COMMUNICATING WITH PROVIDERS Emily Schmidt
Description: COMMUNICATING WITH PROVIDERS Emily Schmidt Barnette, RHIA, CCS, CPC, CPC-P, CPB, CDEO, CPMA, CRC, CPC-I Why am I Qualified? 13 years of experience in coding and supervisory roles Introvert! Have built successful working relationships with
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slide1. COMMUNICATING WITH PROVIDERS Emily Schmidt Barnette, RHIA, CCS, CPC, CPC-P, CPB, CDEO, CPMA, CRC, CPC-I<br>
slide2. Why am I Qualified? 13 years of experience in coding and supervisory roles
Introvert!
Have built successful working relationships with providers<br>
slide4. STATISTICS<br>
slide5. Medscape National Physician Burnout & Depression Report More than 15,000 physicians
Covers 29 specialties
Eye-opening realities…<br>
slide8. Look familiar? Image source: https://thedoctorweighsin.com/the-frustration-of-trying-to-engage-our-patients/<br>
slide9. We are part of the problem Physicians are overwhelmed
Rules and Regulations
Medicare rules
Payer guidelines
NCCI edits
Meaningful use
MIPS
MACRA
HCCs
CPT
ICD-10
HCPCS
ETC<br>
slide10. The Goal Image source: https://thedoctorweighsin.com/how-happy-are-us-doctors/<br>
slide11. VERBAL COMMUNICATION<br>
slide12. Verbal Communication Introduce yourself
Know your material
Be prepared – know your objective
What are you trying to accomplish?
How will you accomplish it?
Be respectful of the physician’s time<br>
slide13. Communication Principles Content
Do you know what you’re going to say?
Even simple messages can be misunderstood
Process
How is your message delivered?
Be aware of nonverbal cues
Context
Environment
Culture<br>
slide14. Method of Communication Scheduled meeting
One-on-one
Group
In person
Virtual
A few minutes here and there<br>
slide15. Be Clear! No matter the setting, always be prepared
Know your topic and exactly what you’re trying to communicate
Know the rules (guidelines, payer rules, etc.)<br>
slide16. Tips for Effective Communication Create trust and confidence
Be clear and concise
Don’t give too much information
Give the provider time to process the information
Encourage questions and feedback
If you don’t know the answer, find the answer and follow up<br>
slide17. “Code speak” Don’t talk like a coder
Use words and terms that your physician is likely to understand
Bad?
“13.0 requires a code from N18.- and also a code from I50.- in order to fully capture this condition and code it correctly”
Better
“When documenting hypertensive heart and kidney disease w/heart failure, it’s important to remember to also include the associated stage of CKD and the specific type of heart failure”<br>
slide18. WRITTEN COMMUNICATION<br>
slide19. Image source: http://www.anthonyshuster.co.uk/blog/<br>
slide20. Image source: https://ben9340.files.wordpress.com/2011/10/bademail1.png<br>
slide21. Written Communication Be clear
Understand the language you are communicating in
Grammar
Punctuation
Context
Use a formal writing style
Be aware of font type, colors, and size<br>
slide22. Tips for Written Communication Prepare your message
Use your resources
Know the purpose of your message
Always be professional
Write clearly and concisely
Proofread!<br>
slide23. Sound Familiar? Written communication is very similar to verbal
Key differences:
Spelling and punctuation matter
Time to review your work
Take advantage of this!<br>
slide24. Remember! Remember that professionalism is key when communicating with the written word
Misspellings and incorrect grammar usage can discredit you
Always, always, always proofread and ensure the message is saying exactly what you want it to<br>
slide25. Image source: http://academy.justjobs.com/dont-suck-at-instant-messaging/<br>
slide26. QUERIES<br>
slide27. “Grant me the serenity to accept the documentation I cannot change and the courage to query the things I must.”
