Cracking the code with EHR

Take-home

Including checks and balances in ophthalmic practices’ electronic health record systems can help ensure proper coding.

By Shareef Mahdavi

With upward of 30% of ophthalmic exams coded incorrectly, the prospects of being audited -and of defending the coding choices-can weigh heavily on any practice or practice administrator.

Plus, incorrectly coding a visit (or tests done during that same visit) can cost a practice thousand of dollars in lost revenue.

Couple these two points with the increased attention directed at ophthalmologists with Meaningful Use, and it becomes even more imperative that a practice’s electronic health record (EHR) system include a checks-and-balances section to ensure proper coding.

Some physicians remain skittish about implementing a system.

“The whole issue of change is always a concern,” said Scott Peterson, chief information officer, The Eye Center of Central Pennsylvania, Lewisburg, PA. “We, like every other place that implements EHR, has that as an issue, and we were very aware of it.

“We made it very clear to our employees that we are all in on this together,” Peterson said. “If it takes extra time working with them, then we will do whatever we need to do to make them successful. This is an investment in the future of the practice and investment in the future of the employees.”

Finding the right fit

From a technology standpoint, Peterson recommends practices look to software systems that fit with the practice-especially if there’s an optical shop and/or optometry division, as well as an ophthalmic one, he said.

“Ophthalmology is such a unique specialty among the health-care industry,” Peterson said. “As a practice, you have to choose a partner that truly understands exactly what is being done from the practice’s standpoint.”

Before the center-which operates more than 15 locations throughout central Pennsylvania-implemented its EHR, it was difficult to train staff to code uniformly, he added.

Jim Riggi, president of Medflow, an EHR provider, agreed.

If patients present with truly complex issues, often physicians may err on the side of caution and under-bill, he explained.

“They’ll down-code something because of fear-fear of an auditor in their offices or fear of penalties,” Riggi said.

That apprehension is likely to escalate once the new ICD-10 codes go into effect in October 2014.

Numerous websites note misinformation about ICD-10, including issues about:

·      Cost.

·      Documentation.

·      Changes in payment models equating to less revenue.

·      Overall confusion.

Preparing for coding changes

For Charles Titone, MD, of East Carolina Center for Sight, Greenville, NC, some of those issues meant getting in front of the coding changes before they became an issue.

“Medflow has already built in an ICD-10 crosswalk, so I’ll never need to worry about coding issues or lost revenue when the transition takes place,” he said.

The practice’s system streamlines Dr. Titone’s testing, interpretation, and coding (via Corcoran Consulting, or C3), and his practice qualified for Meaningful Use reimbursement on its first attempt.

According to Medflow, the C3 software “relies on chart documentation in the electronic medical record (EMR) as the basis for accurate real-time coding recommendations.”

Once data are entered, the program offers suggestions for coding and interacts with the EMR to provide coding for eye exams based solely on the entries.

Dr. Titone has said in today’s technologically savvy world, it’s almost mandatory that any EHR system flow seamlessly among tablets, telephones, and computer systems. With that necessary portability comes an increased need for certified compliance, however.

Dr. Titone believes some practices will lose “a lot of revenue” with the transition to ICD-10, and hence the need for software that is certified compliant.

Conversely, he cites a 20% increase in revenue once he began using the C3 module.

Even in smaller practices-those that might bill only $700,000 a year-increases of 4% are not uncommon, Riggi said.

Though a 4% increase may not sound significant, it could mean the difference between hiring another back-office staff member or purchasing an additional piece of equipment for the practice.

“There is not an individual in our organization who would want to go back [to the way we ran things before automating our health-records system],” Peterson said. “We see more patients today than we did when we were using a paper system.”

And, he stressed, those additional patients are not adding any time to the physician’s daily workload.

Shareer Mahdavi

P: 925/425-9900

Mahdavi is president of SM2 Strategic, Pleasanton, CA.

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