HooahDOc

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Anyone have a clue what these are, or might be? I know that the values probably differ from the medicare/d values. My clinic's productivity outcomes are not matching up to what I get after crunching the numbers using the medicare/d values. I'm becoming suspicious that the DoD values vary substantially, as I cannot find other explanations such as mathematical or coding errors.
 

HighPriest

Specialized in diseases of the head holes
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There's a good chance you're simply not coding in the same way that they are - not that you're using a different system, but that they're not giving as much value to what you do as you are. Depending upon your clinic type, they may be up-coding or down-coding your appointment codes. If you do procedures, I can almost promise you that you're coding differently than they are because in all likelihood they have an LPN with a two day coding course deciding which CPT to use for whatever it is you did. They short change us all the time by not breaking down complex procedures, etc.
 
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HooahDOc

HooahDOc

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Jun 23, 2003
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No, I figured it out. 53% of my intake encounters are being changed to low-level E/M codes like 99212, or the CPT code was magically vanishing between AHLTA and M2, leaving only the 99499 and earning me a whopping 0 RVU. The same is true for others in my specialty here, suggesting that what is on the CART is terribly inaccurate. I'm not sure if it's a local issue or possibly an enterprise issue.

I actually went through and recalculated my SPECs the way it was entered and found that I was shorted about 300 total RVU. Makes me wonder how many people are forced into seeing more patients per day because of horribly inaccurate CART data.
 

HighPriest

Specialized in diseases of the head holes
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Almost everyone. One of our administrators recently made the comment that the hiring of Army coders goes as such:

1 - Hiring action gets placed.
2 - Interviews are performed
3 - Certified coders never apply because the pay isn't there.
4 - Uncertified coder (also referred to as anyone off the street) gets hired.
5 - The Army pays to have uncertified coder certified, so that they can better perform their job.
6 - newly certified coder quits to get a higher paying job on the outside.
7 - repeat.

I think for a while there was some criticism that the Army was doing the same thing with gangland enforces coming out of 11B positions (I think Ice T said he did it), but you know that gets more attention.
 
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HooahDOc

HooahDOc

15+ Year Member
Jun 23, 2003
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Attending Physician
Almost everyone. One of our administrators recently made the comment that the hiring of Army coders goes as such:

1 - Hiring action gets placed.
2 - Interviews are performed
3 - Certified coders never apply because the pay isn't there.
4 - Uncertified coder (also referred to as anyone off the street) gets hired.
5 - The Army pays to have uncertified coder certified, so that they can better perform their job.
6 - newly certified coder quits to get a higher paying job on the outside.
7 - repeat.

I think for a while there was some criticism that the Army was doing the same thing with gangland enforces coming out of 11B positions (I think Ice T said he did it), but you know that gets more attention.
This is very true, but there's also no way a coder can manually review every encounter -- at least I don't think. Plus, some of the changes made absolutely no sense at all. I counted a total of 753 encounters that ended up generating 0 RVU over the past 12 months, and this was among less than 10 providers.

It makes me wonder if it's not also a technical problem with the computer systems and what happens after we sign an encounter. All I know of the actual system is: AHLTA --???--> M2 ---???--> CART.
 

HighPriest

Specialized in diseases of the head holes
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This is very true, but there's also no way a coder can manually review every encounter -- at least I don't think. Plus, some of the changes made absolutely no sense at all. I counted a total of 753 encounters that ended up generating 0 RVU over the past 12 months, and this was among less than 10 providers.

It makes me wonder if it's not also a technical problem with the computer systems and what happens after we sign an encounter. All I know of the actual system is: AHLTA --???--> M2 ---???--> CART.
Well, for starters they can if they have to and if you pay them to, but maybe not in the military. I assure you that a well run practice isn't missing things like this - at least not for very long.
Secondly, one the purposes of having a coder is to perform audits of charts, op reports, etc. to ensure that they're being properly coded and to intervene when they are not. that simply doesn't happen in the military. All of the coders I've worked with wouldn't know a mistake if they saw it. It may be from a technical problem, but that is why you have an actual person checking the work at some point. It doesn't have to be every chart. If you had 753 miscoded encounters, that would have been caught with a basic, percentage audit.

The problem is that while coders are considered very important in the civilian world (because they can mean the difference between a successful practice with a reasonable workload and crushing failure), they're just not seen as very important to the Army. At least not when RVU production isn't a hot button issue that month. Even when it is, the problem is always assumed to lie with the physician or provider - "why aren't YOU seeing more patients??" The truth is, since we directly associate physician workload with RVU production, a coder isn't just a coder in the military, they're the same as a coder PLUS an insurance negotiator (because, of course, in the real world what matters is how much money you generate per RVU).