- Coder’s Serenity Prayer
(Author Unknown)<br>
slide28. What is a Query? A question posed to the provider, typically in written form
Necessary because documentation is sometimes vague or lacking
Good for both communication and education<br>
slide29. The Query Process AAPC and the American Health Information Management Association (AHIMA) both have excellent query resources available online
The rest of the information in this section of the presentation has been adapted from these resources
Links will be listed in the resource section of this presentation<br>
slide30. When to Query? When there is a variation in documentation practices by providers
Clinical indicators of a diagnosis but no documentation of the condition
Clinical evidence for a higher degree of specificity
Uncertainty of a cause-and-effect relationship
Underlying cause when admitted with symptoms
Treatment documented, but no diagnosis documented
Present on admission (POA) indicator status
Clinical validation of a diagnosis<br>
slide31. When to Query? When documentation in the patient’s record fails to meet one of the following seven criteria:
Legibility
Completeness
Clarity
Consistency
Precision
Reliability
Timeliness<br>
slide32. When to Query? Provider documentation entries in the health record should:
Address clinical significance of abnormal test results
Support the intensity of patient evaluation and treatment
Describe the thought process an complexity of medical decision making
Include all diagnostic and therapeutic procedures, treatments, and tests ordered and performed in addition to the results
Include all conditions that coexist at the time of the encounter, that subsequently develop, or that affect the treatment received and the patient’s length of stay, if applicable<br>
slide33. The Query Process Queries may be either verbal or written and may be generated in one or more of the flowing ways:
Concurrent (while the patient is still an inpatient)
Retrospective (post discharge/encounter)
Written and email queries will be made utilizing compliant query templates
Query templates may only be edited as follows:
Deletion of any part of the query form not pertinent to the query
Add any pertinent clinical findings as documented in the health record<br>
slide34. The Query Process Verbal and telephonic queries should follow the same format as written queries
All queries should be:
Clear, concise, and non-leading
Simple and direct
Itemize the clinical indicators or clues from the health record
The query should contain all of the patient’s identifying information such as name, date of admission or service, discharge date (if applicable), unit, etc. as well as the clinical findings with supporting documentation that results in a specific question for the provider<br>
slide35. The Query Process Queries can be initiated by either coding professionals or Clinical Documentation Improvement (CDI) professionals
All queries should be logged for follow-up, to track responses and to trend for any documentation issues that could indicate:
Additional documentation improvement educational opportunities for providers
Over use of queries by CDI professionals or coding professionals<br>
slide36. Example – Verbal Query The documentation of verbal queries should follow a standard format to include all necessary information.
“Spoke with Dr. X regarding the documentation of (condition/procedure) based upon the clinical indicator(s) found in the health record (list what was found and where).”<br>
slide37. Types of Written Queries Open-ended
Multiple Choice
Yes/No<br>
slide38. Example – Open-ended Query Scenario: A patient is admitted with pneumonia. The admitting H&P examination reveals WBC of 14,000; a respiratory rate of 24; a temperature of 102 degrees; heart rate of 120; hypotension; and altered mental status. The patient is administered an IV antibiotic and IV fluid resuscitation.
Leading: The patient has elevated WBCs, tachycardia, and is given an IV antibiotic for Pseudomonas cultured from the blood. Are you treating for sepsis?<br>
slide39. Example – Open-ended Query (continued) Nonleading: Based on your clinical judgment, can you provide a diagnosis that represents the below-listed clinical indicators? The admitting history and PE reveals the following:
WBC 14,000
Respiratory rate 24
Temperature 102° F
Heart rate 120
Hypotension
Altered mental status
IV antibiotic administration
IV fluid resuscitation
Please document the condition and the causative organism (if known) in the medical record.<br>
slide40. Example – Multiple Choice Query Scenario: A patient is admitted for a right hip fracture. The H&P notes that the patient has a history of chronic congestive heart failure. A recent echocardiogram showed left ventricular ejection fraction (EF) of 25 percent. The patient’s home medications include metoprolol XL, lisinopril, and Lasix.
Leading: Please document if you agree the patient has chronic diastolic heart failure.<br>
slide41. Example – Multiple Choice Query (continued) Nonleading: It is noted in the impression of the H&P that the patient has chronic congestive heart failure and a recent echocardiogram noted under the cardiac review of systems reveals an EF of 25 percent. Can the chronic heart failure be further specified as:
Chronic systolic heart failure____________________
Chronic diastolic heart failure___________________
Chronic systolic and diastolic heart failure_________
Some other type of heart failure _________________
Undetermined/unspecified_______________________<br>
slide42. Example – Yes/No Scenario: A patient is admitted with cellulitis around a recent operative wound site, and only cellulitis is documented without any relationship to the recent surgical procedure
Query: Is the cellulitis due to or the result of the surgical procedure? Please document your response in the health record.
_____ Yes
_____ No
_____ Other
_____ Clinically Undetermined<br>
slide43. Further Query Examples All query examples in this presentation retrieved from Physician Query Examples (ahima.org)
Additional examples for further study are available at the above link<br>
slide44. COMMUNICATING AUDIT RESULTS / PROVIDER EDUCATION<br>
slide45. Building the Relationship Always be respectful
Knowledge
Skills
Time
Encourage teamwork
Highlight mutual benefits to correct coding<br>
slide46. Building the Relationship Don’t lecture – encourage interaction
Be open to listening
Ask questions
Be a person!<br>
slide47. RESOURCES<br>
slide48. Resources Query Physicians to Improve Documentation and Dx Coding - AAPC Knowledge Center
Take Your Provider Queries to the Next Level - AAPC Knowledge Center
Querying providers (aapc.com)
Guidelines for Achieving a Compliant Query Process (Journal of AHIMA - April 2019)<br>
slide49. Resources Query Toolkit (ahima.org)
Medscape National Physician Burnout & Depression Report 2018
Physician Query Examples (ahima.org)<br>
slide50. Emily Barnette 386-956-0980 barnette.emilys@gmail.com<br>
slide2. Why am I Qualified? 13 years of experience in coding and supervisory roles
Introvert!
