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More Practices Turn to Coding Consultants

They Optimize Reimbursement, Help With Compliance.

By Jerry Helzner, Senior Editor

You would think that, especially in this difficult economic environment, any ophthalmology practice would welcome the help of someone who could bring more dollars to the bottom line while keeping the practice on the right side of the law.

It is estimated that only about 10% of ophthalmology practices currently use the services of a coding expert, but consultants say the demand for their services has grown as the recession has deepened. These consultants represent a mere handful of experts who know — and stay current with — all the applicable codes set by payers. Their goal is to obtain for practices every dollar they are entitled to while also providing accurate and legal coding advice that keeps auditors away.

"Most practices have a tendency to undercode because they either fear being audited or they lack expertise in coding," says coding expert Riva Lee Asbell of Riva Lee Asbell and Associates. "A good coding consultant optimizes reimbursement while keeping the practice in compliance with the law."

Some practices that have become proactive in training physicians and staff in proper documentation of services report that they have experienced six-figure improvements in the bottom line.

"We no longer ignore defensive undercoding," says a partner in a large Midwestern practice. "We now strive to achieve optimal coding."

Before calling in a coding consultant, practices should do as much as possible to bring their coding procedures up to speed. Some ways to improve coding knowledge include:

► Attending qualified courses at recognized society meetings such as the courses offered by the American Society of Ophthalmic Administrators and the American Academy of Ophthalmology. You do not have to limit yourself to retina-specific courses as general coding courses provide a basic foundation in proper coding practices.

► Learning at the local level; your Medicare carrier offers useful coding courses. These carriers also put valuable information on their Web sites.

► Reading the coding columns offered in the various ophthalmology publications, such as the regular coding column in Ophthalmology Management.

► Conducting a monthly superficial internal audit to ensure that basic principles of documentation are being followed. The audit should cover five charts a month per physician, encompassing such key elements as forms, letters and interpretation and report requirements.

"It is important that the physicians attend the courses and improve their knowledge of proper coding," says Ms. Asbell. "In the past, most physicians have delegated coding to staff. However, it is the physicians who are ultimately responsible for seeing to it that coding is in compliance with the law."

Once the practice has gained a solid knowledge of coding, a consultant can be brought in for staff training, which normally takes a day, or to conduct an in-depth audit of the practice's coding methods. For a large practice, such an audit can take as long as a week.

The consultant can help the practice master some of the more complex areas of coding, including:

► how to choose between E & M and EyeCodes to optimize reimbursement

► proper use of modifiers, which can increase reimbursement by up to 30%

► the perils of breaking bundles

► staying in compliance with regulators.

"There is a great deal that a practice can do to help improve its coding procedures," concludes Ms. Asbell. "Whether the practice decides to bring in a consultant or not, it's an area that deserves more attention, especially in this difficult economic environment."

Medical Practice and Piano Practice

Dr. Andrew Mays enjoys a dual career as an ophthalmologist and an internationally acclaimed concert pianist.

By Leslie Goldberg, Associate Editor

Andrew J. "Drew" Mays, M.D., doesn't ever remember not being able to play the piano. He began playing the piano at age four. "My mom tells me that when I came home from kindergarten, I picked out the tunes to the songs we were singing in school on the home piano. She taught me to read music and I started formal lessons when I was seven," he explains.

The glaucoma specialist, in private practice in Birmingham, Ala., on staff at the Birmingham Veterans Administration Medical Center, and former director of the residency program at the UAB School of Medicine, is an acclaimed pianist and winner of the amateur division of the 2007 Van Cliburn International Piano Competition. He received his bachelor's and master's degree in music from the University of Alabama School of Music. Dr. Mays also studied at the Manhattan School of Music and the Conservatory of Music in Hanover, Germany. He began medical school in 1987.

"The field of ophthalmology fascinated me ever since I got my first pair of contact lenses," says Dr. Mays. "The technology involved with eye surgery and the detail-oriented aspects of this field also attracted me."

Dr. Mays admits to having "pretty good" fingers and hands. "I often tell residents that we operate with our fingers, not our hands. My fine motor skills are fairly highly developed after years of piano practice," he says. "Of course, it's the brain behind the hands that really runs the show!" During medical school, Dr. Mays was forced to take a hiatus from music "due to no time and no piano." He lived in a small apartment and had no place and no time to practice. In 2002, he bought a good piano and discovered how much he had missed playing. "By then we had the children taking lessons and they hedged at practicing, so I started to practice again to set an example for them," he says. The children were encouraged to play in local competitions and festivals, so he found some competitions to participate in for himself. "That led to the Cliburn and my life changed," says Dr. Mays.

Dr. Mays performing — and winning — at the 2007 Van Cliburn International Piano Competition.

He concedes that it is very difficult to manage two careers. "About 6 months before the Cliburn competition, I told my wife that this would be a busy few months until after the competition." He practiced as much as he could. "I likened it to training for a triathlon," says Dr. Mays. Since winning the Cliburn, the training continues. "I've had to limit myself to one performance a month. I have learned to be very efficient with my practice time. It is a great privilege to be able to do this, so I'll rest ‘later.’"

All four of the Mays' children now play the piano. All take lessons and all do well. With dad supervising their practice, he literally stands over them. They accomplish twice as much in half the time by doing it correctly from the start. "Success feeds itself," says Dr. Mays. "The children have learned about the discipline it takes to learn music. There is no instant gratification. I think piano should be taught in schools just like math and science. Studies have shown that children, regardless of talent level, do better in school if they study the piano. I feel that this is part of their basic education."

He admits he is often reduced to bribing the kids into practicing. "We have a reward system. If they play in a competition or recital, they are challenged to practice a certain amount. If they meet the challenge, they can choose a reward. We have a basement full of super-soakers! We also hit the ice cream parlor a lot after a job well done," he says. "I have enjoyed playing again immensely but I have the security of a day job that pays the bills." Bravo, Dr. Mays!