Email Signature Patient Medical History Made Easy

Email signature patient medical history

are you a medical coder that's considering taking the leap into medical auditing well before you do let me tell you about my experience working as a medical auditor and some things you may want to consider before making that transition hey everyone i'm victoria i'm a medical coder auditor educator and content creator and on my channel i provide tips tricks and tutorials to help you be successful in a medical coding career now i've been a certified medical auditor since 2011 and actually when i became a certified coder in 2008 that credential did not yet exist i can't remember if the first time i heard about it was in healthcare business monthly or maybe an email came through from the aapc but i remember showing it to my boss at the time because i was still working in charge entry and i went oh my gosh they're making a credential now for auditing and that's definitely what i want to do i want to move into an auditing role so i'm going to go for this credential i don't think i went for it right away i took some time to study it i used the medical record auditor book by deb grider which was fantastic i'm sure it still is and that really helped prepare me at the time to take my cpma exam which i did in 2011 and that credential has served me really really well by the time i passed my certification in auditing i was actually working in a medical coding role since it was a newer credential at the time and back then not a lot of coders had multiple credentials there were a lot of curious parties where i was working that asked me hey victoria because you've got this new credential are you now making more money like are they paying you extra do they pay you for that and my response was no i paid for the training i invested in the exam i paid for it myself and i'm not expecting to get a raise just based off of the fact that i got an extra credential but i'm expecting that to pay off in the future when i want to transition into an auditing role honestly i never did receive a raise just based off of the fact that i had an extra certification not a lot of organizations do that some do in the instances where maybe they have different tiers of code or code or one code or two code or three and they may say that a coder two or a coder three has extra certifications but that's not the majority of organizations out there they base your pay off of a lot of different factors how many years of experience you have what your job roles are your skills your tasks like what are you doing and if there you just have an extra credential but you're still doing the same job they're not necessarily going to pay you more just because you have an extra credential when you're not actually doing any extra work at that time so there wasn't an instant return on investment but there was a long-term return on investment so there are a lot of things that happened so when i got done at that coding role i wanted to transition to something higher and i found a position for a senior coding specialist and the fact that i had my auditing credential the fact that i had some extracurriculars like published articles in healthcare business monthly and was speaking at conventions that was what helped me transition into that senior role and that senior role oversaw projects for basically the auditing and education department at this healthcare organization and that senior position actually eventually transitioned to a supervisor role where i was not only supervising projects but supervising people at the actual coder auditor educators now management was really not for me so i went back into a high level auditing and education role but that was at a very small catholic hospital that got swept up by a larger corporate organization and when that transition was made and i was fit into the appropriate role under the large corporate umbrella one of the requirements of my new job was that i had my cpma credential so thankfully i didn't have to worry about that because i already had it i gotten it back in 2011 but i actually had a co-worker that hadn't yet gotten her cpma so she had to kind of get the ball rolling and start getting that auditing certification because part of her new job role was to have that certification so that's really one of the first key things i want to stress about the transition from coder to auditor yes get that cpma credential that is fantastic have that ready get that in your back pocket just understand that it might not immediately mean that you are going to transition into an auditing role or that you're going to get an increase in your pay but when an auditing position opens maybe in your organization or in another organization you're already going to have that set in your back pocket and be positioned better because of that because it sounds a lot better saying oh i'm already certified as an auditor versus um well i've been thinking about getting that auditing credential so stop thinking about it you can't achieve your goals by thinking about them you have to do actionable things so go out there make that first step and get that auditing credential and another tip i'll give you is you don't have to schedule your exam right away you can actually call the aapc for any of their credentials and purchase an exam voucher and that voucher will give you a one-year period of time to schedule your exam so if you purchase it now in december you have till december of next year to schedule it you could schedule it in if you could find an exam february of the following year you could schedule it then you have a year to schedule the exam the aapc just had their black friday deal where they had if you already are a certified member you can get an additional credential exam for half off so i purchased the cpb so i can get my billing certification and i got the voucher at half off and now i have a year to schedule that so i don't have to worry about it right away because there weren't a lot of exams in my area so when they open up i'll be all ready so now let's talk about actually being an auditor so in most auditing roles you're going to be doing retrospective audits which means you're going to be looking back on things that are already billed as an auditor you have to know the differences of these types of audits so retro if you think of in the past those are auditing past cases prospective audits are auditing things kind of before they go out the door i used to do these for if we were starting maybe a new practice or service line we would set edits in the system so that they would not be released until someone actually audited through them made sure that the you know all the charges were going out correctly that the right diagnoses were attached the providers were selecting the right level of service but in the majority of auditing roles they are going to be retrospective looking at things that have already gone out to insurance and in that case you might be auditing something that was submitted by a provider maybe they picked their own level of service or you could be auditing services that were coded by a coder and that's something to think about because if you're in a large organization with a lot of other coders and now you're transitioning to an auditor role and you may be auditing people that used to be your peers that's something you have to think about because those could be some difficult conversations you might have to have with people that were used to your your coding friends there is a lot of delicacy and a lot of tactfulness that has to go into having those peer-to-peer conversations in regards to audits and then providers is a whole other ball game now