1. Third Party Reimbursement Training

2. Julia Hidalgo, ScD, MSW, MPH Positive Outcomes, Inc. Harwood MD www
Julia Hidalgo, ScD, MSW, MPH Positive Outcomes, Inc. Harwood MD (443)

3. HRSA HAB Project Officers
Planning Committee
Aubrey Arnold
Gayle Corso
John Eaton
Theresa Fiano
William Green
Deidre Kelly
Syd McCallister
AHCA
Heidi Fox
HRSA HAB Project Officers
Johanne Messore
Yukiko Tani
TPR Trainers
Curt Degenfelder
Marilyn Massick
Michael Taylor

4. Ground Rules I do not represent HRSA, CMS, or AHCA
Let me know if you do not understand
We can share our feelings at the end of each section
You will be rewarded for staying awake
Shut off your electronic devices
A 15 minute break means 15 minutes!

5. Overview of Today’s Session
Overview regarding organizing patient/client charts, basics of billing, developing billing systems
Additional training modules and materials are available on website
Real life examples will be used
Resources for more in-depth information are identified
Each section includes training and discussion
Train the trainer approach is used
Please follow-up by with additional questions
Focus of the training is on beginning to intermediate skills
Advanced training and TA are available

6. What is third party reimbursement (TPR)?
Patient
1st Party
Provider
2nd Party
Insurer
Medicaid
Medicare
3rd Party
services $
TPR is receiving payment from a source other than the patient for services provided to patients by a provider. This other source is the “third party”

7. Constructing an Effective TPR Strategy

8. HRSA Grant Funding Versus TPR
The CARE Act is considered by the HIV/AIDS Bureau to be the payer of last resort
This requirement is subject to audit
CARE Act grantees have been audited
Grantees and subgrantees should not rely on grant funds as their sole source of revenue
HRSA grant funds are finite because they are capped in annual appropriations
TPR is driven by patient service and volume
Funds from TPR should be used in addition to HRSA grant funds

9. The Role of a Grantee’s Sponsoring Organization
Communicate the availability and value of TPR
Grantees and subgrantees (i.e., contractors) should agree upon billing and collections responsibilities and procedures
Grantees should request periodic accounting of collected TPR payments, as appropriate
These payments should be reported as grant income
Grant income should be retained by direct service provider grantees or contractors
Grantees should develop and implement clear, adequately documented processes for CARE Act invoices for Title I and Title II

10. Documenting CARE Act and Other Funded Services

11. Health and Case Management Record Basics
The record is the core element of a visit or other unit of service
It is a systematically organized record of a patient’s total care
Everyone who records progress of care in the record should follow the same note writing format
Policies and procedures dictate its organization and use
Creates a verifiable record of services provided for third party payers and other interested parties (QI, accreditation, etc.)

12. Health and Case Management Record Basics
The record is the primary instrument for planning care
Forms the basis to bill and pay for care
Documentation in the record can be reviewed by third party payers
Records are legal documents that assist in protecting the interests of the patient, facility, and providers
They are considered to be more reliable than an individual’s memory about events
They can be used in court or for other legal matters
They can protect you in a law suit

13. Record Documentation
Documentation provides the who, what, when, where, why, and how of patient care
Regardless of the complexity of documentation, records must be comprehensive enough to meet regulatory, licensing, accreditation, legal, research, and patient care needs and purposes
Record notes must be comprehensive enough to support evaluation and management code assignment

14. Record Contents Date and time of service Place of service
Chief complaint/presenting problem
Objective findings
List of tests/labs that are ordered and lab results
Diagnoses
Therapies administered and medications provided or prescribed
Preventive services provided
Disposition and patient instructions
Provider’s name and title
Length of the visit (e.g., minutes required to document time-specific procedures)

15. Minimum Records Processes
Develop and implement a process addressing the use of standard forms including
Responsible parties for form development and revision
Form approval process
Definition of timeframe for periodic review and revisions of forms
Consistent use of forms across sites

16. CMS/AMA General Principles of Record Documentation
An individual record is established for each person receiving care
The patient’s name should appear on every page with their unique identifier (patient record number)
The record should be complete and legible
Documentation of each encounter should include
Reason for the encounter
Relevant history and physical examination findings
Prior diagnostic test results
Assessment, clinical impression, or diagnosis
Care plan
Date and legible identity of the observer

