A Look Back At 2017

2017 was a big year for the MedPro Services’ blog.  Not only did we cover some of the most important topics of today’s medical billing industry and practice management, but we also hit record numbers of views and visits.  Thank you for making 2017 such a great year!

Throughout the year, we covered numerous topics, all of which were designed with the provider in mind.  Here at MedPro Services, we strive to educate and help our providers in whatever capacity that we can.  Our blog just happens to be one of those informational avenues, which really allows us to reach a vast, global audience.

We began the year introducing our new website.  MedProServices.net is a project we are really proud of.  The MedPro tech-team put a great deal of time and energy into planning and redesigning the MedPro website.  The new site introduces who we are, what we do, and how we can help providers from all over the United States.  Visitors to the site are able to meet the staff and put names to faces, something we feel really gives us that personal touch.  We also provide information on pricing and practice solutions.

Later, we discussed topics related to medical billing best practices.  Some of our favorite topics covered were:

  • Appeals Best Practices: This post discussed the most efficient and appropriate means for addressing appeals in a timely and successful fashion.  This post is a favorite because we pride ourselves in quick, accurate, and successful follow-up.  At MedPro Services, each dollar is valuable and we continuously strive to follow-up on all claims, no matter the dollar amount.  Appeals Best Practices perfectly illustrates how we operate as a company in one aspect of the follow-up process.
  • Is Your Data Entry Team Working for You?: This is another favorite and one that has been visited numerous times by viewers globally.  The MedPro Services’ data entry team is competent, educated, and hard-working.  Since data entry is the first point in the claims process, we believe it is also one of the most important.  Clean claims can make all the difference in provider revenue.
  • Electronic Health Record (EHR) Systems: This year, we wrote two posts (EHRs are the Solutions: Making a Successful Transition; Are You Avoiding EHR Perils?) on EHRs and how these can make or break a modern practice.  With current and upcoming Medicare initiatives, EHRs are becoming increasingly important and knowing how to use them correctly is one of the best tools for success in today’s medical billing and healthcare industry.  These posts were some of our favorite to write and really highlight how EHRs can be used to the fullest potential possible, as well as some of the downfalls of relying on the electronic features.
  • Evaluation and Management (E/M) Series: Finally, we ended the year with a 3-part (Part 1, Part 2, & Part 3) series on E/Ms. E/Ms are notoriously difficult to code.  By writing these 3 posts, we hoped to emphasize some of the important components of the E/M and how they can be correctly coded by providers.  This was not only an interesting post to research and write, but we believe it was also informative to our audience too.

We hope that 2018 will also be a landmark year for MedPro blogging.  Our team has numerous projects in the works, including upcoming seminars and conferences.  It is our goal to share those experiences and what we learn with our audience and clients.

For more information on some of the services we provide and how we can help your provider practice, please feel free to send us a message.  We would love to hear from you!

Evaluation & Management Part 3: Medical Decision Making

Now it is time to wrap up the evaluation and management (E/M) series with the third and final part: the medical decision-making component.  This too was a topic covered at the Karen Zupko & Associates conference on General Surgery coding in Chicago, IL, and has been identified as one of the more difficult components to code because of its complexity.  The Centers for Medicare and Medicaid Services (CMS), does, however, provide detailed guidelines for documenting and determining the appropriate level of medical decision making.  Per CMS (2017), “medical decision making refers to the complexity of establishing a diagnosis and/or selecting a management option” (p. 13).  Additionally, per CMS (2017), the medical decision-making component is determined by three major factors:

  1. The number of potential diagnoses and/or various management options
  2. The amount and complexity of data, such as diagnostics and medical records, that are reviewed or must be obtained
  3. The level of risk associated with the patient’s condition.

What makes coding medical decision making so difficult is determining exactly which level of complexity the E/M represents.  Per CMS (2017), there are four levels of medical decision-making complexity.  These are ordered from level of least complexity to level of highest complexity:

  • Straightforward:  Minimal or no amount and complexity of data reviewed, minimal diagnoses or management options, and a minimal level of risk
  • Low Complexity:  Limited amount of complexity of data reviewed, limited diagnoses and management options, and a low level of risk
  • Moderate Complexity:  Moderate amount and complexity of data reviewed, multiple number of diagnoses or management options, and moderate level of risk
  • High Complexity:  Extensive amount and complexity of data reviewed, extensive number of diagnoses or management options, and a high level of risk.

Even with these definitions and guidelines put forth by CMS, there still remains some confusion as to how to accurately represent this component of the E/M.  The language may seem clear, but as was discussed at the conference and from my personal experience in coding, there is still a gray area in determining just how complex a provider’s medical decision-making component really is.  CMS does provide a useful table, which indicates the various levels of E/M medical decision-making complexity and examples to illustrate what each might look like in actual practice.  As was mentioned in parts 1 and 2, documentation is key and must reflect all medical decision-making aspects performed during the E/M.  This will help medical billers, coders, and providers alike in determining which level of complexity is most appropriate, and ultimately will lead to more accurate and appropriate E/M coding.

MedPro Services continuously seeks out educational opportunities, such as the Karen Zupko & Associates conference that was featured prominently in this three-part series.  Our team is informed and knowledgeable on current and future CMS guidelines and initiatives.  For more information on how we can help your practice, please send us a message and we will be more than happy to assist.

References

Centers for Medicare & Medicaid Services. (August, 2017). Evaluation and management services.  Medicare Learning Network. 

