DRG Coding Advisor

Liaisons enhance the ties between docs and hospital 

Goals: Increase revenue, bill correctly 

Four physician liaisons at Straub Clinics and Hospital in Honolulu streamline the relationship between business services and caregivers, providing education on coding and feedback on billing errors, among other duties. "If there is information about coding, changes in Medicare regulations, or any process at Straub that has an impact on physicians and their practice, these four people are the link," adds Linda Dullin, RN, director of admitting, whose department reports to business services. The physician liaisons also work under the administrator of business services and report directly to Sheri Richard, billing and operations manager. "Their main goal, their whole function is to enhance revenue in the physician office and to ensure that [physicians] are coding and billing appropriately, to be the link with business services," Richard says. "They’re able to give [physicians] feedback on what charges are being submitted and to make sure that a charge tag has been submitted on all patients." 

Following trends 

The physician liaisons work hand in hand with Straub’s coding department, she says, learning about trends found from audits or from reviewing or spot-checking charges and then passing that feedback along to physicians. If Straub’s 150 or so physicians — in the hospital or in satellite clinics on Oahu and on the other Hawaiian islands — have questions about billing, "they have someone to go to," Richard adds. The physician liaison positions were created, she explains, when Straub converted in July 1998 to the IDX computer system for both billing and admitting for hospital and clinics. At that time, the registration personnel in the physician offices began reporting to business services rather than to clinical operations, Richard says. "The whole idea was that registration [errors] could be so detrimental to billing," she adds, that it made sense to have business services provide that oversight. To facilitate the relationship with these employees who were physically separate, the physician liaison positions were established. Since that time, the physician receptionists have moved back under clinical operations, Richard notes, which makes the role of the physician liaisons more crucial than ever. The decision to return the employees to clinical oversight, she says, was the realization that they played a number of roles unrelated to registration. "The clinical operation [administration] truly believed they needed more control over the front desk [staff]." Initially, the physician liaisons reported directly to her boss, the administrator of business services, Richard says, but since October 2000, she has been their supervisor. Because she supervises both claims processing and a department called Charge Corrections, where denials are handled, Richard can provide the data and information the liaisons need to do their job, she notes. 

The liaison positions are "really a good thing," Richard says. "[Otherwise], it’s hard for the business office to get information to the physicians. They see a lot of errors, but there’s no one to do the training and education." A problem with the billing for immunizations, she notes, led to the institution of brown-bag lunches to address billing concerns with physicians and their staffs. "All the [immunization bills] needed an administration code and there were various types of codes and different bills for different payers," Richard explains. "[The physician offices] weren’t picking the right code, and we were getting a lot of denials." A lunch session was scheduled to present the errors and discuss how to code the bills correctly, she adds. The brown-bag sessions — at 11 a.m., noon, and 1 p.m. — now are held monthly and last about one-half hour, Richard says. "We usually take our top rejection or denial problem and pinpoint that issue." The sessions, which are open to the entire organization, begin with a brief presentation and the distribution of cheat sheets on the topic at hand, she adds. "We’re pretty focused." Afterward, the physician liaisons — who divide their duties by medical specialty, such as pediatrics or orthopedics — may meet separately with a group they cover, Richard says. "We have data to show this is how much [the billing system] is kicking out for internal medicine or pediatrics and so forth and to show specific errors," she adds. 

Sessions count as compliance education 

Richard, who chairs the brown-bag sessions, says she works closely with Straub’s compliance department in planning the meetings. In most cases, the presentations can count toward the two hours of compliance education required annually for all Straub employees, including physicians, she notes. "Physicians usually look at, What’s in it for me?’" Dullin points out. "We look at whether [the topic] is something we can give them credit for. We have sign-in sheets that are turned over to human resources. That’s something you can use as a hook." An upcoming topic that she will address at the session, Dullin notes, is the handling of outpatient observation patients. "I will meet with the physician liaisons beforehand to go over the presentation and also to make sure that they provide feedback to me when questions arise from their physicians." The presentation will probably be a group effort, she says, with involvement from other utilization/case management, medical records, and business services personnel. An earlier presentation on advance beneficiary notices was made by Straub’s former training coordinator and business services compliance advisor, Dullin adds. The physician liaisons, Richard points out, work individually with all the players in the physician practice. "There is the physician, the nurse, the clinical director, and the front desk supervisor, and we treat them each separately," she says. "Just because [the physician liaison] has talked with the physician, doesn’t mean [he or she] has communicated with the whole department. "Any employee of the organization can go to the physician liaison to ask about coding or reimbursement, and the liaison gets the answer and responds back," Richard adds. One of the liaison’s main goals, she notes, is to present to the physician various reports done by Straub. "There are financial reports and an accounts-receivable analysis. These tell the physician how well he’s done, how many procedures he’s done within that month." The liaisons are responsible for providing education — on coding and other issues — to any new physician that joins the organization, she says. 

Minipreadmits’ done by physician staff 

Because physicians’ offices and the hospital are on the same computer system, the physicians’ staffs are able to do "minipreadmits" or "minipreregs" that facilitate the registration process, Dullin points out. "If a patient goes to the physician and needs to get an arthroscopy, for example, someone in the physician’s office goes into our computer system and does a mini prereg," she says. "Once they’ve done that, they also schedule the physician’s time. They send a notice to us to anticipate that patient on this day for this procedure." This eliminates the need for paper being faxed back and forth to arrange the procedure, Dullin adds. Having a physician champion is another important way that patient access and business services can enhance physician cooperation and avoid having physicians feel "they’re being dictated to," she says. "If the physicians are moaning about a certain thing, or just don’t get it, you need somebody who will support what’s being done and will be a link in communicating corrective action." The medical director of a group that deals with a large number of patients from Pacific Ocean islands, for example, is a good person to champion issues that have to do with length of stay and utilization management, she says. Because those patients often require extensive care and follow-up, Dullin notes, that physician is particularly well-equipped to explain accompanying concerns to his colleagues.