PAGE 1 @GoKareo; #KareoTipPAGE 1 KAREO | CONFIDENTIAL
Your Medical Office Software
Coding Pitfalls & Promises
PAGE 2 @GoKareo; #KareoTip
Your Hosts Today…
Betsy Nicoletti
MS, CPC
Lea Chatham
Content Marketing Manager, Kareo
PAGE 3 @GoKareo; #KareoTip
Our Schedule for Today…
1 Introduction & Welcome Betsy
2 Your Medical Office Software: Coding
P...
PAGE 4 @GoKareo; #KareoTip
Participate via Social
Facebook.com/GoKareo
Twitter.com/GoKareo
Linkedin.com/company/Kareo
We’l...
PAGE 5 @GoKareo; #KareoTip
Betsy Nicoletti, MS, CPC
 Speaker, writer, and consultant in
coding education, billing, and ac...
PAGE 6 @GoKareo; #KareoTip
Our Schedule for Today…
1 Introduction & Welcome Betsy
2 Your Medical Office Software: Coding
P...
PAGE 7 @GoKareo; #KareoTip
Agenda
 Use coding functions in software to improve
accuracy
 Describe key audit functions in...
PAGE 8 @GoKareo; #KareoTip
Use Software to Improve Accuracy
 Complete coding descriptions reduce errors
 Incomplete CPT ...
PAGE 9 @GoKareo; #KareoTip
Set Coding Edits
 Modifier use
 Edits that remind user when modifier
needed
 Pre-adjudicatio...
PAGE 10 @GoKareo; #KareoTip
Verify Eligibility, Coverage
 Use these functions prior to patient arrival
 Allows you to co...
PAGE 11 @GoKareo; #KareoTip
Templates for Procedures
 Can be very helpful, save typing
 Can be tied to CPT codes
 Pitfa...
PAGE 12 @GoKareo; #KareoTip
In the beginning, was the stimulus
PAGE 14 KAREO | CONFIDENTIAL
“Robert Burleigh was overbilled
for an emergency-room visit
because the hospital’s electronic...
PAGE 15 @GoKareo; #KareoTip
Letter from HHS and Attorney General
“Troubling
indications…game
the system…
potential cloning...
PAGE 16 @GoKareo; #KareoTip
Protect the Integrity of the Medical Record
 Purpose is clinical
 Other providers must be ab...
PAGE 17 @GoKareo; #KareoTip
Key Audit Functions
 OIG recommendations are described on coming
slides as “required” in thei...
PAGE 18 @GoKareo; #KareoTip
OIG report: OEI-01-11-00571
“CMS and its contractors
have adopted few program
integrity practi...
PAGE 19 @GoKareo; #KareoTip
From the New York Times
19
PAGE 20 @GoKareo; #KareoTip
OIG report: OEI-01-11-00570
“Not all fraud
recommended
safeguards have been
implemented in Hos...
PAGE 21 @GoKareo; #KareoTip
OIG Audit Recommendations
 Have an audit log
 Method of entry should be logged (direct,
copy...
PAGE 22 @GoKareo; #KareoTip
OIG User Access Recommendations
 Use user IDs and passwords
 Use provider National Provider ...
PAGE 23 @GoKareo; #KareoTip
OIG E/M Recommendations
 Requires that EHR technology not prompt an
EHR user to add documenta...
PAGE 24 @GoKareo; #KareoTip
OIG Patient ID Recommendations
 How do you know the patient is really Betsy
Nicoletti?
 Prio...
PAGE 25 KAREO | CONFIDENTIAL
Overdocumentation is the practice of
inserting false or irrelevant documentation
to create th...
PAGE 26 @GoKareo; #KareoTip
Templates & Copying Notes
 Is using a template any different than copying
from previous note?...
PAGE 27 KAREO | CONFIDENTIAL
Copy-pasting, also known as cloning, allows
users to select information from one source and
r...
PAGE 28 @GoKareo; #KareoTip
Develop a Policy
 “Just say no?”
