How E/M Coding Changes Became an Urgent Problem for a TN Clinic

People, processes, and technology

To improve medical coding and clinical documentation at AFC Urgent Care Memphis, McKee evaluated people, processes, and technology.

The physicians at the urgent care clinic had been documenting visits a certain way for so long (think, this was the largest overhaul to the CPT code set in several decades). They had created habits to ensure they documented visits according to the old way of coding and documenting E/M services. Furthermore, McKee understood that some physicians do not document some services to save time or prevent a costly audit.

However, those habits were leaving money on the table under new coding and documentation guidelines.

“Did you document your discussions that you had with the patient? Did you document decision-making? What about the pros and cons of choosing a certain treatment? Did you review any other materials or talk to people other than the patient,” McKee posited to the physicians.

“These are all thing that would improve the complexity of the visit, and if these things did happen, you definitely want to document them because that justifies your Level 4 or Level 5 visit, which has a better level of reimbursement. But it’s a totally different mindset.”

McKee said changing habits took a lot of education about coding, but a new process with a new technology helped to move that along.

With such an urgent revenue problem, AFC Urgent Care Memphis decided to engage the help of a technology solution to fill in a process missing from the clinic’s coding and billing functions. The solution from Exdion takes data from the EHR and practice management system and uses an artificial intelligence tool to parse through all of the clinic’s encounters—which numbered in the thousands—to identify potential revenue gaps. If the tool identifies a gap, it notifies the physicians through email to take a look at the documentation and provide missing information to support the appropriate coding.

The technology solution helped to educate physicians on not only new E/M documentation guidelines but also on the use of outdated codes that would lead to rejections, missing modifiers, and other coding errors. The solution also bridged the gap “between what happens from the chart to the billing,” McKee explained.

“There was no real process [before implementing the solution],” McKee stated. “The biller was expected to pick up on things, but nobody was checking.”

Entering the new era of E/M coding and documentation

With the right people, process, and technology in place, AFC Urgent Care saw a 25 percent boost in revenue, which was a lifeline for the clinic.

“I’m sure it saved the clinic because it wouldn’t have made sense to keep going the way it was,” McKee stated.

Fortunately, walk-in traffic is picking back up after the initial surge of COVID-19. The clinic also invested in the equipment to provide COVID-19 testing to patients, which proved to be an important service line for the struggling clinic over the last year.

But just as importantly, the clinic is now ready for a new era of E/M coding and documentation. AFC Urgent Care is continuing to educate its physicians on new coding and documentation guidelines to ensure more clean claims go out and the clinic receives the reimbursement that is truly owed for the services its physicians delivered.

“Small amounts of money add up to a large amount of money in medicine,” McKee stated. “If even one procedure is routinely not being billed properly, like a urine analysis or the administration of an injection, those things add up to large amounts of revenue being lost.”

For other clinics looking to bring their processes up to code, assessing people, processes, and technology is key to preventing revenue losses during this difficult transition.

“Don’t be too afraid of the technology and having people who check is extremely important, even if it is just routine audits,” McKee advised. “Every day there should be some system for checks and double checks.”