3-2 Final Project Milestone One Draft of Evaluation

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Dec 6, 2023

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3-2 Final Project Milestone One: Draft of Evaluation DeVonda L. Smith Southern New Hampshire University HIM-360: Coding and Classification II Leslie Marcozzi November 12, 2023

Evaluation In 2019 from the Family Practice case study, it shows there were several mistakes being made and there was a lot of money that was lost due to the mistakes. The overall outcome of the audit showed that it was $671 overbilled to the patients. The reason for money being over billed was due to the errors with overcharging or upcoding. 10 charts were chosen at random for the 2019 audit at the Family Practice. The encounters that were selected were from 90 days (about 3 months) prior. Of the encounters selected only 9 errors were found out of 150 records. The encounters were either overcharged or over coded as it was stated. The code of 99214 was selected instead of the code 99213 in 7 of the 9 charts and the other 2 of the charts was coded with 99214 instead of 99212. After reviewing the data, it showed that the incorrect amount that was billed was $1737 and the correct amount that was to be billed was $1066. Due to the overages charged that means the patients were overbilled by $671 as stated previously. For future references the best way to improve audits and have less errors is to better educate their employees. When referring to educating the employees it is referring to the providers to ensure that they know which code to enter for which claim. Also, it would not hurt if they double checked their work to ensure that everything is correct before submitting the claim. Maybe doing random audits could help as well to ensure less mistakes. There were also mistakes that could have been easily prevented in the operative notes, for example the doctor forgetting to sign and date the documentation. Overall documentation is key even if it is just signing and dating something to show that you viewed or made changes. In the long run it could help prevent forgery and also if there was ever a legal issue the document is dated and signed. Even though the majority of the notes was signed but for the ones that were not signed should be addressed right away due to the fact that it could cause issues for the facility and or the provider. Those

providers would need to be informed of the negative outcome of not signing and dating the notes. Documentation is very important and the more detailed the documentation the better. All the coding guidelines need to be followed. The evaluation and management of coding starts by classifying patients as new or established. (Green, 2022). It is up to the provider to determine the correct level to code. The correct level code is based on the provider’s conversation with the patient and finding out about the patient’s medical history, performing an examination, and the medical decision of selecting the correct code during the visit. The patient history can be the main complaints as well as a review of the systems. When it comes to the examination it is the provider gathering his or her own facts about the patient and what is going on with the patient. Medical decision making has to do with collecting all the data and reviewing it. This will also reflect the diagnosis that is given by the provider. In some cases, there will be patients that are at a higher risk than others and this is where the level of coding will come into play. The Family Practice claims did not have huge mistakes and the mistakes that they had were small and simple to fix. To help the future audits go smoother fixing the mistakes quickly will aid in this process. If you are following the rules and the guidelines of coding it will make the process, go smoother and will prevent having to go back and update the documentation in the charts because a claim was denied. Checking over the documentation with a once over and even double checking the documentation will ensure that the correct codes are being documented. By doing this it will prevent the over charges or over coding as The Family Practice did. Long term this will help your facility get the correct reimbursement that is owed. Another option to consider is to have a refresher once a year for the employees and have them tested on the material to ensure

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