the in-patient hospital CDI implementation. They are also available for consultation to physician offices/groups -- we took advantage of that a couple of years ago for our hospitalist group.

    There are other similar services out there.

    We have not done any actual concurrent CDI work for physician services -- in part as the rules and processes are sufficiently different that it comes close to learning another discreet set of coding rules and guidelines. In addition, we simply don't have resources to expand into that arena. This is something that we discuss in a general format when giving presentations, etc.

    Don


  • nbrunson84nbrunson84
    edited May 2016
    A group of our physicians had an outside company speak to them about
    their hospital and overall documentation - how it would impact their
    practice/business.

    They are by far the best group for documentation in our hospital. I
    rarely have to Query their charts!!

    So - I would think it could be quite helpful!!


    N. Brunson, RHIA
    Clinical Documentation Specialist
    Bay Medical Center

  • tiffany_susantiffany_susan
    edited May 2016
    Similar situation here.

    Thank you,
    Susan Tiffany RN, CDS
    Supervisor
    Clinical Documentation Program
    Robert Packer Hospital & Corning Hospital
    570-882-6094 pager 465
    Fax 570-882-6768
    Tiffany_Susan@guthrie.org





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