Use education to prevent fraud and abuse problems

Good training can be simple and cheap

There are many different ways HIM professionals can educate their staff about how to prevent coding mistakes that could lead to a Medicare fraud and abuse investigation.

"Figure out your staff’s educational levels," advises Karen Scott, MEd, RHIA, CPC, CCS-P, owner of Karen Scott Seminars and Consulting Services of Bartlett, TN. Scott also is an associate professor at the University of Tennessee in Memphis.

"You can bring someone in to do seminars, but if they teach coding basics and your staff have been working for 20 years in the field, their needs may not be met," Scott says.

HIM departments might use any of these education/training strategies:

  • Lunch and learn sessions: This is where a department might have one day a month for staff to meet and be educated over lunch, Scott suggests.

Lunch could be bags from home or pizza provided by the facility. The education could be any topic of current interest, such as a change to local medical review policy.

Make staff part of training process

The luncheon session could be led by one person who is in charge of educational updates, or it could be a shared responsibility where everyone on staff has the opportunity to educate themselves and then teach others about a particular topic, Scott says.

"You could divide up new information and give everyone a page or new policy to study and then report back," Scott says. "This approach puts more emphasis on the staff, and it makes them a part of the training process."

Lunch and learn sessions often succeed because the informal setting encourages group discussion, which helps to reinforce the lecture, Scott adds.

Sessions might include information from the Medicare rules and regulations and the Coding Clinic publication that is published quarterly by the American Hospital Association.

"Coding Clinic is something else that every facility should be aware of because it has the official guidance, approved by the cooperating parties, including the Centers for Medicare and Medicaid Services (CMS). If Coding Clinic gives a certain way to code a scenario, then that’s the gospel and you have to follow it," Scott says. "Do the lunch-and-learn session as the new Coding Clinic publication comes out, and this is another cheap and easy way to train and update staff."

  • State coding roundtables: Each state’s health information management association, which are affiliates of AHIMA, has a coding roundtable that is offered in free one- or two-hour sessions, Scott says.

In Memphis, TN, for example, the coding roundtables are held every other month and include a physician speaker who discusses a particular procedure or diagnosis. After the speaker is finished, HIM professionals discuss how the procedure should be coded.

"When we talk about it, we get different opinions," Scott says. "So many times there’s not one right way to code something. It’s more how someone interprets it."

  • Audio seminars: These are growing in popularity because they are relatively inexpensive and allow flexibility in scheduling educational sessions.

"You listen to the conference over telephone lines while watching a PowerPoint slide show on the computer screen," Scott says.

The way these typically work is that a company will put the slide presentation on a web site that can be accessed through a password, which is given to facilities when they buy the service.

Then the facility has a number of staff taking the conference through the telephone lines while watching the web site slide presentation on either a big screen or individual computer monitors.

"You can have 40 people in the room and pay one set fee," Scott says. "Usually these are one or two hours long, so they’re not taking staff away for a whole day, and there are no travel costs."

Another advantage is that the facility may select audio conferences that provide precisely the education or training that is needed, Scott adds.

  • Physician query sheets: Most facilities have physician query sheets as a way for coders to ask doctors questions about diagnoses, coding, and charts.

What’s new is that CMS now says that these forms can be used, but they cannot be considered adequate documentation on which to base coding. In other words, coding has to be based on what’s documented in the medical record. So if a physician left something out, he or she has to return to the medical record to make the change.

"The whole reason we use query sheets is [doctors] didn’t write it down and it’s hard to call them up on the phone or catch them in the hall."

Coders can let physicians know what is needed by leaving a query sheet or notes with the medical chart where physicians will view it, Scott says. You can write, "Here’s clinically what we found in the chart. Can you comment on the appropriate diagnosis?" Scott says.

"We need to educate physicians about doing this," Scott stresses.