Evaluation & Management Part 2: The Exam

In continuation of the evaluation and management (E/M) series, this post will be on the exam, a part of the E/M that can vary greatly in extent and specificity.  At the recent Karen Zupko & Associates conference on General Surgery coding in Chicago, IL, a great deal of emphasis was placed on the importance of accurately documenting and coding the E/M.  The examination is one of the main components of the E/M, which was discussed at some length during the conference.  Depending on the patient’s presenting condition, the provider may determine at what level an exam is required.  An examination may be performed on numerous body systems, or it may be performed on the problem of focus and body part for which the patient is presenting.  Per CPT guidelines, a problem focused visit is usually just that, focused on the problem at hand, and a problem focused examination will be limited and directed at the impacted body part or system.  This varies greatly from a comprehensive examination, in which a provider will perform a more general evaluation of numerous patient systems (e.g. cardiovascular, respiratory, musculoskeletal) and organs.  It really all depends on how familiar the provider is with the patient’s specific condition and how much time and consideration is needed to determine the level of medical decision making.

As was mentioned in part 1, documentation is key.  Today’s electronic health records systems (EHRs) are especially useful in documenting the level of examination and on which body parts and systems and examination is performed.  Documentation may include such things as notating appearance, vital signs, or any assessment tools utilized during the exam.  These should all be documented and should be unique per the visit.  I have seen EHRs be very useful, but cloning can really affect the quality of documentation.  Providers must ensure that what is recorded is accurate for the specific visit.  For example, vitals from a visit two months ago should NEVER be included in a follow-up visit.  If these are going to be documented, then they must have been performed in that specific E/M.  Correctly documenting the examination portion of the E/M is critical because it plays a key role in determining which level of service to code (e.g. 99202, 99213).

I find that overall, providers do tend to code the examination portion of the E/M better than other portions.  That being said, as a medical biller and coder, I cannot emphasize enough how critical it is to correctly and accurately document.  MedPro Services strives to maintain coding and billing accuracy, but we cannot control a provider’s documentation.  We are, however, always willing and endeavoring to assist our providers in more accurate documentation, superbill coding, and other aspects of medical billing.  Please contact us with any and all inquiries, including consultation, coding,and billing.

Evaluation & Management Part 1: the History Component

MedPro Services strives to maintain current knowledge of the ever-changing medical billing and coding industry.  In one of our many continuing education efforts, a group from the MedPro Services’ team recently attended the Karen Zupko & Associates conference on General Surgery coding in Chicago, IL.  With the recent changes in the healthcare industry, medical billers/coders and providers alike must be especially vigilant in maintaining appropriate and accurate practices.  Insurance companies are cracking down on coding and billing errors and ensuring that provider reimbursement reflects services rendered.  With insurance auditing on the rise, providers must make sure that documentation and coding meets the Centers for Medicare and Medicaid Services (CMS) guidelines.  Over the next few weeks, I will be writing a series of posts highlighting some of the most integral aspects of what we learned at the conference and what we feel providers should know to keep their practices operating as efficiently and successfully as possible.

Today’s post focuses on something almost everyone in the medical billing industry is highly aware of, are continuously learning about, and is one of the most commonly miscoded and over-billed services: the evaluation and management (E/M).  This was a hot topic at the conference and something that all medical billing companies should be acutely aware of and knowledgeable on.  From personal experience, I can tell you that E/M codes are notoriously difficult to code simply because the CMS language is not as clear as it is for other areas of coding.  The most important thing to consider when coding E/M services is documentation.  Regardless of what happened in the exam room, documentation MUST meet CMS guidelines to bill varying levels of services.  Without appropriate and accurate documentation to support the level of service billed, providers are really opening themselves up for major issues with payors and very possibly the law.  As was mentioned in a previous post, today’s electronic health records (EHR) systems are highly intuitive and useful in hitting all of the necessary documentation markers.  Do NOT fall pray to templates and cloning.  Always document the unique aspects of each examination.

The speakers at the conference spoke extensively on correct E/M coding.  To code E/M’s properly, providers must be aware of three main components: history, exam, and medical decision making.  The level at which each of these are completed is what determines the level of service billed.  I must emphasize that wordy or over-documentation does NOT equate a higher level of E/M.  Because each component requires a great deal of consideration, I am only focusing on the history component in this post.

What does the history component in an E/M entail?  There are some important areas that should be hit to ensure that a history component is accurately and appropriately performed and documented. First, what is the chief complaint?  Document this in a clear and efficient statement, basically explaining why the patient is presenting for the visit.  Second, the history of present illness (HPI) should be performed and documented.  An HPI includes such things as when and where the injury or illness began to occur/appear, symptoms of the illness, when the injury/illness seems to worsen or get better, how often is it experienced and in what environments, etc.  Detail clearly the history behind the patient’s condition.  Third, past, family, social history (PFSH) should be addressed.  PFSH is pretty self explanatory, but includes such details as any family diseases, social history, such as smoking and alcohol use, etc.  Finally, a review of systems (ROS) is needed in the history component of the visit.  An ROS is as it sounds, a review of different bodily systems and part, such as the eyes, the heart, respiration, etc.  PFSH and ROS may be documented on a patient-completed form, but the provider must review this with the patient to ensure accuracy and to ask any questions that may arise.

Clearly coding E/M services is lengthy and requires special attention to detail, but doing so will result in not only more accurate and appropriate payor reimbursement, but will also help to maintain practice integrity and better patient care.  MedPro Services is continually educating and informing our providers on appropriate and accurate E/M documenting and coding.  We strive to ensure that documentation meets CMS standards and is reflective of actual services rendered.  In the following weeks, I hope to address further aspects of E/M coding and how MedPro Services can help providers address any areas of issue or concern with the topic.  If you have questions on E/M coding or are concerned your current billing company is not performing up-to-par, feel free to send us a message detailing your questions and concerns.