Grady Health System's director of physician revenue cycle shares a framework for creating effective physician coding education programs that improve compliance and performance against quality metrics.
Providers understand the importance of medical coding. While promoting the financial well-being of health systems, it can deliver better clinical outcomes through the accurate documentation of information that improves care coordination and reduces gaps in care.
Despite this, the administrative toll that coding takes on clinicians is well documented. However, provider coding education programs can help organizations meet compliance and quality metric goals without significantly increasing burdens on clinical resources, according to Abeni Lee, director of physician revenue cycle for the Grady Health System.
While not quite as easy as 1-2-3, Lee shared her framework for success in the development or redesign of coding education programs.
Understand the needs of your entity and providers
The first step to building an effective coding education program, Lee says, is identifying the necessary behavioral and cultural changes.
"You really have to, first, understand your entity," she says. "Every entity is different. And once you understand that, then you can build what it looks like."
A solid understanding of organizational culture and goals for a coding education program will aid revenue cycle leaders as they:
- Assess the educational needs of providers to inform the development of training material.
- Establish a pathway via pre-AR coding review, coding denial rates, or compliance audits to identify providers who are candidates for education.
- Develop modes of provider coding education.
Build a coding education team and develop training material
Now comes the hard part.
"Developing the team is probably going to be your biggest hurdle," Lee says. "You have to identify coding educators that are really specialty specific. If you have a large cardiology program, you want to make sure you get some of your specialty-specific coders that are really good with guidelines that represent cardiology."
Training materials should also be specialty-specific and specific to providers' educational needs, while complying with clinical billing standards and relevant government regulations.
With a coding education team and training material in place, there needs to be a process for onboarding providers into the program. Grady Health has established three separate pathways for new and existing providers.
All new providers are enrolled in specialty-specific education programs to bring them up to speed on coding expectations at Grady Health. These training sessions are typically more robust than sessions for existing providers.
For existing providers, training is delivered upon request and can be tailored to a degree based on the coding issue providers are experiencing. Grady Health also requires that any providers scoring 80% or lower on compliance audits receive additional training.
Communication is key
"Communication is imperative," says Lee.
To streamline requests for training, Grady Health has implemented a shared group e-mail. The coding education team also uses an IT-like ticketing system to categorize training requests and ensure that providers receive training appropriate to their specialty and the specific coding issue they are facing.
Training itself usually occurs "elbow-to-elbow," Lee says. Coding educators meet with providers in their clinics and provide real-time feedback as charting occurs. This arrangement limits any added burden on providers and ensures that they don't need to go searching through their e-mails or files for training materials.
Once training is complete, providers receive an e-mail with a training summary and feedback on coding practices within 72 hours. Additionally, providers are asked to complete a survey on the training so that the coding education team can identify areas for improvement and ensure that training material meets providers' needs.
It is important to remember, Lee notes, "Our customer in the coding education program is the provider."
Luke Gale is the revenue cycle editor for HealthLeaders.
KEY TAKEAWAYS
Understanding organizational culture is crucial to the development of effective physician coding education programs.
Tailoring training to the specific needs of physicians requires specialty-specific coding educators and training material.
Delivering “elbow-to-elbow” training helps to reduce administrative burden associated with coding tasks.