Q&A: How can we improve provider response to coding queries?
Q: Our physicians do not have a great query response rate when requests come from coders. What can we do to improve that rate and be more efficient with the query process?
A: When you must approach your physician with a coding question, keep these four points in mind to ensure an efficient response with a minimum of fuss:
- You are not questioning their judgment; you are helping them get credit for taking care of complex patients.
- At the same time, it’s best not lead off with how the query will impact reimbursement. Instead, stress the need to clarify when the medical record is imprecise, incomplete, ambiguous or inaccurate, or leaves questions as to clinical validity. Also, you must seek clarification if medical necessity is not evident in the physician’s documentation.
- Acceptable query formats include those that are open ended (though this may be the hardest for a provider to quickly decipher and respond to), multiple choice or yes/no questions, depending on the type of information you need. Remember, it’s important for providers to include the clinical rationale for their answers.
- Remember that clinicians are short on time so make your query clear and concise so the provider can answer it quickly.
Editor’s note: Erica Remer, MD, a nationally recognized CDI expert who specializes in helping coders and their doctors improve communication with each other, answered this question. She will share her insights, plus numerous examples of successful physician queries, during the keynote presentation at this year’s Advanced Specialty Coding, Compliance & Reimbursement Symposium from October 15-17 in Orlando, Florida.
This answer was provided based on limited information. Be sure to review all documentation specific to your own individual scenario before determining appropriate code assignment.
Need expert advice? Email your questions for consideration in the Revenue Cycle Daily Advisor. Note: We do not guarantee that all questions will be answered.