 Policy: who imports PFSH, how do we know the
clinician rev...
PAGE 29 @GoKareo; #KareoTip
Hospital Visits
 This note looks
familiar
 Entirely copied from
previous day, and
“edited”
PAGE 30 KAREO | CONFIDENTIAL
With copying and pasting notes in
EHRs, the rule is that you should not
document it if you di...
PAGE 31 @GoKareo; #KareoTip
What Makes Sense?
 78 y.o. m. w/COPD,
pulmonary nodules…
 45 y.o. f w/stage 2
breast cancer,...
PAGE 32 KAREO | CONFIDENTIAL
Clinical summary
Pleasant 58-year-old with a past medical history
of coronary artery disease,...
PAGE 33 @GoKareo; #KareoTip
“Since last seen…”
 Now, the HPI elements that describe
patient’s condition
 This is the new...
PAGE 34 @GoKareo; #KareoTip
Assessment
 Should contain only problems addressed at this
visit
 Avoid listing all of the p...
PAGE 35 @GoKareo; #KareoTip
Use or Not Use E/M Calculators?
 Do they work?
 Will they result in coding higher or lower t...
PAGE 36 @GoKareo; #KareoTip
History in the E/M Calculator
 Can only read structured fields: HPI is often free
texted
 RO...
PAGE 37 @GoKareo; #KareoTip
Exam
 Easiest part of note for EHR to audit
 But, find out which guidelines are used: 1995 o...
PAGE 38 @GoKareo; #KareoTip
Medical Decision Making
 Complexity: hardest part for an auditor, hard for a
machine
 New or...
PAGE 39 @GoKareo; #KareoTip
Check Accuracy
 Physician is responsible for coding submitted
under his/her provider number
...
PAGE 40 @GoKareo; #KareoTip
Audit Strategies: New Patients
Select three common conditions for new patients
 Specialty sp...
PAGE 41 @GoKareo; #KareoTip
Audit strategy for established visits
 Select patients followed multiple times in a year
for ...
PAGE 42 @GoKareo; #KareoTip
Engaging Physician Leadership
 Print out and review both OIG reports
 Print out Documentatio...
PAGE 43 @GoKareo; #KareoTip
Show Results of Audit
 Save audit results as
part of compliance
activities
 Celebrate
 Revi...
PAGE 44 @GoKareo; #KareoTip
Our Schedule for Today…
1 Introduction & Welcome Betsy
2 Your Medical Office Software: Coding
...
PAGE 45 @GoKareo; #KareoTip
Discover Kareo’s Role
Cloud-based
Medical Billing
Patient Payment Services
Insurance Billi...
PAGE 46 @GoKareo; #KareoTip
Educational Resources
PAGE 47 @GoKareo; #KareoTip
Discover Kareo’s Role
•Kareo EHR
• Built-in templates
• Template editing
• Set user
permission...
PAGE 48 @GoKareo; #KareoTip
Discover Kareo’s Role
•Kareo EHR
• Built-in templates
• Template editing
• Set user
permission...
PAGE 49 @GoKareo; #KareoTip
Discover Kareo’s Role
•Kareo EHR
• Built-in templates
• Template editing
• Set user
permission...
PAGE 50 @GoKareo; #KareoTip
Discover Kareo’s Role
•Kareo EHR
• Built-in templates
• Template editing
• Set user
permission...
PAGE 51 @GoKareo; #KareoTip
Discover Kareo’s Role
•Kareo EHR
• Built-in templates
• Template editing
• Set user
permission...
PAGE 52 @GoKareo; #KareoTip
Discover Kareo’s Role
PAGE 53 @GoKareo; #KareoTip
Discover Kareo’s Role
PAGE 54 @GoKareo; #KareoTip
Our Schedule for Today…
1 Introduction & Welcome Betsy
2 Your Medical Office Software: Coding
...
