Provider Feedback Report
HRA Medical Management Inc. has devised a unique reporting method to identify provider documentation deficiencies. When medical charts reach the certified coder, compliance issues preclude "re-dictating" the chart to capture lost revenue. The coder must assign a level of care supported by the existing documentation. This often results in a down-code in the evaluation and management (E&M) code. The Provider Feedback Report will itemize lost revenue for the E&M in the following areas: History of Present Illness (HPI), Review of Systems (ROS), Physical Exam (PE) and Medical Decision Making (MDM).
By comparing the potential revenue, determined by the certified coder and the evidence in the down-coded charts, trends can be determined by individual physician. This is of particular advantage in changing the habits of chronically inadequate documenters (physicians and physician extenders) and in quickly getting new, often somewhat inexperienced documenters quickly up to speed in their documentation. It basically allows the ED Director to assure the group of honest remuneration for work often being done but not documented.
The report has the capability to capture any other ancillary services or surgical procedures the provider may perform. Some examples of commonly used procedures are: pulse oximetry, EKG, Cardiac Monitor, transfusions, IV Infusions, Splints, Peak Flows, and wound repairs. Reports are created at month end and provided to the directors of the group. Each provider receives a monthly report of their documentation deficiencies with copies of the down-coded charts attached.
HRA will provide training with group or individuals to help reduce the occurrences of the down-codes resulting in improved compliance and ultimately increased reimbursement.