The other issue is, of course, that even if they caught it what would the military do to fix the problem? The answer, of course, is nothing. Other than maybe make it your problem somehow.

I look at it like this:

You know how to doctor. I know how to doctor. I will always do the best job that I can and I will always code my encounters to the best of my ability, not because I love the Army but because its the right thing to do. I'm not an expert coder. i would love to know more, but it's a full time job, as evidenced by all the people who do that as a full time job.
After a chart leaves my hands whether or not anyone believe I actually did any work or not is entirely up to resources out of my control. I'd prefer that they hire someone competent to control that process, and that would be an experienced, certified coder (at least). Someone who can at the very least identified if there is a system problem causing a mismatch. Someone who can correct my coding if need be. Because otherwise it'll always be someone in the command suite who doesn't understand the process themselves asking me why I'm not doing more.
 
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HooahDOc

HooahDOc

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Jun 23, 2003
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Attending Physician
Well, for starters they can if they have to and if you pay them to, but maybe not in the military. I assure you that a well run practice isn't missing things like this - at least not for very long.
Secondly, one the purposes of having a coder is to perform audits of charts, op reports, etc. to ensure that they're being properly coded and to intervene when they are not. that simply doesn't happen in the military. All of the coders I've worked with wouldn't know a mistake if they saw it. It may be from a technical problem, but that is why you have an actual person checking the work at some point. It doesn't have to be every chart. If you had 753 miscoded encounters, that would have been caught with a basic, percentage audit.

The problem is that while coders are considered very important in the civilian world (because they can mean the difference between a successful practice with a reasonable workload and crushing failure), they're just not seen as very important to the Army. At least not when RVU production isn't a hot button issue that month. Even when it is, the problem is always assumed to lie with the physician or provider - "why aren't YOU seeing more patients??" The truth is, since we directly associate physician workload with RVU production, a coder isn't just a coder in the military, they're the same as a coder PLUS an insurance negotiator (because, of course, in the real world what matters is how much money you generate per RVU).

The other issue is, of course, that even if they caught it what would the military do to fix the problem? The answer, of course, is nothing. Other than maybe make it your problem somehow.

I look at it like this:

You know how to doctor. I know how to doctor. I will always do the best job that I can and I will always code my encounters to the best of my ability, not because I love the Army but because its the right thing to do. I'm not an expert coder. i would love to know more, but it's a full time job, as evidenced by all the people who do that as a full time job.
After a chart leaves my hands whether or not anyone believe I actually did any work or not is entirely up to resources out of my control. I'd prefer that they hire someone competent to control that process, and that would be an experienced, certified coder (at least). Someone who can at the very least identified if there is a system problem causing a mismatch. Someone who can correct my coding if need be. Because otherwise it'll always be someone in the command suite who doesn't understand the process themselves asking me why I'm not doing more.
Very valid, and I agree. I'm not concerned personally with RVU that much, since really the only impact to active duty is getting yelled at or forced to see more patients unnecessarily, which certainly would harm morale. The larger issue is the impact inaccurate CART data has on the staffing matrix (feeding into the first point) and evaluations for the GS providers -- minimal RVU productivity expectations are now a requisite part of their performance standards beginning this FY. I would be livid if my evaluation could be negatively affected by questionably accurate RVU data. I suppose that is why they have the union.

Digging deeper is only causing me to become increasingly annoyed and frustrated, realizing more and more how completely broken it all is.
 

HighPriest

Specialized in diseases of the head holes
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I don't -personally- care about RVU production either, but only because I'm not long for this hellscape that is the DOD. But it does make a difference. You want new equipment? If you can demonstrate a productivity advantage, it helps. You want a PA? How productive will they be? If your FTE is low, you don't get help. If it's high, you do. So when I had the unpleasant experience of being in charge of a department, RVU production was actually helpful in getting what I felt I needed to have an efficient clinic. As someone who is no longer a department chief, RVUs are only meaningful to me when someone complains nowadays, and like everything in the Army if I just wait a month I never hear about it again. its the same reason they're always hammering on how important DHMRSI is - they don't give a crap about how much time you spend in PT. What they care about is your productivity/productive time.

But RVUs are like medical documentation - if they're not recorded, you didn't do what you say you did.