PAGE 55 @GoKareo; #KareoTip
Let’s Answer Your Questions
888-775-2736
sales@kareo.com
Kareo.com/chat
Facebook.com/GoKareo
T...
Kareo - Your Medical Office Software: Coding Pitfalls and Promises
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Kareo - Your Medical Office Software: Coding Pitfalls and Promises

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Practices want to use their EHR and practice management (PM) software capabilities in a way that both ensures capturing fee-for-service revenue and doesn't conflict with Office of Inspector General (OIG) warnings about cloning and over-documentation.

The OIG has released two reports recently warning healthcare providers about copy/paste, over documentation, and audit functions in their EHRs. Healthcare providers need to balance these warnings with their desire to use software tools and techniques to make coding easier.

In this webinar, coding expert Betsy Nicoletti will describe the OIG recommendations and suggest policies and procedures that will allow clinicians to use their EHRs in a way that saves them time and promotes good patient care, but doesn't conflict with those OIG recommendations.

At the end of the session participants will:
- Have three techniques to help use the coding functions in their software to improve accuracy and efficiency
- Know three key audit functions that a practice should use in their EHR programs
- Understand the pros and cons of using an E/M calculator and how to assess its accuracy

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  • Kareo provides templates for top 100 primary care visits, 44 mental health visits with ability to customize to your needs. You can also pay a small fee for Kareo to do custom templates.
  • Control user permissions by role or person. Audit access to patient records. All the tools you need to ensure compliance in your EHR.The system all tracks notes based on OIG recommendations…- We log the author of the note- We log that the note is "copied"- We log the originating note that it came from
  • Code your superbill moreaccurratelyKareo is excited to announce the Evaluation and Management (E/M) Code Assistant, which was created to assist you with completing your Superbill with the appropriate code levels. The Code Assistant is intuitive and makes suggestions for codes to speed up the Superbill completion process and help ensure accurate billing.
  • Kareo PM scrubs codes and edits are pre-built into the scrubbing engine so you are alerted to issues
  • You can also set user permission in Kareo PM and audit access to accounts
  • Kareo has just been named the #1 seamlessly integrated EHR, PM, and RCM solution by Black Book for the second year in a row!
  • Find our more and sign up for a demo at www.kareo.com!
  • Kareo - Your Medical Office Software: Coding Pitfalls and Promises

    1. 1. PAGE 1 @GoKareo; #KareoTipPAGE 1 KAREO | CONFIDENTIAL Your Medical Office Software Coding Pitfalls & Promises
    2. 2. PAGE 2 @GoKareo; #KareoTip Your Hosts Today… Betsy Nicoletti MS, CPC Lea Chatham Content Marketing Manager, Kareo
    3. 3. PAGE 3 @GoKareo; #KareoTip Our Schedule for Today… 1 Introduction & Welcome Betsy 2 Your Medical Office Software: Coding Pitfalls & Promises 3 Discover Kareo’s Role 4 Answer Questions
    4. 4. PAGE 4 @GoKareo; #KareoTip Participate via Social Facebook.com/GoKareo Twitter.com/GoKareo Linkedin.com/company/Kareo We’ll be live tweeting during today’s webinar! How to participate: 1. Follow @GoKareo on Twitter 2. Join the conversation using #KareoTip 3. Join Building Best Practices group on LinkedIn
    5. 5. PAGE 5 @GoKareo; #KareoTip Betsy Nicoletti, MS, CPC  Speaker, writer, and consultant in coding education, billing, and accounts receivable  Author of The Field Guide to Physician Coding  Founder of Codapedia.com  Developer of The Accurate Coding System  MS in organization and management  20 years experience in medical coding  Member of MGMA & the National Speakers Association Betsy Nicoletti, MS, CPC www.betsynicoletti.com www.codapedia.com Betsy.nicoletti@gmail.com @BetsyNicoletti
