Name: Terri Hall

Title: HIM/RM Coordinator

Location: Billings, Montana

Q: How did you achieve your current position?

A: My official title is HIM/RM Coordinator, and in the course of my duties and responsibilities surrounding coding of ICD, CPT, and HCPCS codes, I realized I had to learn to use the E&M auditing tool. Working collaboratively with the billing staff is essential when using the E&M auditing tool. In the last five years, I have used many different E&M audit tools and I have even created one myself, thinking it would meet my needs, however, in the long run I ended up liking the CMS E&M Audit tool the best.

Q: How long have you worked in healthcare?

A: I can retire in eight years and have worked in the field of HIM for 30 years.

Q: What is one aspect of your position that you enjoy?

A: Presenting and training on E&M audit tools, HIPAA, Privacy Act, and OIG compliance.

Q: Everyone knows working in healthcare - let alone in auditing - is demanding and at times, can be stressful. What has kept you loyal to a career in this field?

A: I enjoy the focus of discipline of the chart review in determining if the provider's documentation meets and level of service coded and billed. I enjoy working one on one with physicians, bringing them up to speed with ways they can improve their documentation, so they feel comfortable in their selection of the most accurate E&M level of service.

Q: What is the biggest auditing challenge you face, and how do you overcome it?

A: Getting the physician to understand the importance of his role and responsibility in documenting the most accurate E&M code for the services he provided. The second biggest challenge is finding the time to perform the required audits. It seems that this is the last task on our "to do" lists and sometimes we seem never to get it done and done right. Our focus has to change and all of us have to put forth a concerted effort to perform the required audits, whether they are annual, semi-annual, or quarterly audits, so in the end, we know without fail the codes we code and bill are accurate, medically necessary, and warrant the reimbursement from the third party payers.

Q: What advice would you give to others in field to help them be successful in their position?  

A: Master using the E&M tool. Develop an auditing schedule based on high risk, high volume, problem-prone areas of coding and provider documentation. Educate your medical staff about your findings and give small five to ten-minute trainings at the quarterly medical staff meetings. Ask to be put on the medical staff agenda for five to ten minutes each quarter so that you are communicating your findings to the medical staff members. Update the coding and billing staff on new coding and billing rules and regulations as best as you can. Train your coding staff to conduct their own audits on those providers they are assigned to and make the process concurrent (before the bill goes out the door) versus retrospective. This way, the coder is not only meeting the auditing requirements but she/he is establishing a solid working relationship with those providers and the visits she codes and analyzes.