Successfully educating providers and coders about the growing list of billing rules and regulations, not to mention how to code and document, may not be an easy task, but the results are worth it. A successful auditing and compliance program is designed to do more than just find errors and point out mistakes. It includes a robust set of training and change management processes. And, it is designed to teach providers and coders how to avoid denials and ensure they are being paid for everything they do, all while avoiding compliance risk.
Recently, Hayes hosted a roundtable discussion with a selection of billing compliance and audit team leaders that use MDaudit to hear their best practices for educating providers and coders.
Here are some of their best tips:
1. Communicate effectively with relevant examples: Make the training relevant to the person or group being educated. Know what the problem is that you are trying to solve. Focus only on the specific issue(s) that person/group is currently dealing with based on your review of their audits. Similarly, ensure the examples you share are relevant. For example, when educating cardiologists, use examples from recent cardiology cases. If you show examples from a different specialty, they won’t relate to the material and will lose focus.
2. Motivate and give credit: Focus on what the providers or coders are doing right in addition to the corrections they need to make. Highlight the positive changes they made since their last review.
3. Design shorter training sessions: Be concise and focused during the training. Shorter sessions that focus on no more than three items will help keep their attention and make it easier for them to retain the information.
4. Provide visual examples that resonate: Give real examples, don’t just broadly explain the problem. Many people are visual learners, so showing them how to apply what you are explaining goes a long way. For example, when explaining which modifier to use, pull up a screenshot of the code used in the billing system to reinforce the point. And, if applicable, provide links to guidelines and other resources that would be helpful.
5. Actively engage in virtual sessions: To help keep the audience engaged when doing remote training using Teams or Zoom, request cameras remain on and build pauses for discussion into your training plan.
6. Get stakeholder buy-in: When discussing a critical topic, a trick to ensure your audience understands the importance of the topic is to first review the training materials with a supervisor or stakeholder to get their buy-in to the topic and presentation. Then, when conducting the training, have that same person introduce you and the program to the team.
7. Offer multiple training formats: While group online training sessions may work well for most of your curriculum, some people prefer one-on-one or in-person training. A more focused learning environment may help some people better retain information and encourages questions and discussion. One health system was able to extend the use of their training by putting the recordings of their web training on an intranet site for providers and coders to watch when convenient. The staff who watch the recorded sessions can get CME credits after completing the training by following some steps and filling out a form.
8. Define and socialize action plan with participants: Ensure you have a plan to evaluate the effectiveness of your training and that trainees understand what the plan is. Similar to school, students pay more attention if they know there is a quiz at the end. While you may not be giving quizzes at the end of your sessions, you will probably be doing a follow-up audit in 30 days to ensure the coder/provider has corrected any errors. Beyond that first 30-day review audit, organizations differ in their next steps. One organization we spoke to requires that when a provider does not pass a second audit review, all their claims are reviewed prospectively for the next 30 days. If they continue to make these errors, further action will be required – which may financially impact the provider to offset the additional scrutiny and education. Another organization doesn’t consider remediation until a provider fails an audit 3 times in a row.
Perhaps the best part of the roundtable discussion was seeing how proud these leaders were of the work they do and the progress they have made in pivoting their education during the pandemic. They bragged of high audit pass rates, engaged audiences, and corrective action plans that worked.
To learn more about how MDaudit can help your audit team identify revenue and compliance risk and enable corrective action, request a demo.
