Hospitals are acquiring physician practices left and right – with consolidation increasing exponentially over the past decade. In fact, in just the four years between 2012 and 2016, there was a 63 percent increase in the percentage of hospital-employed physicians, in addition to thousands of practice acquisitions. Most of this consolidation is due to the negotiating power that comes with being larger – particularly with the managed care giants.
As is the case with any acquisition, hospitals have to evaluate all facets of the acquired organizations’ operational performance – and the world of billing and coding is no exception. Coding for hospitals and physician practices represent two very different worlds – and a merging of these two worlds often requires a close look at practices, standardization and training. Here are some tips for ensuring your newly acquired practice’s coding is in line with your organizational standards.
Step 1 – Evaluate Policies & Procedures
It’s not too surprising that many smaller independent physician practices don’t actually have written policies in place for how coding is handled. Because coding isn’t an exact science, a lack of written policies and procedures can lead to inconsistency, inaccuracy and even the potential for breach in compliance. Hospital coding leaders should work with practice staff to identify current coding practices, determining whether or not they match the system’s coding policies. If not, it’s time to train, educate and hold staff accountable to adhering to the hospital system’s standards to ensure accuracy and compliance.
Step 2 – Conduct a Coding Audit
Accuracy in coding is critical – most organizations strive for 95% accuracy. Conducting a coding quality audit of your new practice is an important first step to identifying their baseline performance. After the initial assessment, quarterly audits are the best way to ensure performance and accuracy remain on target. The audit should include coding accuracy by coder and a thorough evaluation of each provider’s documentation habits. Providing detailed reports and/or feedback to all coders and providers is critical to your success. Because many independent practices have never gone through an audit, it’s important to communicate openly and ensure they understand the audit isn’t a punitive process, but that it’s designed to ensure compliance, quality and optimal reimbursement. After the audit, work with the team to help them understand recommendations for improvement and explain the potential impact of better performance – whether it be financial, regulatory or quality-related.
Step 3 – Educate, Support and Mentor
Once your audit is done, you’re likely to have a much better idea of the educational and training opportunities needed for your new coders and providers. Coders from the newly acquired practices can benefit from a mentor who can help them understand the whole new world of outpatient facility coding practices. They may also appreciate the opportunity to participate in webinars on best practices, in-person training sessions with senior coding staff, or even attending local, regional or national coding professional meetings to learn and stay on top of the latest coding guidelines. Regardless of how the training is delivered, ensuring your new coders have access to continuing education is motivational and helps improve performance.
Acquiring practices brings new challenges and opportunities – ensuring your new practices’ coding practices are the best they can be will help ensure you achieve a faster return on your investment. GeBBS Healthcare Solutions offers a wide range of medical coding and billing services, including coding audits. To learn more, visit gebbs.com or Request for Consultation.