Have built successful working relationships with providers<br>
slide4. STATISTICS<br>
slide5. Medscape National Physician Burnout & Depression Report More than 15,000 physicians
Covers 29 specialties
Eye-opening realities…<br>
slide8. Look familiar? Image source: https://thedoctorweighsin.com/the-frustration-of-trying-to-engage-our-patients/<br>
slide9. We are part of the problem Physicians are overwhelmed
Rules and Regulations
Medicare rules
Payer guidelines
NCCI edits
Meaningful use
MIPS
MACRA
HCCs
CPT
ICD-10
HCPCS
ETC<br>
slide10. The Goal Image source: https://thedoctorweighsin.com/how-happy-are-us-doctors/<br>
slide11. VERBAL COMMUNICATION<br>
slide12. Verbal Communication Introduce yourself
Know your material
Be prepared – know your objective
What are you trying to accomplish?
How will you accomplish it?
Be respectful of the physician’s time<br>
slide13. Communication Principles Content
Do you know what you’re going to say?
Even simple messages can be misunderstood
Process
How is your message delivered?
Be aware of nonverbal cues
Context
Environment
Culture<br>
slide14. Method of Communication Scheduled meeting
One-on-one
Group
In person
Virtual
A few minutes here and there<br>
slide15. Be Clear! No matter the setting, always be prepared
Know your topic and exactly what you’re trying to communicate
Know the rules (guidelines, payer rules, etc.)<br>
slide16. Tips for Effective Communication Create trust and confidence
Be clear and concise
Don’t give too much information
Give the provider time to process the information
Encourage questions and feedback
If you don’t know the answer, find the answer and follow up<br>
slide17. “Code speak” Don’t talk like a coder
Use words and terms that your physician is likely to understand
Bad?
“13.0 requires a code from N18.- and also a code from I50.- in order to fully capture this condition and code it correctly”
Better
“When documenting hypertensive heart and kidney disease w/heart failure, it’s important to remember to also include the associated stage of CKD and the specific type of heart failure”<br>
slide18. WRITTEN COMMUNICATION<br>
slide19. Image source: http://www.anthonyshuster.co.uk/blog/<br>
slide20. Image source: https://ben9340.files.wordpress.com/2011/10/bademail1.png<br>
slide21. Written Communication Be clear
Understand the language you are communicating in
Grammar
Punctuation
Context
Use a formal writing style
Be aware of font type, colors, and size<br>
slide22. Tips for Written Communication Prepare your message
Use your resources
Know the purpose of your message
Always be professional
Write clearly and concisely
Proofread!<br>
slide23. Sound Familiar? Written communication is very similar to verbal
Key differences:
Spelling and punctuation matter
Time to review your work
Take advantage of this!<br>
slide24. Remember! Remember that professionalism is key when communicating with the written word
Misspellings and incorrect grammar usage can discredit you
Always, always, always proofread and ensure the message is saying exactly what you want it to<br>
slide25. Image source: http://academy.justjobs.com/dont-suck-at-instant-messaging/<br>
slide26. QUERIES<br>
slide27. “Grant me the serenity to accept the documentation I cannot change and the courage to query the things I must.”