17. CMS/AMA General Principles of Record Documentation
If not documented, the rationale for ordering diagnostic and other ancillary services should be easily inferred
Past and present diagnoses should be accessible to the treating and/or consulting physician
Appropriate health risk factors should be identified
The patient’s progress, response to, and changes in treatment and diagnosis should be documented
The CPT and ICD-9-CM codes reported on the health insurance claim form or billing statement should be supported by the documentation in the medical record
If it’s not legible, it’s not there
If it’s not there, it wasn’t done

18. Universal Record Standards
All clinical information pertaining to a patient is kept in the record and must be readily available any time the facility is open
Multiple sites
Filing systems
Records elsewhere – radiology, counseling, etc.
Standards apply across all settings and are compiled from JCAHO, NCQA, AAAHC, Medicare, and Medicaid

19. Universal Record Standards
Information should be recorded by the provider at the time of care
At least on the same day
The longer the delay, the lower the quality of the entry
All staff should use the same set of approved abbreviations and symbols
All entries must be dated, timed, chronological, legible, and signed in non-erasable blue or black ink by the provider with his/her credentials noted after their name
No blank spaces in between entries
Corrections can only be made with a new entry-cross out and initial

20. Reimbursement and Records
Physicians and mid-level providers can make entries in the record and may generate charges during a patient visit
All payers have specific guidelines about how to submit claims for non-physician charges
Some payers may credential non-physicians to allow charges to be submitted under their own provider number
Others only allow billing under a physician
Whatever the rules, be sure that your health record documentation backs up the billing

21. Reimbursement and Records
Charges can be generated based on office visits, consultations, procedures, diagnostic tests, X-rays, injections, vaccinations, and/or supplies
Supporting documentation (including who provided the service) has to be located in the progress notes, laboratory reports, X-ray reports, or diagnostic service reports
If services are provided in multiple sites (e.g., exam room and lab), charges have to be collected and organized for billing purposes
A data collection form is the best way to do this

22. Why set-up record policies and procedures?
Maintaining record policies and procedures is essential to protect your program and patients
Licensing and accrediting bodies, as well as governmental entities, require them
Your policies and procedures dictate how health information will be maintained and protected
Your policies set the basis for your legal record

23. Minimum Record Policy Elements
Confidentiality policies and procedures
Chart organization: sections, forms, and their order in the chart
Including specifications of what constitutes a complete record
Record maintenance, storage, retrieval: access to and archiving, backing up, security, and destruction
Patient compliance: informed consent and authorization to release information
Health record documentation practices: who, how and when; entry authentication; correcting the record
Sanctions or progressive discipline policy for staff who do not make proper entries into records

24. Set Your Record Audit Policy
Internal record audits should be performed as part of your program’s QA procedures
Internal review allows problems to be identified and corrected before someone else does it for you
Record internal audit policies should address
Audit content
Auditors
Audit timeframes, breadth, and scope
Levels of review
Audit types
Qualitative or quantitative deficiency analysis
Detailed audit process

25. Records Policy Implementation
When policies are developed, be sure
Input on the content has been received from all levels of staff, as appropriate
Staff are trained on the content and retrained annually
Maintain training session attendance records
All new employees should be oriented upon hire
All staff training should be documented
Staff should have easy access to relevant policies
Computer access is ideal

26. Step-by-Step Billing Process

27. Determine Eligibility
Billing Process
Schedule Appointment
Generate & Sign Bill
Register/
Determine Eligibility
Submit Bill
Contact Payer No
Verify/Auth
Payment? No
Pend/Denial?
Yes
Yes
Provide Care
Deposit
Correct
Coding
Post Payment
Re-submit
Bill Patient
if applicable
Charge Entry

28. Components of Bill Generation
Schedule appointment
Collect as much patient information as possible
On-site registration
Collect and verify outstanding patient demographic and insurance information
Conduct financial screening, as necessary
Create or have patient health record available
Generate encounter form
Provider encounter form
Provider completes encounter form and health record, both of which go to coding

29. Components of Bill Generation
Coding a claim
Coder verifies record notes, assigns appropriate codes, completes encounter form, and forwards it to billing department
Generating a bill
Billing department books appropriate service charge and produces bill based on completed encounter form
Submitting a claim
Bills are aggregated to form a claim, claim is attached to transmittal sheet identifying included bills, and both are submitted to third party payer

30. Common Billing Forms
The CMS1500 is the standard form used to bill all third party payers for professional services
It must be completed accurately
Timely collection of third party reimbursement depends on this form
The CMS1450 (UB-92) is the billing form used for hospital-based outpatient care

