‘Roaming coders’ offer fast feedback

On-site coders free others for inpatient work

Instituting "roaming coders" in the group practice system at the University of Texas Medical Branch (UTMB) in Galveston is slashing the lag time between when a service is performed and when the bill is coded and ready to send out, says Eugene Felter, assistant director of UT-MED financial services.

But the real gain, Felter says, has been the opportunity for immediate feedback from coders to the physicians preparing the bills. The new practice has drawn praise from several of the physicians involved, he notes, and requests from those at sites where the coders have not yet been added.

The new program was devised by Felter and his boss, Robin Thompson, director of UT-MED Financial Services, as a way to expedite the charge capture process at various outpatient service sites. Before the roaming coders were hired, that process worked like this:

The registration staff and the physician at the outpatient practice sites made various notations on the superbill, based on the service provided to the patient, and then sent it to the appropriate department, be it internal medicine or obstetrics/ gynecology or another specialty, to be coded by the departmental coders. The bill might languish there, as the coders tracked down the department’s physicians, who are required to review and sign off on bills prepared by residents.

Having the roaming coders in the practice sites has enabled them to address such issues right away, making sure the bills they have coded have the necessary signatures at the end of the day, Felter says. Additionally, it allows the coders to immediately question a bill that lacks the proper documentation.

"Doctors don’t always understand what they mark on the superbill," he says. "The coder might say, ‘Dr. Smith, you’ve indicated a Level 5 visit, but your documentation is only sufficient for Level 3. Either you did more and you didn’t document it, in which case you need to add some information, or you didn’t do any more than is indicated and so can justify only the Level 3 visit.’"

In that way, the coder makes sure the superbill agrees with the medical record and gives the physician the tool he needs to bill the way he wants to, Felter adds.

In response to Felter’s and Thompson’s original proposal, UTMB authorized the funds needed to hire four entry-level coders, who have worked since September in five locations: primary and specialty internal medicine, primary and specialty obstetrics/gynecology, and pediatrics.

The coders primarily stay in one area, but when they’ve finished their work there, they move to another location. Between Sept. 1 and Jan. 30, those four coders — really, 3.5 FTEs, Felter says, because one went on to a higher-paying job midway through the period — coded 50,884 accounts. Since the project began, internal medicine has cut three days off its processing time for an account, pediatrics has cut 2.2 days, and ob/gyn has cut about two days, he adds.

"This was a pilot project, but we can say it’s a success now," Felter notes. "We’ve sent a proposal for an additional four [roaming coders] so we can accommodate other sites."

Meanwhile, Felter has received e-mail and other messages from physicians who are delighted with the on-site coders. The departmental coders, who initially were concerned that the new roaming coders might put their jobs in jeopardy, have had their fears relieved, he says.

What’s happened instead, Felter says, is that the departmental coders now can spend more time on inpatient coding and handling appeals for help from the billing department. Now, when billers call saying they need more documentation on an account, he says, the departmental coders are able to respond. "Before, we just didn’t have the staff to address those issues in a timely manner."

[For more details, contact: Eugene Felter, assistant director, UT-MED Financial Services, 301 University Blvd., Galveston, TX 77550. Telephone: (409) 772-7103.]