PRACTICE PEARLS

 


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Fam Pract Manag. 2007 Jun;14(6):50-53.

Stay on top of documentation

Often, when I'm done with a patient visit, a staff member will take the patient's chart to complete referrals or other tasks. Without the chart on my desk, I can easily lose track of the fact that I still need to document the visit. To help me remember, I place a check mark by the patient's name on the schedule before going into the exam room (this indicates that the visit really took place), and then I highlight the name when the note is complete. This has been a fail-safe method for ensuring that my documentation is complete.

Welcome your patients back to your practice

My practice is striving to transform itself into a welcoming medical home for our patients. One way we have done this is by using an electronic database to identify patients with diabetes who have not had an office visit in the past year. Instead of expecting them to call us, we proactively invite them back. To expedite the physician encounter, we perform fasting blood and urine work one week prior to their appointment. I believe these efforts show that our priority is to reach out to our community and patients.

Use a template to improve your documentation

I use a template with standard questions for patients to improve the thoroughness of my documentation. The template reminds me to capture past medical, family and social history. The details I gain from this make it easier to document the code level that is appropriate for the services I provided.

How to handle overpayments from insurers

Q

My practice made a coding error that resulted in an overpayment by a patient's insurer. How do we correct the mistake? Do we have to correct it since the insurer hasn't raised the issue?

The answer depends on whether the mistake was an isolated incident or was repeated over a period of time. An occasional error can be fixed by simply sending a corrected claim. A repetitive error requires more action.

Often, a repetitive error happens because the person completing the billing does not understand the correct way to submit a certain type of claim and makes the same mistake repeatedly. This can result in an overpayment by the insurer that the practice is not entitled to. A repetitive error must be handled by contacting the carrier in writing in a way that creates a record of the inquiry (e.g., overnight delivery or certified mail). This indicates that the practice has identified the error.

If Medicare is the overbilled payer, you will need to explain how you found the error, how you calculated the amount you should have been paid, how much the overpayment is and what you have done to correct the problem. If the overbilled payer is not Medicare, the payer may not have an organized mechanism to accept your repayment even though you are legally obligated to provide it. Do not send money to any payer until you are told where to send it.

Before you leap forward with repayment, understand that the calculation of the repayment amount is often complicated. In some cases you can receive credit for the amount you would have been paid if you had billed correctly, and sometimes you can receive credit for what someone else did. For example, if the error occurred because the physician did not document enough to qualify the service for the level of evaluation and management code that he or she billed, but a nurse practitioner performed services that qualify as incident-to services, you can take credit for those. It is a completely different problem if the code was so wrong that you were never entitled any payment.

When dealing with repetitive errors, another decision you have to make is whether you will repay the payer based on a review of every single claim or on the basis of an extrapolated sample. Determining how far back you should analyze depends on the facts of the case as well as the law. For example, if a physician or coder began coding incorrectly after attending an educational program because he or she misunderstood the advice given, that defines the timeframe, unlike a situation in which a billing person was simply incompetent.

In most instances that involve a repetitive problem, I recommend involving an experienced attorney. Generally, the attorney contacts the relevant carrier and describes the client's situation without identifying the client until it is clear what information the payer needs and where the money should be sent. Once the information is obtained, the attorney will assist the client in sending the money to the correct payer.

A simple coding error is not a major event, but it may suggest there are problems you need to address. How you handle these problems can be significant, given the current fraud and abuse environment. A simple repayment that is not characterized appropriately to the payer can trigger a far larger audit and more.

Show appreciation for other departments

At our multispecialty practice, we created a way for each department to show appreciation for the others. At the end of each month, a specialty is randomly selected to receive a friendship basket from a different department. The basket is usually full of fruit, candy, juice and cookies. A new department is chosen each month as the recipient, and the department that received the basket the month before becomes the provider. This rotation continues throughout the year so that all of the specialties have the opportunity to be both provider and recipient. This unique gift exchange builds camaraderie, demonstrates how we function as a cohesive team and shows that we care about one another.

HELP US HELP YOU

Practice Pearls presents the best advice on effective, efficient practice operations and patient care drawn from the medical and business literature, along with tips developed from your experience. Send us your best pearl (250 words or less), and if we publish it, you'll earn $25. We also welcome questions for our Q&A section. Send your pearls and your questions to us at fpmedit@aafp.org.

WE WANT TO HEAR FROM YOU

Practice Pearls presents readers' advice on practice operations and patient care, along with tips drawn from the literature. Send us your best pearl (250 words of less), and you'll earn $25 if we publish it. We also welcome questions for our Q&A section. Send pearls, questions, and comments to fpmedit@aafp.org, or add your comments below.


 

Copyright © 2007 by the American Academy of Family Physicians.
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