31. CMS1500 – Top of Form

32. CMS1500 – Bottom of Form

33. Code Sets
Coding transforms descriptions of diseases, injuries, conditions, and procedures from words to alphanumerical designations
The purpose of coding is to utilize code sets (ICD-9-CM, CDT, CPT, DSM, HCPCS, DSM) to classify patient encounters
The actual code set used is determined by
Healthcare setting
Regulatory agency
Reimbursement system
Approved HIPAA transaction code sets
ICD-9-CM, HCPCS and CPT are the primary coding systems that are used to determine reimbursement in the United States and selected under HIPAA

34. International Classification of Diseases (ICD)
ICD-9-CM has two volumes of diagnosis codes and one volume of procedure codes
Resources for ICD
Coding Clinic is a newsletter containing coding advice
It is published quarterly and helps you keep up to date with ICD-9-CM
Coding Clinic is agreed upon by a wide variety of parties and is considered authoritative
Call to subscribe

35. Sample ICD-9-CM Codes

36. Current Procedural Terminology (CPT)
Owned by the AMA and designed to facilitate communications between physicians, mid-level practitioners, and third party payers
Codes represent procedures and services performed by clinicians and some codes for other staff
Contains evaluation and management (E/M) codes
To help with CPT coding, the AMA publishes a monthly newsletter called CPT Assistant
Call for subscription, or go to
CMS, Medicare carriers, and fiscal intermediaries publish transmittals and bulletins about CPT coding to guide you in their use

37. Sample CPT Codes

38. Healthcare Current Procedural Coding System (HCPCS)
HCPCS Level II Codes represent supplies, materials, injectable medications, DME, and services
Used mostly for ambulatory care and is a three level system
Level I is the CPT code
Level II codes are developed and maintained by CMS and updated quarterly
They are used primarily for reporting purposes in ambulatory care claims processing
Level III codes are for new procedures, devices, and services not in Levels I and II
Defined by fiscal intermediaries and vary by location or payer
HCPCS – useful information at

39. Sample HCPCS Codes

40. Other HIPAA Standard Code Sets
Code on Dental Procedures and Nomenclature, Second Edition (CDT-2)
Developed and maintained by the American Dental Association to record dental procedures
Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM IV)
Developed and maintained by the American Psychiatric Association to code diagnoses made by mental health and substance abuse treatment providers
National Drug Codes (NDCs)
Developed and maintained by the Food and Drug Administration to report prescription drugs in pharmacy transactions and some claims by health claim professionals

41. Coding Process
The process of who does the coding may vary among settings
However, the function of assigning codes does not change
Providers and coders take clinical information (e.g., diagnostic terms, procedure descriptions) and assign a code to each one according to official rules
Coders would take this clinical information from the provider’s portion of the health record
The provider is responsible to record proper information
Coding professionals do not make assumptions or use personal preferences
Coding guidelines absolutely prohibit this

42. Coding Tips Documentation must substantiate the bill
The note should back up the code chosen, and vice versa, or you can lose reimbursement
Coding is a joint effort between the clinician and coder to achieve complete and accurate documentation, code assignment, and diagnostic and procedural coding
ICD codes labeled “not elsewhere classified (NEC)” or “not otherwise specified (NOS)” should be used only when the documentation in the record does not provide adequate information to assign a more specific code

43. More Coding Tips
Code to the highest level of specificity when applying codes (i.e., use the 4th or 5th digit if they exist)
Do not code diagnoses documented as “probable,” “suspected,” or “rule out” as if the diagnosis is established
Guidelines for these were developed for inpatient reporting and do not apply to outpatients
You have to code the symptoms, signs, abnormal test results, or other reason for visit if no diagnosis is established at that time
When no definite condition or problem is documented at the conclusion of a patient care visit, the coder should select the documented chief complaint or symptom

44. Evaluation and Management (E/M) Coding
All physicians, regardless of specialty, may use any E/M service code
History, examination, and medical decision-making are the key elements when determining a level of service
There are different codes for new and established patients
E/M codes encompass wide variations in skill, effort, time, responsibility, and medical knowledge required for diagnosis and treatment
Includes private/clinic “office” visits or hospital-based outpatient visits and other types of services provided by physicians and mid-level providers

45. Coding and Reimbursement
Coding errors can result in delayed, incorrect, or no payment
With the added scrutiny of the Office of Inspector General and others, it is increasingly more important to minimize errors that can result from incomplete documentation or inappropriate use of codes
Patient records have to include documentation for medical care, diagnostic tests, procedures and all other services submitted for payment

