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    • 07 FEB 23
    Signify Spotlight: Stacy Carlile, CPC, CDEO

    Signify Spotlight: Stacy Carlile, CPC, CDEO

    Artesia General Hospital uses educational newsletter to improve HCC Coding

    Originally published in the Signify Health Weekly Digest, January 18, 2022 (Volume 102)

    Artesia General Hospital (Artesia) is located in rural Artesia, New Mexico. They joined Signify Health in 2016 and participate in the Collaborative Care ACO. Every day, healthcare professionals are understanding the importance that coders have as it relates to standards of care and patient outcomes and optimizing the financial component of the organization.

    Stacy Carlile, CPC, CDEO, Coding Supervisor, has played a pivotal role in not only educating staff and providers about effective HCC documentation at Artesia, but also by gaining buy-in and successful support by distributing an educational newsletter. We talked with Stacy to learn more.

    What did Artesia do to gain provider buy-in for your educational newsletter?
    Previously, there had not been much in the way of this type of provider education. The providers were excited to receive information regarding documentation and coding to help them support the services they provide and to gain information on the appropriate billing of those services.

    How often do you distribute your newsletter?
    Initially, we sent it weekly. This was done mostly because there was a lot of information to share, and we wanted providers to get used to seeing these newsletters and we wanted their feedback as well. After the first year we sent them monthly and most recently we started sending them quarterly.

    How do you choose which codes or conditions to include?
    Some articles come from onsite documentation and coding audits, but I get the most relevant data for education from working claim edits. Because our coding team works on all claims regarding medical necessity, CCI edits, and all other coding edits, I am able to see where our documentation falls short of supporting medical necessity for any type of coding, CPT, and ICD-10. I maintain logs to show trends of the codes, and of the providers. Sometimes one-on-one education is more beneficial than information in the newsletter and I’m flexible in that way. When we see CCI edits for the same CPT/HCPCS codes and the documentation or provider order does not support billing those services, or maybe we are not permitted to bill certain codes on the same day, as in the case of ‘a panel within a panel’, I will add this to the newsletter. Of course, the provider will order and provide the patient with what they believe is medically necessary for the patient, but my hope is to decrease the number of write-offs/adjustments for lack of supporting documentation. Ultimately, we want the provider to understand the guidelines.

    What lessons have you learned along the way?
    One is to have a provider advocate. It doesn’t matter how many years a person has been in the field of healthcare and worked in documentation, coding, and billing, my experience is that providers will still be skeptical of what a lay person tries to educate them on.

    Two is to not take it personally like in the example above. If you get upset when providers may not trust you in the beginning and you take it personally, it won’t help anything. Bide your time, find a provider who believes in proper documentation and coding. There is always at least one and work with them to help you learn to communicate with the providers in a way that they will begin trusting you and be willing to listen to what you have to say.

    And three, always have references available. I do not provide information as education to providers when I cannot quote or reference an article from a reliable source. Most of the time those sources are CMS, Medicare, Medicaid, other payers, or physicians who write articles that have been published in specialty journals, etc. I have always made it known to providers during live education sessions that I will not tell them anything just because ‘I believe so’ or ‘I think so’. I have always been able to gain trust from providers because I use data and facts.

    Click here to learn more about the services offered at Artesia General Hospital.