Having worked in both the private practice sector, hospital sector and payer sector in healthcare, I have seen things from all sides for both patient and provider. I am a firm believer in Pre-Visits and having the provider “set up” ahead of the patient visit. When I worked in for an Orthopedic and Physical Therapy practice, the providers all wanted the charts in a holder outside the patient exam room (yes, I am dating myself), so that they could review what was going on since they last saw the patient (labs, tests etc.) or if it was a new patient, all relevant information for the visit. The medical assistants would all assemble the pertinent information and organize it for each provider, so when they walked into the room, they were ahead of the game. Every provider knew where to start before each visit, thus allowing for a shorter but more productive exam with valuable focus on what needed to be addressed during the visit.
The AAPC has posted a great article on Pre-visits recently and how adding this one quality assurance measure to the daily flow in your office will assist with elevating patient care, as well as outcomes and profits. Read it here: https://www.aapc.com/resources/the-power-of-pre-visits-in-maximizing-patient-care-and-profits. I have pasted the infographic from the article for you below.
When you consider that on average, a primary care (family practice & internal medicine included), sees a large number of Medicare aged patients and older. Generally, this means that the provider is probably addressing upwards of 4 or more chronic conditions like Diabetes type 2 (DM2), chronic kidney disease (CKD), Congestive Heart Failure (CHF), Chronic Obstructive Pulmonary Disease (COPD) and most if not all, will need to be discussed during the visit for further work up. This can be very overwhelming for many providers to address during a visit, if they walk into what I call a “cold room”. A “cold room”, in essence, is when a provider goes to see a patient without any prior review of the patient’s last visit or any updated information, or it is a new patient, and they have not reviewed the patient’s health status to date.
In 2022, there was a case study of services performed by the AAPC, that focused on how practices performed with the capture of HCC ICD-10 CM codes and truth be told, the majority were found to be under-coding HCC ICD-10 codes, mainly because there were numerous deficiencies in documentation, coding mistakes, and over-utilization of unspecified codes. The purpose of shifting from ICD 9CM to ICD 10CM, was to reduce the number of unspecified codes used and hone in on specificity, so clearly, there is still a lot of education that needs to occur in diagnosis code assignment. Unfortunately, there was a shared loss upwards of $160,000.00 yearly.
https://www.aapc.com/resources/converting-risk-into-revenue-risk-adjustment-case-study
Now you may be reading this and thinking this sounds like she is going to talk about Risk Adjustment and to some degree, you would be correct. Risk Adjustment (RA), in and of itself is designed to assist with the “capture” of these chronic conditions on an annual basis and provide a better snapshot of a patient’s health risk profile. Having worked in both RA and regular environments in healthcare, I have always felt that the guiding principles of RA, Pre-visits, is a well deployed tool that can ensure a patient’s risk factors, and current health status is assessed to provide them with better care and outcomes. The goal of Pre-visits is to allow both patient and provider to have a more productive face-to-face visit when this data is collected and prepared ahead of the visit. This in turn, points the visit focus on understanding, conversing, and answering questions about the reviewed data and setting a treatment plan with the patient.
WHAT’S NEXT?
As providers and staff both play a key role in this process, it is mission critical that everyone buys in to it. It’s a simple daily process that has the potential to provide both patient gains and revenue gains. On the patient side, providers will reduce visit times by being more prepared and potentially drive better patient health outcomes or faster interventions, which makes both patients and providers happy. On the revenue cycle management side (RCM), physicians that contract with Medicare Advantage plans have the potential to earn bonuses with more accurate diagnosis coding, provide documentation that captures chronic conditions annually from their patients, reduce re-admissions to hospitals and control continuity of care. Additionally, pre-visit reviews will assist with denial reductions and assist coders and billers by providing them with precise documentation to maximize reimbursement compliantly.
The question is to me, why would you not want to incorporate this simple strategy into your practice?
Happy Coding!
RESOURCES:
Pre-Visit Planning Toolkit by AMA ( for more info please visit www.stepsforward.org )
https://edhub.ama-assn.org/steps-forward/module/2702514
https://innovista–health-com.webpkgcache.com/doc/-/s/innovista-health.com/pre-visit-planning/
MBR AAPC/NAMAS
Director of Compliance and Education, ZENMED Solutions INC.
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