46. Coding Audit Triggers On Medicare’s Current Hit List
Excessive use of higher-level E/M codes—too much use of 99215
Billing for consultations on established patients for minor diagnoses that do not support this level of service
Billing for excessive repetition of lab tests when results are typically normal for that patient
Upcoding and overutilization billing for office visits, especially when services were not medically necessary

47. TPR Collections: Step-by-Step

48. Determine Eligibility
Billing Process
Schedule Appointment
Generate & Sign Bill
Submit Bill
Contact Payer
Register/
Determine Eligibility No
Payment?
Pend/Denial?
Verify/Auth No
Yes
Yes
Provide Care
Deposit
Correct
Coding
Post Payment
Re-submit
Charge Entry
Bill Patient
if applicable

49. Collecting Third Party Payments
Remittance Advice (RA)
Third party payer forwards a RA to billing provider
RA is usually accompanied by an Explanation of Benefits (EOB) form and a check for paid bills
Deposit payment – deposit payment immediately upon receipt
Post payment – payments made on outstanding amounts should be posted to patient accounts

50. Collecting Third Party Payments
Bill secondary payer
As appropriate, bill secondary payer (s) for remaining patient balances (or coordination of benefits)
Bill patient
After payment from a secondary payer is received, bill patient accordingly
Analyze pended and denied bills
Analyze RAs and EOBs to identify and resolve correctable billing errors
Resubmit corrected bills

51. Remittance Advice (RA)
The RA, or remittance statement (RS), is a written notice from a third party payer
Itemizes submitted bills
Identifies the payment amount for each submitted bill
Gives the payment status of each bill (paid, pending, or denied)
For each bill, the RA also shows
Provider’s name and number
Date of service
Patient name and insurance ID number
Service description, coding and billed charge
Amount paid or payable for billed service (s)
Patient deductibles or co-pays
Payment status

52. Remittance Advice (RA)

53. Explanation of Benefits (EOB)
Provider and patient identification
Dates of service, procedures, and charges submitted
Disallowed charges and explanation (usually codes)
Allowed charges and explanation (usually codes)
Deductible (if applicable) and year to date total
Co-pay, if any
Amount payable by the payer
Identifies incorrect billing information that can be perfected and resubmitted
Highlights ineffective operating procedures for collecting patient and service data used in billing so they can be modified, as needed
Identifies the need for staff training on data collection and billing

54. Explanation of Benefits (EOB)

55. Bill Tracking and Adjustment Activities
Essential bill tracking and adjustment functions
Provider productivity
Analysis of coding
Frequency of illnesses
Frequency of chronic versus acute illness
Analysis of cost of care
Account aging
Cost center income and expense
Profit and loss (yes, even in not-for-profits)
Status of reimbursement transmittals/claims
Bill tracking and adjustment activities are essential to maintain adequate cash flow
Adding computerized tools can help with tracking and management, thereby improving cash flow

56. Overview of the Claims Payment Process
Reject Claim
Patient ID Match?
Calculate Allowed Charges No
Yes
Procedure(s) Covered?
Reject Claim No
Calculate Deductible (if applicable)
Yes
Procedure(s) Match Diagnosis?
Reject Claim No
Calculate Copay (if applicable)
Yes
Duplicate Claim?
Reject Claim
Yes
Create EOB No
Yes
Other Payer Responsible?
Reject Claim
Send EOB and payment No

57. Overview of the Claims Payment Process
Payer scans the claim for a match with their database
Claim procedure codes are checked
Procedure codes are compared to claim diagnosis codes to confirm medical necessity
Claim checked against previous claims
Claim is checked to determine if another payer has responsibility to pay
Allowed charges are calculated
Deductible, if any, is calculated
Co-pay, if any, is calculated
EOB form is created
EOB and payment is sent to provider

58. Rejected Bills Payable bills can be rejected due to correctible errors
It is important to track rejected bills to
Identify improvements in billing and collection processes
Highlight correctable program operations and billing problems
Assess performance of billing staff
Get additional revenue
Some bills are rejected because they are un-payable
Other bills are rejected because the claim was completed incorrectly or contained incorrect data
Electronic bill submission, either internally or through an outside firm, can reduce rejections and expedite payment

