The foundation of accurate medical billing is thorough and complete medical documentation. While physicians and ancillary health care providers are trained to document the services they perform during a patient encounter, the medical reimbursement industry is evolving to require strict requirements regarding documentation standards. Different third-party payers issue their own coverage determinations, and each of these published policies requires different standards of documented medical necessity.
EHR and Documentation Specialist
Health care providers’ time is best spent on treating patients. It is what brings them professional satisfaction as well as being what they primarily went to school for. While physicians are technology-savvy, the intricate software programs used in Electronic Health Records (EHR) is best left to dedicated administrative staff. While EHRs have created greater access to patient information, the time it takes to master software should not subtract from a physician’s time treating patients. Physicians constantly absorb the latest information in their field. Cutting edge medical techniques are more valuable to them, and to their patients, than cutting-edge documentation requirements.
Even the best computer program cannot substitute for a trained, human professional. Medical documentation specialists undergo their own rigorous course of study and they earn credentials to ensure that they bring top-notch skills to the job of translating medical documentation into industry-standard medical codes. No software program can understand documentation the way a person can. While current programs have made great advances over the years, the technology has not yet developed to where it is 100% reliable. Couple this with individual payer requirements and the benefits of oversight from a professional coding and compliance specialist become obvious.
Speech Recognition is still not perfect
Speech Recognition technology is proving useful in the field. It does eliminate some transcription overhead. However, the technology has not yet advanced enough to recognize mispronunciations, accents, or regional dialects. Documentation produced through Speech Recognition still requires review and editing by a human being to recognize transcription errors that a machine cannot.
Documentation Specialist can improve Medical Billing
The medical record is the basis for every financial transaction that follows its creation. EHRs have the advantage of being instantly accessible to a credentialed medical coder or biller at any location. The value of EHRs cannot be underestimated, nor can computer assisted coding software, but they are not a panacea for the elimination of billing errors. Trained staff needs to review the codes generated from a medical record to ensure that the codes applied match the existing documentation. Further, the combinations of codes need to match the guidelines established by payers.
While medical coding, using CPT codes, HCPCS Level II codes, ICD-9-CM codes and, soon enough, ICD-10 codes, is a universal language. Different payers can interpret the same codes differently. This is especially true when payers require that modifiers be used to hone the meaning of a particular procedural code. While software can recognize and accurately apply some modifiers, modifier use should never be applied under a blanket policy. Rather, modifiers are applied on a case-by-case basis based on the available documentation.
To take a very specific example, the Centers for Medicare and Medicaid Services (CMS) pays particular attention to modifier -59 in its CPT Manual. This modifier is applied to indicate a “Distinct Procedural Service.” In surgical pathology, modifier -59 is applied when more than one special stain is performed on a tissue sample. This can be applied only if two different stains, that are described by the same code (88313, for instance) are performed, not two of the same stains on the same sample. Only a qualified medical documentation professional can determine if this modifier is applicable for two charges of 88313.
While one medical bill with inappropriate modifier use may result in a small overpayment, thousands of bills with the same error result in evidence of fraudulent medical billing practice. This is not only true in surgical pathology, but in all medical specialties.