hold on to that thought because i'm going to circle back to the provider communication part at the end of this video so make sure that you stay through the entire video to circle back on that i want to talk a little bit about the skills of a professional coding auditor and i apologize i should have said this before this video is going to focus on professional medical coding because that's primarily what i do i don't do a lot of inpatient coding or actually technically none and i do some risk adjustment coding so i know about rad v audits and things but not so much um inpatient and stuff so this is really going to focus on professional provider based service auditing so as a auditor you have to know medical records standards like the back of your hand like you have to know that if you see an up or down arrow in the medical record that that's not acceptable you also need to understand things like signature requirements who can document in the medical record for purposes of coding what kind of attestations might be needed what you can abstract and even things like abn's and are those completed correctly and how to compliantly fulfill an abn and apply the correct modifiers and bill that out to insurance when we have that abn on file and then compliance plays a role too what are your compliance plans if you're working for a carrier what kind of audits are you performing what are your standards and that in that organization if you're working for a healthcare organization where are your risks what are those commercial payers what is medicare going to be auditing get familiar with the oig work plan get familiar with the audit activity that's going on in the industry and even understand things like uh the false claim act how long do you have after you've discovered a problem to send that money back to the payer if you're sitting for the cpma credential they'll test you on all of that they'll test you on the oig work plan recovery audits uh fraud and abuse the false claims act even things like ncci edits or evaluation and management coding guidelines as an auditor you also need to understand things like medical necessity you know did this technically meet the requirements but is medical necessity a component that plays into this was this really a medically necessary service and policies what is your contracted policies with your commercial insurances your high marks your aetnas and then what are your federally mandated policies from cms and then you need to know how to formulate your audit findings so what are the things that you need to pull out if you're auditing e m is it your history exam medical decision making is it instant 2 split shared what are the things that you need to really look at and report on and how do you formulate that report because ultimately if you're auditing a provider you need to very clearly easily explain what the criteria was and why they didn't meet it and a lot of time in auditing it's not just formulating your report and sending it off and that's the end of it you also have to have that communication with the provider what needs to be improved in their documentation what is the minimally acceptable thing that they could have done to fix it and what is the best practice and decide you know how they can formulate it to fit what they're providing and even things like identifying their risk areas like you know this might scrape by an internal audit but it really is a risky practice and it isn't something we would recommend provider communication is a very key point because you have to be able to present the audit findings to the provider in a very stern but supportive way like you you are on their side you want them to pass you want them to be successful but they also have to understand that there are certain regulations that they do have to follow and sometimes the conversations can get pretty heated i thankfully have never been in a position like some of the colleagues that i've worked with where they've had things thrown at them or providers have called them unruly names i have had providers that have done things like slam their fists on the table one accused me of harassment and wanted to know who exactly sent me but honestly for the most part i've experienced that most providers do just want to do the right thing a lot of times though they just want it to be very easy so anything you can do to help the provider understand the regulation and make it easier for them for example i had a provider i was talking to once about split shared services they were working in the hospital and they were working with mid-level providers so when a mid-level provider like a physician assistant sees a patient in the hospital we can bill it under the provider that provider can oftentimes get the rbu the credit for it and get a higher reimbursed service but in order to do that they have to meet certain criteria that provider has to see that patient face to face themselves and they have to perform some element of history or exam or medical decision making so when i explained to the provider that they only needed a history exam or medical decision making she asked me well does it need to be a full exam and i said no it just has to be some component of an exam and she said well you know when i see those patients after the physician assistant has seen them i always read you the heart and lung exam so i'll just build a template that i can build in the heart and lung exam since i do that every single time and that works perfectly because it was part of her routine it wasn't that she was mocking it up or making up a heart and lung exam that was just her medical you know modus apparently every time she went and saw the patient she redid the heart and lung exam so she made it easier for herself when she's trying to fill that component of the documentation so communication is a really really key component of auditing sometimes even if you're doing e ms you know right in your head like what all the components are and you can score them out without any problem but sometimes having to formulate what that rationale is and get it into paper in a really easy to understand format can be a different concept and honestly those positions where you can really communicate with providers get good outcomes get them to code more compliantly those are going to be the positions that are going to pay you quite a bit more there are positions where you probably can just do audits and formulate the reports and that's the end of it but the positions where you can communicate with providers and present your findings and work with them as part of a team those are going to be the ones that are worth their weight in gold so if you're currently working in a coding role maybe one thing you want to start doing is as you're working through some of your cases start thinking about like how would i explain this to someone else how would i explain this to a provider how would i communicate something in a report and then you can start getting yourself into that auditing mindset and definitely get that cpma credential even though you may not have the years of experience that may be required yet for an auditing position you definitely want to have that already done by the time that you do have an acceptable experience and that will look way better to your potential employer so i hope you found this video helpful please give it a big thumbs up it does support me and the channel and if you haven't already i would really encourage you to subscribe if you want more awesome medical coding content and don't forget to hit that notification bell so that you can get alerts when i post new episodes i will see you in the next episode and until then just keep on coding on