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RAPS Review: Another Step Toward Effective Coding

September 1, 2007

Health First Network is committed to supporting physicians in their efforts to serve patients AND to build profitable and sustainable businesses. Toward these ends, the organization recently reviewed the WellCare charts of 69 physicians. The objective: to reinforce the importance of proper coding and, ultimately, to ensure physicians are collecting appropriate revenue for patient care.

This review resulted in finding 6,732 adjustments. Consequently, Health First Network staff filled out attestations forms with recommendations to physicians. Physicians signed off on the forms, and the Med3OOO claims department entered them as corrected claims.

The most common issue uncovered was that medical notes in the patient chart diagnosis were not carried over to the claim, mostly because of limited space for only four diagnoses. Health First Network encourages physicians and office administrators to be aware of this and maintain a focus on proper coding overall.

Effective diagnostic coding ultimately leads to higher reimbursement. Both Health First Network as an organization and its physicians as shareholders reap the financial benefits.

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