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Mind the Gap: Bridging the Coder-Clinician Relationship for Gains

Here at The Wilshire Group, we take pride in bringing resources together and navigating multidisciplinary areas to achieve optimal workflow and revenue cycle results. Last week we provided some ideas around CDI (clinical documentation integrity), and today we go a step further, discussing how to bring some of those concepts to fruition, through increased collaboration between clinical and revenue cycle resources.

The importance of aligning clinician objectives with those of revenue cycle operations has become a pillar of organizational strategy and success. Yet when these two groups get together, there can be frustration that stems from competing priorities, time constraints, and the expectations they have for each other. Revenue cycle staff spend time correcting the same things repeatedly and want clinicians to pay more attention to documentation and charges up front. Clinicians remind everyone that they aren’t reimbursement specialists, nor desire to be, and have plenty on their plate already. You end up sympathizing with both sides.

How then do you create a culture that promotes and supports a shared understanding of coding, charging, and billing efforts that doesn’t overwhelm clinicians, but which keeps them informed and primed for success? What works to get the sides together and working toward improvement, and exactly what sort of improvements can you expect? Remember that while individual measures of success may be different, at the end of the day there are a number of common goals: working efficiently, contributing to the overall organizational financial success, and creating optimal patient experiences and outcomes.

Founded in experience, here is a brief summary of our recommendations, along with some of the specific gains to be realized.

Build Rapport and Establish Effective Communication

  • Take the right first steps. Make introductions and get the sides together for positive, productive, face-to-face conversation.
  • Re-route instincts to blame, point fingers, criticize, or make excuses. Use a third party like us, or an operational manager to facilitate when necessary.
  • Educate regularly. Official EMR training is critical for long-term success, but so is continued assistance with expectations for charging and system use, which directly impacts your charge capture metrics.
  • Be concise, consistent, and relevant. Everyone’s time is important, so make sure improvement efforts are organized and focused. Clinicians are most receptive to items they can digest quickly and that will save them time, and billing staff seek consistency and accuracy, so will be looking for quick wins that improve trends and patterns.
  • Offer lunch & learn or other group education sessions. Staff can connect with their peers about what works well or not so well, and questions raised are generally ones almost everyone benefits from.

Use Examples and Data to Prompt Change

  • Show providers their results. They are always eager for data, so being able to show them how their E/M distribution or percentage of forgotten charges compares to peers is invaluable.
  • Provide examples of prior work, alongside the downstream billing outcomes. Clinicians respond well to clear, direct connection points, so showing them their own work is a great way to frame the conversation.
  • Make feedback and other requests precise. Telling a doctor that his or her procedure documentation needs to improve isn’t likely to go over well. Pointing out specifically which procedures need greater detail, in what context, and for what reimbursement reasons, is far better.

Optimize Tools for Efficiency and Revenue Integrity

  • Customize front-end tools such as smartphrases and smartsets to streamline information in support of medical necessity.
  • Utilize decision support and alert features to accurately capture and report Hierarchical Condition Categories, along with other key information.
  • Craft detailed templates to ensure specificity for procedures such as heart catheterizations that are difficult to document.
  • Employ problem list etiquette and adherence to best practices. Effective use and maintenance leads to more accurate codification and reimbursement patterns.
  • Organize charge preference lists and use automation where possible, in the capacity of both documentation and orders.

Requirements will change, and patterns and gaps will emerge over time, so regular collaboration between clinicians and revenue cycle experts is critical. By investing time & effort on the front-end to educate, provide feedback, and to show how clinical system tools can be optimized for greater efficiency and accuracy, you can build a foundation of sustainable workflows and reimbursement patterns. Not only will you gain improvements to clinical documentation, but you’ll reap other billing and revenue integrity rewards as well - greater operational efficiency, the reduction or elimination of missed charges, fewer coding errors, increased clean claim rates, and reduced denial rates, all of which lead to a healthier reimbursement stream. Experts here at The Wilshire Group are ready to provide even more of the revenue cycle advice and clinical strategies you need to be effective. Let our expertise work for you!