    6. 6. PAGE 6 @GoKareo; #KareoTip Our Schedule for Today… 1 Introduction & Welcome Betsy 2 Your Medical Office Software: Coding Pitfalls & Promises 3 Discover Kareo’s Role 4 Answer Questions
    7. 7. PAGE 7 @GoKareo; #KareoTip Agenda  Use coding functions in software to improve accuracy  Describe key audit functions in EHRs that support compliance  Develop a copy/paste policy  Discuss the pros and cons of Evaluation and Management calculators in the EHR
    8. 8. PAGE 8 @GoKareo; #KareoTip Use Software to Improve Accuracy  Complete coding descriptions reduce errors  Incomplete CPT code descriptions can lead to incorrect codes selected  Discourage users from changing descriptions of ICD-9 and CPT codes  ICD-9 codes that are changed are often least specified
    9. 9. PAGE 9 @GoKareo; #KareoTip Set Coding Edits  Modifier use  Edits that remind user when modifier needed  Pre-adjudication edits  Medical necessity edits  Linking  For vaccines, preventive medicine service
    10. 10. PAGE 10 @GoKareo; #KareoTip Verify Eligibility, Coverage  Use these functions prior to patient arrival  Allows you to collect patient due amounts, discuss finances with patient
    11. 11. PAGE 11 @GoKareo; #KareoTip Templates for Procedures  Can be very helpful, save typing  Can be tied to CPT codes  Pitfall: can be too generic and non-descriptive  “IV was removed and pressure applied for 3-5 minutes or until bleeding stopped”
    12. 12. PAGE 12 @GoKareo; #KareoTip In the beginning, was the stimulus
    13. 13. PAGE 14 KAREO | CONFIDENTIAL “Robert Burleigh was overbilled for an emergency-room visit because the hospital’s electronic records included examinations he had not been given.”
    14. 14. PAGE 15 @GoKareo; #KareoTip Letter from HHS and Attorney General “Troubling indications…game the system… potential cloning” Katherine Sebelius and Eric Holder in a letter
    15. 15. PAGE 16 @GoKareo; #KareoTip Protect the Integrity of the Medical Record  Purpose is clinical  Other providers must be able to treat from the record  Misleading, inaccurate entries must not be tolerated by physician leaders  Billing is secondary!
    16. 16. PAGE 17 @GoKareo; #KareoTip Key Audit Functions  OIG recommendations are described on coming slides as “required” in their report but are not mandates  These are their recommendations, not current requirements  These are suggestions to CMS and the ONC  CMS developing guidelines
    17. 17. PAGE 18 @GoKareo; #KareoTip OIG report: OEI-01-11-00571 “CMS and its contractors have adopted few program integrity practices to address vulnerability in EHRs” January 2014  Contractors not looking for this  OIG recommends CMS develop policies  CMS agrees “We will.”
    18. 18. PAGE 19 @GoKareo; #KareoTip From the New York Times 19
    19. 19. PAGE 20 @GoKareo; #KareoTip OIG report: OEI-01-11-00570 “Not all fraud recommended safeguards have been implemented in Hospital EHR Technology” December, 2013  Audit trail  Cloning  Overdocumentation
    20. 20. PAGE 21 @GoKareo; #KareoTip OIG Audit Recommendations  Have an audit log  Method of entry should be logged (direct, copy/paste/import)  Track original author when info entered by someone else (e.g., medical assistant)  Changes tracked by addendum, original saved
    21. 21. PAGE 22 @GoKareo; #KareoTip OIG User Access Recommendations  Use user IDs and passwords  Use provider National Provider Identifier to restrict access  “Auditor” class user to have read only access
    22. 22. PAGE 23 @GoKareo; #KareoTip OIG E/M Recommendations  Requires that EHR technology not prompt an EHR user to add documentation but be able to alert a user to inconsistencies between documentation and coding. “Just add family history and you get a four!”
