1. Streamlining Documentation and Coding of the Well Woman Exam (WWE)
Catherine Scarbrough, M.D., John Adams, M.D., Mary Margaret Clapp, M.D., Katie Gates, M.D., Ambreen Mardhani, M.D., Maury Minton, M.D.,
Melanie Tucker, Ph.D.
University of Alabama Family Medicine Residency Program
Tuscaloosa, AL

2. Background
A Well Woman Exam (WWE) is an annual preventive screening for gynecological diseases and can include a breast and pelvic exam.
Coding and billing for these exams is complex.
Medicare, Medicaid, and private insurance carriers require different diagnosis codes.
There are different pap collection fee codes for the different carriers.
If a visit is incorrectly coded, reimbursement may be denied or delayed by insurance carriers.

3. Not A New Problem
“When you perform a well-woman exam, you could have trouble getting paid for the visit if you don’t know how to properly code Pap tests, and if you don’t understand how Medicare and private payers’ guidelines differ.” -Medical Economics; Oct 7, 2005

4. Importance Reason Percent Diabetes Mellitus 2.8 Gyn Exam 1.8
Hypertension
1.1
Fever
0.9
Back Symptoms
1.0
20 Leading Principal Reasons For Outpatient Visits: CDC/NCHS National Hospital Ambulatory Medical Care Survey, 2010

5. Expected Source of Payment
Importance
Expected Source of Payment
Percent
Medicaid
42.9
Private Insurance
36.4
Medicare
10.8
No Insurance
7.5
Other
8.6
Preventive Care Outpatient Visits Expected Sources of Payment: CDC/NCHS National Hospital Ambulatory Medical Care Survey, 2010

6. Importance
Large number of WWE’s per year by family medicine physicians
Lost revenue
Increased expenses
Denials and re-submitting claims = increased workload on billing departments

7. Could rates be improved through resident education/training?

8. A Potential Solution

9. Study purpose
Determine whether the use of a concise, single-page coding reference improves reimbursement rates for well woman exams (WWEs) at the University Medical Center (UMC).
Hypothesis: the availability of a reference card that instructs resident physicians in proper coding of WWEs will result in better reimbursement rates at UMC.

10. Methods Data mining by the business office Reference tool created
Educational session performed
After 6 months, data mining run again
1. Data mining: performed by the business office to determine the number of WWEs performed in a six-month period at UMC, as well as the dollar amount billed for the exams and whether or not the claims were denied.
2. Reference tool: created that provided proper visit codes, pap collection codes, and correct EHR templates to be used for WWEs, organized according to different insurance carriers.
3. Educational session: performed for residents, attendings, nurses, and other staff from the Family Medicine and OBGYN clinics.
4. After using the reference resource for 6 months, the reimbursement/denial rate report was run again and compared to initial data to determine if reimbursement rates are improved and claims denials are decreased.

11. Postintervention March-Oct 2015
Results
Preintervention
Postintervention March-Oct 2015
Pap smears performed
817
127
Appealed by insurance due to documentation
714 3
% Denials Due to Documentation
87% 2%

12. Postintervention March-Oct 2015
Results
Preintervention
Postintervention March-Oct 2015
% Denials Due to Documentation
87% 2%
Lost Revenue
$21,470
$231.81

13. Study Limitations Modifier acceptance per insurance carrier changed
Missed educational opportunities
Some residents not aware
Reference tool handouts “lost” during construction in preceptor room
OBGYN faculty
Changing targets per guidelines
Study crossed academic year
Study crossed ICD-10 implementation

14. Topics for Further Study
Nature of claim denials
How our claims denial rate compares with other parts of the country
Means of improving teaching tools for coding

15. References
No authors listed. Well Woman Exam. Med Econ 2007 Feb 16; 84(4):18-9
As-Sanie S, Zolnoun D, Wechter ME, Lamru G, Tu F, Steege J. Teaching residents coding and documentation: effectiveness of a problem-oriented approach. Am J Obstet Gynecol Nov, 193(5):1790-3
Skelly KS, Berqus GR. Does structured audit and feedback improve the accuracy of residents’ CPT E&M coding of clinic visits? Fam Med 2010 Oct, 42(9):648-52
CDC/NCHS National Hospital Medical Care Survey, 2010

16. Questions? Thank You!