59. Common Reasons for Rejected Bills
The patient not on file
The bill is for non-covered services
The procedure not medically necessary
Out-of-network provider (rejected or reduced payment)
A required preauthorization was not secured
The patient’s coverage was terminated prior to date of service
Other payer responsible

60. Automation

61. To Computerize or Not HIPAA requires electronic claims submission
Billing and collections effectively require on-going management
It is advisable, although not necessary, for a very small operation to computerize the data you need to collect
General benchmark
< 10,000 visits annually = manual system
> 10,000 visits annually = computerized system
Billing software vary in cost and training requirements
Look before you leap

62. Building Your TPR Team: Tips in Reviewing Your Staff Responsibilities

63. Staff Responsibilities: Registration Clerk
Constructs patient health records before visits
Has records available when patients arrive
Ensures patients arrive at your program and “sign in”
Registers arrival time
Ascertains if insurance status or address have changed
Ensures patient demographic data is correct
Handles appointment reminders by calling patients or preparing reminder cards
Clerk may
Record the patient’s chief complaint
Complete forms in the health record with demographic data
Explain co-payment or deductible to patient and collect the cash or charge to credit card
Transcribe codes to face sheet or a super-bill based on the patient’s chief complaint (if trained by your coder)

64. Staff Responsibilities: Coding Staff
Encounter forms typically allow providers to check off item(s) on the forms that list many visit/procedure options and diagnoses, with the corresponding codes
The medical visit level and diagnoses and procedures are taken from the encounter form, coded, and entered into a billing system
Coders should ensure corresponding notes are in the record
If coding notes, obtain health records, encounter form(s), or charge slip(s) and determine codes
Enter codes into billing system if they assigned the code, otherwise this is a biller’s function
If coding staff are not entering information directly in a computer program, a manual log sheet can be used
Verify accuracy of date and place of service
If billing software is available to execute claims, coders and then billers initiate the billing process
Physical layout is important for coders to be able to be most effective, they need to concentrate

65. Staff Responsibilities: Billing Staff
Charges or fees are then applied by the biller and CMS1500 claim forms are generated
Verifies that all services provided were coded
Matches encounter slips to appointment register
Enters charges for services and generates bills
Completes claim transmission and submits claim in a timely manner
In small organizations the biller and coder can be one person

66. Staff Responsibilities: Accounts Receivable (AR) Staff
Posts, or records, the payments received from the payer
Reviews Remittance Advice for
Inaccurate information
Adjustments
Pended bills
Denials
Examines the EOBs to identify reasons for payment delays
Communicates each reason to the provider, coder, or biller, as appropriate
If payment is banked by electronic fund transfer, this reduces days in AR
AR staff should know the date these deposits should be made and ensures the transactions occur
Claims should all be paid within specific time limits
AR staff should track or project payment dates and analyze this information to identify slow payers
Provide input into fee schedule changes

67. Staff Responsibilities: Finance Staff
Oversees all financial transactions, including billing, coding and collections
Posts cash to the accounting system
Produces cash flow reports, including aged AR, days in AR, and dollars in AR
Regularly reports performance to CEO and board of directors
Periodically audits coding and billing practices and ensures staff compliance with appropriate internal controls

68. Reimbursement Infrastructure

69. Constructing a Billing Department
Well-trained intake/registration, coding, billing and collections staff, as well as adherent providers, are essential for success
It is important to remember billing begins with the first contact by the patient
This is their point of entry into service
Consider billing process and functionality when making staffing decisions

70. Constructing a Billing Department
For those of you who do not currently bill
To decide on a plan to go forward
Analyze who currently handles
Scheduling
Intake and registration
Eligibility verification
Creation of records
These staff members can work collaboratively to create an effective billing department which integrates front desk, coding, billing, and claims submission functions

71. Re-engineering a Billing Department
For those of you who currently bill
It is a good time to get the entire front and back office together and go over all of your functions
Ensure everyone is on board with the philosophy that you need to be paid for what you do, and their connection to the payment cycle
Review everyone’s functions while together to ensure that everyone understands the jobs that others do
Be sure everyone understands they are an essential piece of an important process
Cross-train everyone, plan for vacancies and vacation

72. Constructing a Billing Department
Before you meet with all staff, review financial and demographic data that are currently collected to identify information gaps in your data
If currently billing
Pick one important issue/problem, and teach people how to flowchart the current process
Then, together, develop one ideal process
For those not currently billing
Develop flowcharts documenting optimal patient flow processes and supporting administrative functions
Design a physical office layout around the optimal
Create tracking tools to ensure same problems do not recur