    23. 23. PAGE 24 @GoKareo; #KareoTip OIG Patient ID Recommendations  How do you know the patient is really Betsy Nicoletti?  Prior relationship  Picture ID  Photo then imported into medical record
    24. 24. PAGE 25 KAREO | CONFIDENTIAL Overdocumentation is the practice of inserting false or irrelevant documentation to create the appearance of support for billing higher level services. Some EHRs auto- populate fields when using templates. Other systems generate extensive documentation on the basis of a click of a checkbox, which if not appropriately edited, may be inaccurate. Such features can produce information suggesting the practitioner preformed more comprehensive services than were actually rendered.
    25. 25. PAGE 26 @GoKareo; #KareoTip Templates & Copying Notes  Is using a template any different than copying from previous note?  Templates: can encourage documenting elements that aren’t needed  “Sameness” about notes  Need enough variety of templates to accommodate different types of visits and problems
    26. 26. PAGE 27 KAREO | CONFIDENTIAL Copy-pasting, also known as cloning, allows users to select information from one source and replicate it in another location. When doctors, nurses, or other clinicians copy-paste information but fail to update it or ensure accuracy, inaccurate information may enter the patient's medical record and inappropriate charges may be billed to patients and third- party health care payers. Furthermore, inappropriate copy-pasting could facilitate attempts to inflate claims and duplicate or create fraudulent claims.
    27. 27. PAGE 28 @GoKareo; #KareoTip Develop a Policy  “Just say no?”  Policy: who imports PFSH, how do we know the clinician reviewed it  Medical director input into policy  Particularly troubling for inpatient records
    28. 28. PAGE 29 @GoKareo; #KareoTip Hospital Visits  This note looks familiar  Entirely copied from previous day, and “edited”
    29. 29. PAGE 30 KAREO | CONFIDENTIAL With copying and pasting notes in EHRs, the rule is that you should not document it if you did not ask it, review it, examine it or consider it. If you copied from a previous note, read your new note and see if it contains any details that do not meet one of those criteria. If so, delete that element.
    30. 30. PAGE 31 @GoKareo; #KareoTip What Makes Sense?  78 y.o. m. w/COPD, pulmonary nodules…  45 y.o. f w/stage 2 breast cancer, tx’ed…  7 y.o. w/ADHD who…  Update ages and add detail as needed “Since our last visit, he reports feeling increasingly SOB, unrelieved by inhalers,…” Yes, copy the clinical summary Always new: “Since last seen”
    31. 31. PAGE 32 KAREO | CONFIDENTIAL Clinical summary Pleasant 58-year-old with a past medical history of coronary artery disease, previous acute coronary syndrome. He had bypass surgery. His last cardiac catheterization was June 2011. At that time bypass grafts were patent. The third obtuse marginal demonstrated 80 percent stenosis in the proximal third. The RCA demonstrated 100 percent proximal stenosis. The mid RCA was supplied by collaterals. There was diffuse coronary disease. Ejection fraction was 55 percent. There was no intervention at that point in time.
    32. 32. PAGE 33 @GoKareo; #KareoTip “Since last seen…”  Now, the HPI elements that describe patient’s condition  This is the new work and part we will credit for the elements of the HPI  Status of three chronic diseases: yes, if new and updated
    33. 33. PAGE 34 @GoKareo; #KareoTip Assessment  Should contain only problems addressed at this visit  Avoid listing all of the patient’s problems  Update status of patient’s conditions
    34. 34. PAGE 35 @GoKareo; #KareoTip Use or Not Use E/M Calculators?  Do they work?  Will they result in coding higher or lower than note audited by an auditor?  Will they result in coding higher or lower than code selected by the clinician? Goal: Accurate Coding!
