TCN’s Outlier Coding Program

Some group practices have used the results of our coding accuracy audits identify “outlier” providers who code their own service and create a program just for them.

One practice had a doctor who insisted on coding all of her services at a lower level, just to avoid any audit exposure.  She was tired of having the medical group’s Compliance Officer constantly “on her case” and had already attended a number of training programs.  While her goal to stay “under the radar” might be considered admirable, it resulted in the group leaving many thousands of dollars “on-the-table,” and undervaluing a service is also a compliance violation.  The group then decided to have us code all of her services, with our fee deducted from her paycheck.  Surprisingly, it was a win-win-win outcome; she no longer had to deal with what she considered the onerous task of coding.   Our accurate coding increased her collections so much that her monthly check was larger (even net of our fee) so she felt like she got a raise.  Her partners’ paychecks were larger, too.

Another group used the same solution for the opposite problem.  One of their cardiologists felt that he was so extraordinarily talented and saw only the sickest of patients who had failed treatment by all of the other cardiologists in town.  He therefore believed that essentially all of his services should be at levels four and five.  While this might be correct, his medical record documentation did not support coding his services at those levels.  After a cycle of audits- training sessions-and then follow-up audits, it was clear that he was unwilling to change either his coding or documentation habits.  The other physician-shareholders in the group were greatly concerned about the compliance exposure he created for each of them personally, so they decided that The Coding Network would code just his services, also at his personal expense.  The other cardiologists in his medical group were happy that their compliance exposure had abated, but he hated seeing the modest deduction for coding services on his check-stub.  After about seven months he asked for a “one-on-one” refresher training session and retesting.  His medical record documentation was vastly more detailed and his coding accuracy improved to meet the OIG’s 90% requirement.

Whichever problem your practice may have, the carrot-and-stick approach of our “outlier” program works very effectively.  Most practices using our “outlier” service charge The Coding Network’s fee to the offending provider rather than making the fee a group expense.  This gives specific monetary motivation (“the stick”) to the offending provider to be more compliant in his/her coding.  Because the “outlier” program can be started and stopped at any time, as soon as a provider demonstrates compliant coding (usually by shadow coding The Coding Network for a period of time,) the provider can once again take control of his/her own coding (“the carrot”).  The Coding Network’s “outlier” program allows the group to benefit from compliant coding immediately, increasing revenue and/or reducing recoupment exposure.  Any number of providers can utilize the program for varying durations based upon each provider’s particular circumstance.  Since RAC audits target “outliers” in group practice settings, this program can be a valuable tool for RAC audit prevention.

If you need assistance with setting up an Outlier Coding Program, just give us a call at888-CODE-MED.  We’ll be glad to help.

Latest Blog Posts:

  • eclinicalworks-booth-youtube-screensnap-712_0_0

eClinicalWorks Fined For Failing To Comply With DOJ Settlement Agreement

August 7th, 2018|Comments Off on eClinicalWorks Fined For Failing To Comply With DOJ Settlement Agreement

The Inspector General of the Department of Health and Human Services fined eClinicalWorks $132K for violating a 2017 agreement which had required them to report patient safety issues with its EHR in a timely manner.

Read the […]

  • Medicare-Claims-OIG-466x311

OIG Estimates Medicare Improper Payments at $3.7 million

August 6th, 2018|Comments Off on OIG Estimates Medicare Improper Payments at $3.7 million

The Office of Inspector General (OIG) reviewed 191,118 Medicare paid distant-site telehealth claims, totaling $13.8 million, that lacked corresponding originating-site claims. The watchdog agency then reviewed provider supporting documentation of these claims to determine if the services met Medicare’s requirements for reimbursement. 31% of […]

  • 2443221331_3117feed17_b

Medicare Cuts For Academic Hospitals

August 3rd, 2018|Comments Off on Medicare Cuts For Academic Hospitals

Scholastic and country healing centers will probably observe a cut in Medicare subsidizing if the CMS concludes a proposition to diminish repayment for more-complex patients, as indicated by a Moody’s Investors Service examination discharged Monday.

Under […]

  • vaccination in hospital 1

Evaluation & Management Coding Handbook 2018

August 1st, 2018|Comments Off on Evaluation & Management Coding Handbook 2018

According to CMS, Evaluation and management (E/M) codes are the most frequently reported—and the most audited. In a study referred to by CMS, the OIG noted that 42% of claims for E/M services were incorrectly coded. Medicare reports a […]