73. Billing and Collections Processes Implementation
For agencies newly billing
Now you are ready to conduct a simulation of the entire billing process from patient registration to payment posting and refine, as necessary
For agencies currently billing
Be sure to pilot your solutions first, and then implement them on a full scale
Work out the bugs
If your program does not have a provider number (s) and/or claims transmission authorizations, apply for these now
Test transmission capability before submitting the first “real” claim

74. Qualified Coding Staff
Coding professionals are trained and often certified
Beginning coders’ skills and credentials are adequate for primary care or freestanding outpatient settings
Two organizations award coding credentials
American Health Information Management Association (AHIMA)
American Academy of Professional Coders (AAPC)
Both have national credentialing exams

75. Three types of information are essential to estimate your return
How do we estimate our financial return from TPR billing and collections?
Three types of information are essential to estimate your return
Patient base
Services offered
Service volume

76. What is your patient base?
Identify prevalent insurers for your patient population
Learn their payment rates, what services each plan covers and under what circumstances
Evaluate your patient population to identify uninsured clients versus individuals eligible for Medicaid, other public programs, and commercial insurers

77. What billable services does your HIV program offer?
Insurers vary in covered services, authorized providers, and payment rates
Adjust your operations accordingly
Hire Nurse Practitioners (NP) rather than RNs because NPs are billable
Case management may be a covered service
Charge for services that were previously provided at no charge

78. What is your service volume?
A shift in perspective may be required
Fee-for-service reimbursement and all inclusive rates are driven by the number of encounters or services provided
Managed care capitated payments are driven by the number of patients enrolled with the provider

79. Alternative Billing Arrangements: Partnering
Alternatives exist if the costs of developing internal billing infrastructure are prohibitive
Collaboration with complementary organizations
Buying into a common computer system, with a firewall to protect your organization’s autonomy and information
Share staff to access greater expertise than you might afford on your own
Leveraging technical and financial resources

80. Alternative Billing Arrangements: Outsourcing
Do we build or buy our own billing systems?
Companies exist that can handle all of the registration, billing, and collection processes by providing experienced on-site staff
Billing services can
Speed up payments through efficient processes, helping to improve cash flow
Reduce rejected claims by catching billing errors during front-end editing
Stay current with any changes in payer billing requirements
Produce reports tracking billing performance

81. Staffing and Patient Flow
Consider patient flow and your space needs and construct your design layout accordingly
Maximizing patient flow is the key
Processes to consider include
Constructing charts
Scheduling patients
Verifying their insurance
Collecting copays
Handling walk-ins
Telephone calls
Making referrals
Level of staff training on your software
Understand what your processes are, if they deter or enhance patient flow, and aim for “no waits/no delays”
Map the entire process so that you can be sure that staff can carry a task to completion

82. Staffing and Patient Flow
Cross-trained staff should know when to jump in and help and be trained in troubleshooting
To start your process mapping, gather some information
Number of incoming and outgoing calls per day
Number of visits per day/total and totals by type
How many individual people call in by type -patients/ referrals/ pharmacies, etc.
How many walk-ins per day - patients and others (sales people)
Number of other interruptions, e.g., audits, deliveries
Frequency of diagnoses (severity of illness)
Service volumes, e.g., number of blood draws per day
Number of new versus established patients seen per day
Vacancy rates/absentee rates for all staff
Number of charts constructed per day

83. Billing and Collection Processes Implementation
Train all of your staff, including providers
All policies and procedures relating to coding, billing, health and other record management and accounting
Federal/state and local regulations and new regulations, as they evolve
Corporate compliance
HIPAA requirements, general fraud and abuse issues
Documentation
Confidentiality and security
Coding requirements, such as E/M code rules and prohibitions on up-coding/double billing
Third party payer expectation

84. Implementation: Staff Education
All staff need education
Concentrate on provider and front office staff concurrently
Keep providers coming by making training topical and relevant to what they do on a daily basis
Keep training limited to 30 minutes per session
Provide follow-up to training by documenting results of what was learned
ALWAYS follow policies and procedures as written
If you do not, then revise the policies
Motivate staff to come to training
Reinforce the consequences of inadequate documentation

85. Other TPR Modules on Website
Visit for additional training modules
Automation of Records and Billing Functions
In-depth Coding and Documentation Practices
In-depth Billing and Collections Management
Corporate Compliance
Credentialing
HIPAA