    35. 35. PAGE 36 @GoKareo; #KareoTip History in the E/M Calculator  Can only read structured fields: HPI is often free texted  ROS, PFSH  Make sure fields have information when clinician checks “Reviewed, no changes”
    36. 36. PAGE 37 @GoKareo; #KareoTip Exam  Easiest part of note for EHR to audit  But, find out which guidelines are used: 1995 or 1997  Probably doesn’t have 1997 single specialty exam in system
    37. 37. PAGE 38 @GoKareo; #KareoTip Medical Decision Making  Complexity: hardest part for an auditor, hard for a machine  New or established problem to examiner?  May over count data  Table of risk—probably needs physician input
    38. 38. PAGE 39 @GoKareo; #KareoTip Check Accuracy  Physician is responsible for coding submitted under his/her provider number  Coder who is experienced auditor should review sampling of notes if using E/M calculator  Should allow for override by physician in both directions: “It just wasn’t that complicated”
    39. 39. PAGE 40 @GoKareo; #KareoTip Audit Strategies: New Patients Select three common conditions for new patients  Specialty specific: frequency, headache, shoulder pain Select three encounters for this service  Review the notes  What is the level of template?  Does the HPI tell the story?  Do they look eerily the same?
    40. 40. PAGE 41 @GoKareo; #KareoTip Audit strategy for established visits  Select patients followed multiple times in a year for chronic conditions  Do not include acute visits in this sample  Review sequential encounters  Look at HPI and A/P for identical documentation
    41. 41. PAGE 42 @GoKareo; #KareoTip Engaging Physician Leadership  Print out and review both OIG reports  Print out Documentation Guidelines  Research your EHR’s audit functions (who entered data, time stamp)
    42. 42. PAGE 43 @GoKareo; #KareoTip Show Results of Audit  Save audit results as part of compliance activities  Celebrate  Review problems with managing physician  Review with clinical staff  Develop a plan that emphasizes patient care No problems Problems
    43. 43. PAGE 44 @GoKareo; #KareoTip Our Schedule for Today… 1 Introduction & Welcome Betsy 2 Your Medical Office Software: Coding Pitfalls & Promises 3 Discover Kareo’s Role 4 Answer Questions
    44. 44. PAGE 45 @GoKareo; #KareoTip Discover Kareo’s Role Cloud-based Medical Billing Patient Payment Services Insurance Billing & Remittance Scheduling & Practice Management Electronic Health Records Medical Billing Services Education, Training, & Support Included 20,000 Providers Nationwide
    45. 45. PAGE 46 @GoKareo; #KareoTip Educational Resources
    46. 46. PAGE 47 @GoKareo; #KareoTip Discover Kareo’s Role •Kareo EHR • Built-in templates • Template editing • Set user permissions • Superbill
    47. 47. PAGE 48 @GoKareo; #KareoTip Discover Kareo’s Role •Kareo EHR • Built-in templates • Template editing • Set user permissions • Superbill
    48. 48. PAGE 49 @GoKareo; #KareoTip Discover Kareo’s Role •Kareo EHR • Built-in templates • Template editing • Set user permissions • Superbill & E/M Code Assistant
    49. 49. PAGE 50 @GoKareo; #KareoTip Discover Kareo’s Role •Kareo EHR • Built-in templates • Template editing • Set user permissions • Superbill • Kareo PM • Eligibility verification • Code scrubbing • Set user permissions
    50. 50. PAGE 51 @GoKareo; #KareoTip Discover Kareo’s Role •Kareo EHR • Built-in templates • Template editing • Set user permissions • Superbill • Kareo PM • Eligibility verification • Code scrubbing • Set user permissions
    51. 51. PAGE 52 @GoKareo; #KareoTip Discover Kareo’s Role
    52. 52. PAGE 53 @GoKareo; #KareoTip Discover Kareo’s Role
    53. 53. PAGE 54 @GoKareo; #KareoTip Our Schedule for Today… 1 Introduction & Welcome Betsy 2 Your Medical Office Software: Coding Pitfalls & Promises 3 Discover Kareo’s Role 4 Answer Questions
    54. 54. PAGE 55 @GoKareo; #KareoTip Let’s Answer Your Questions 888-775-2736 sales@kareo.com Kareo.com/chat Facebook.com/GoKareo Twitter.com/GoKareo Linkedin.com/company/Kareo Follow us!
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