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LESLIE: This month we take our readers to North Platte, NE, to visit with Chris Lee, RHIA, CPC, medical coding coordinator at a local physician group practice.
PATTY: The physician office is a health care setting that needs HIM expertise, and I am glad we can discuss Chris' experience with our readers. Chris, please share a bit about your role and your employer.
CHRIS: I work at North Platte Nebraska Physician Group, LLC, which is a 21 physician provider group and includes seven specialty clinics. The physician group is a wholly owned subsidiary of our local hospital, Great Plains Regional Medical Center. It's a fairly new group - about 1 year old.
LESLIE: To whom do you report and how long have you worked in the physician group?
CHRIS: I report to the executive director, and I have been working here for 7 months. This is a newly created role. In the past, the physician group worked with coders at the medical center but their expertise is primarily in inpatient coding. This led the physician group to seek an HIM professional with outpatient coding experience.
PATTY: Do you interact with the HM department at the hospital?
CHRIS: Yes, I do. We have a good relationship. We have become resources for one another. I completed my professional practicum experience (PPE) in the medical center's HIM department and as a result I was able to hit the ground running in terms of developing a relationship with the HIM team.
LESLIE: That is great! PPE's are so important because they often lead to a job or open a door in some way.
PATTY: What does a day in the life of Chris look like?
CHRIS: I spend a good part of my day fielding coding questions from our providers. I get a lot of questions such as: Can we bill this with that? How do we bill this procedure? What is the diagnosis code for that? I think it's very important to be accessible to the physicians and their office staff so coding and billing can be done in an accurate and timely way. I basically provide education on a daily basis.
PATTY: This seems like a just-in-time coding education program.
CHRIS: You could say that! I also have scheduled education for particular topics.
LESLIE: How responsive are providers to the education you provide?
CHRIS: They are very accepting of education. They are wonderful doctors but they don't necessarily have the training to know how to get reimbursed for what they do. I can help educate them on coding guidelines, documentation requirements and reimbursement rules. The primary reason for my position is to ensure documentation and coding compliance. My philosophy is that achieving compliance requires a collaborative effort.
PATTY: Who performs the coding function?
CHRIS: We are in a rural setting and don't have a lot of support staff. The responsibility for CPT and ICD-9-CM coding rests directly on the physicians. It's their responsibility to code, and they take it very seriously. Codes are built into our EHR and the providers select the code that best describes the diagnosis and procedure performed. Our EHR also determines the appropriate E/M code based on the history and physical exam and medical decision making.
PATTY: Do you perform coding audits?
CHRIS: I conduct coding audits at least quarterly. Usually I perform two audits myself and retain the services of an HIM company to conduct an additional two audits. I also perform "explanation of benefits" audits to review for appropriate reimbursement by payer, and I ensure we are covering our costs. I will also look at medical necessity.
PATTY: Does the physician group practice have an EHR?
CHRIS: Three of our clinics have implemented an EHR, and we are in the throes of bringing one more clinic up.
PATTY: What is your role in the implementation of the EHR?
CHRIS: I support the development and implementation of exam templates, review of system templates and diagnosis short lists. I also support the information technology department in any way I can.
LESLIE: What are your current priorities?
CHRIS: I am working with our physicians on implementing the physician quality reporting initiative (PQRI) and on implementing e-prescribing. But a good amount of time also gets spent on our EHR implementation. Once clinics are up and running, I participate in making process improvements as needed. I also audit our electronic records to ensure appropriate documentation and code selection. Perhaps one of the biggest challenges early on was addressing issues related to "cutting and pasting." This is becoming less of an issue as physicians get used to the EHR and understand that cutting and pasting is not a supported practice.
LESLIE: Is a patient's hospital record integrated with their physician record?
CHRIS: We have separate EHRs that do not interface at this time. Results and transcribed reports from the hospital's EHR are printed and scanned into the clinic's EHR. While this may seem temporarily cumbersome, the clinic does not have to rely on the medical center for copies. In the future it will be more integrated.
PATTY: What are your leadership challenges?
CHRIS: My challenges are around change management as it relates to the implementation of the EHR.
PATTY: What are physicians' objections to the EHR?
CHRIS: Physicians complain it takes too long to work with an EHR and that using an EHR is impersonal during an office visit. I try very hard to present change as being done to support physicians and not that it is being done to them. I try to show them the benefits of the EHR. For example, I worked with a physician who used to go home after a day at the clinic, have dinner with his family and then return to dictate and complete his records. With the EHR, when he leaves at the end of the day he is done. He no longer has to return to the clinic. The EHR has allowed him to spend more time with his family and other interests.
LESLIE: What are some tips for our readers who are interested in working in a physician office?
CHRIS: Coding in an outpatient setting is a horse of a different color when compared to inpatient. We don't rely on an encoder in a physician office setting. We do use online resources to help us with CPT/ICD cross coding, bundling, modifiers, etc.
We rely on our physicians to make day-to-day decisions related to code assignment. No one day is alike and most days include multiple interruptions throughout the day. I also think promoting collaboration is important because that is how things get done in physician offices. It's important to get everyone's input and hear all ideas.
PATTY: What kind of experience did you have prior to joining the physician group?
CHRIS: Ibegan my career filing in a physician's office, which led to an office manager position. I was responsible for charge entry, but as coding and reimbursement became more complex and new regulations were introduced, I began to focus on CPT and ICD-9-CM coding. I have worked in a physical therapy office and with an orthopedic practice. I also held a remote coding role and have performed coding audits. I recently earned my bachelors degree in HIM, which helped me obtain my current role and an increase in salary.
PATTY: It's been great talking with you Chris. Thank you for sharing your experience. We wish you all the best in your new role and encourage our readers to consider working in a physician office setting.
LESLIE: Next month we will explore the American Recovery and Reinvestment Act and its impact on information management. Until then, happy spring.
Leslie Ann Fox is chief executive officer and Patty T. Sheridan is president, Care Communications Inc., Chicago. They invite readers to send their thoughts and opinions on this column to lfox@care-communications.com or ptsheridan@care-communications.com.
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