- Coder’s Serenity Prayer
(Author Unknown)<br>
slide28. What is a Query? A question posed to the provider, typically in written form
Necessary because documentation is sometimes vague or lacking
Good for both communication and education<br>
slide29. The Query Process AAPC and the American Health Information Management Association (AHIMA) both have excellent query resources available online
The rest of the information in this section of the presentation has been adapted from these resources
Links will be listed in the resource section of this presentation<br>
slide30. When to Query? When there is a variation in documentation practices by providers
Clinical indicators of a diagnosis but no documentation of the condition
Clinical evidence for a higher degree of specificity
Uncertainty of a cause-and-effect relationship
Underlying cause when admitted with symptoms
Treatment documented, but no diagnosis documented
Present on admission (POA) indicator status
Clinical validation of a diagnosis<br>
slide31. When to Query? When documentation in the patient’s record fails to meet one of the following seven criteria:
Legibility
Completeness
Clarity
Consistency
Precision
Reliability
Timeliness<br>
slide32. When to Query? Provider documentation entries in the health record should:
Address clinical significance of abnormal test results
Support the intensity of patient evaluation and treatment
Describe the thought process an complexity of medical decision making
Include all diagnostic and therapeutic procedures, treatments, and tests ordered and performed in addition to the results
Include all conditions that coexist at the time of the encounter, that subsequently develop, or that affect the treatment received and the patient’s length of stay, if applicable<br>
slide33. The Query Process Queries may be either verbal or written and may be generated in one or more of the flowing ways:
Concurrent (while the patient is still an inpatient)
Retrospective (post discharge/encounter)
Written and email queries will be made utilizing compliant query templates
Query templates may only be edited as follows:
Deletion of any part of the query form not pertinent to the query
Add any pertinent clinical findings as documented in the health record<br>
slide34. The Query Process Verbal and telephonic queries should follow the same format as written queries
All queries should be:
Clear, concise, and non-leading
Simple and direct
Itemize the clinical indicators or clues from the health record
The query should contain all of the patient’s identifying information such as name, date of admission or service, discharge date (if applicable), unit, etc. as well as the clinical findings with supporting documentation that results in a specific question for the provider<br>
slide35. The Query Process Queries can be initiated by either coding professionals or Clinical Documentation Improvement (CDI) professionals
All queries should be logged for follow-up, to track responses and to trend for any documentation issues that could indicate:
Additional documentation improvement educational opportunities for providers
Over use of queries by CDI professionals or coding professionals<br>
slide36. Example – Verbal Query The documentation of verbal queries should follow a standard format to include all necessary information.
“Spoke with Dr. X regarding the documentation of (condition/procedure) based upon the clinical indicator(s) found in the health record (list what was found and where).”<br>
slide37. Types of Written Queries Open-ended
Multiple Choice
Yes/No<br>
slide38. Example – Open-ended Query Scenario: A patient is admitted with pneumonia. The admitting H&P examination reveals WBC of 14,000; a respiratory rate of 24; a temperature of 102 degrees; heart rate of 120; hypotension; and altered mental status. The patient is administered an IV antibiotic and IV fluid resuscitation.
Leading: The patient has elevated WBCs, tachycardia, and is given an IV antibiotic for Pseudomonas cultured from the blood. Are you treating for sepsis?<br>
slide39. Example – Open-ended Query (continued) Nonleading: Based on your clinical judgment, can you provide a diagnosis that represents the below-listed clinical indicators? The admitting history and PE reveals the following:
WBC 14,000
Respiratory rate 24
Temperature 102° F
Heart rate 120
Hypotension
Altered mental status
IV antibiotic administration
IV fluid resuscitation
Please document the condition and the causative organism (if known) in the medical record.<br>
slide40. Example – Multiple Choice Query Scenario: A patient is admitted for a right hip fracture. The H&P notes that the patient has a history of chronic congestive heart failure. A recent echocardiogram showed left ventricular ejection fraction (EF) of 25 percent. The patient’s home medications include metoprolol XL, lisinopril, and Lasix.
Leading: Please document if you agree the patient has chronic diastolic heart failure.<br>
slide41. Example – Multiple Choice Query (continued) Nonleading: It is noted in the impression of the H&P that the patient has chronic congestive heart failure and a recent echocardiogram noted under the cardiac review of systems reveals an EF of 25 percent. Can the chronic heart failure be further specified as:
Chronic systolic heart failure____________________
Chronic diastolic heart failure___________________
Chronic systolic and diastolic heart failure_________
Some other type of heart failure _________________
Undetermined/unspecified_______________________<br>
slide42. Example – Yes/No Scenario: A patient is admitted with cellulitis around a recent operative wound site, and only cellulitis is documented without any relationship to the recent surgical procedure
Query: Is the cellulitis due to or the result of the surgical procedure? Please document your response in the health record.
_____ Yes
_____ No
_____ Other
_____ Clinically Undetermined<br>
slide43. Further Query Examples All query examples in this presentation retrieved from Physician Query Examples (ahima.org)
Additional examples for further study are available at the above link<br>
slide44. COMMUNICATING AUDIT RESULTS / PROVIDER EDUCATION<br>
slide45. Building the Relationship Always be respectful
Knowledge
Skills
Time
Encourage teamwork
Highlight mutual benefits to correct coding<br>
slide46. Building the Relationship Don’t lecture – encourage interaction
Be open to listening
Ask questions
Be a person!<br>
slide47. RESOURCES<br>
slide48. Resources Query Physicians to Improve Documentation and Dx Coding - AAPC Knowledge Center
Take Your Provider Queries to the Next Level - AAPC Knowledge Center
Querying providers (aapc.com)
Guidelines for Achieving a Compliant Query Process (Journal of AHIMA - April 2019)<br>
slide49. Resources Query Toolkit (ahima.org)
Medscape National Physician Burnout & Depression Report 2018
Physician Query Examples (ahima.org)<br>
slide50. Emily Barnette 386-956-0980 barnette.emilys@gmail.com<br>