THE HERO'S CODE - 3RD EDITION Flipbook PDF
THE HERO'S CODE - 3RD EDITION
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HERO'S CODE May 2022
Embracing the new normal.
TABLE OF CONTENTS MANAGER'S CORNER Message from the Operations Head
Message from the Director
Changes in Provider Billing
Ponder first, Ask later
Trip to Memory Lane
WS Manila @ 13
Life at Office ... I wanted to take the time to thank each one of you who are hardworking and dedicated team members of our department. To those who have been working on site ever since the pandemic started, braving the Covid-19 virus, I want you all to know that your effort and courage to come in daily to the office to perform the daily tasks is commendable. It's not at all easy to go through the risk and challenges of a series of lockdowns, lack of transportation, and risk of catching the virus from outside, but that did not stop you from showing up and performing despite these hurdles. To the rest of the team, I am thankful for all of you, the last 2 years have not
On the side note, you’ll notice various changes in the way our workplace
understand these changes may be difficult and we are here to support you. Our goal is to collaboratively ensure you feel safe and secure so together we can navigate the complexities of our “new normal.”
Richelda Macaraig, CPC Coding Operations Head - Asia
On coding process ... Change is a part of life, it comes when we work towards it and also when we least expect
numerous changes over the past couple of years and have learned to adapt to a new normal.
But in the nature of our work, where we must be cautious not to simply
documentation of format of the medical records we rely on as the basis for our coding. Along with the changes brought about by this unprecedented
Have you started to downcode more for PFSH at your favorite facility? Have you observed any difference in the way the providers add
statement? When you see something has changed in the records you are working day in and day out, say something. Report these changes to your Team Lead immediately. As coders, you are the first line of defense in detecting a change to the charting that could be a potential detriment. We are relying on you to remain vigilant and be proactive in your communication of any change so it can be investigated and if need be, addressed.
Thank you for your attention to this matter, and for all you do to delight our company and clients.
Adrian Soll, CPC, CPC - I Director of Coding
2022 Rules for Split Visits
Before 2021 ended, CMS has dropped a bomb and set new rules governing how a paired care team - physicians and midlevel providers can bill split visits. Effective January 1, 2022, CMS has issued updated guidance on evaluation and management services that qualify as split or shared services by two providers who are in the same group. The new rules say what a " substantive portion " of a visit really means and utilize the whole care team to contribute to quality, patient satisfaction, and care outcomes.
Definition of split (or shared) E/M visit is an E/M visit provided in the facility setting by a physician and an NPP in the same group. The visit is billed by the physician or practitioner who provides the substantive portion of the visit.
By 2023, the substantive portion of the visit will be defined as more than half of the total time spent. For 2022, the substantive portion can be history, physical exam, medical decision making, or more than half of the total time (except for critical care, which can only be more than half of the total time). The treating provider who performs the “substantive portion” of the visit will bill the service. Split (or shared) visits can be reported for new as well as established patients, initial and subsequent visits, prolonged services as well as critical care services.
In Today's Hospitalist site, he quoted “More transparency and visibility for NPs/PAs could be a good thing.” ~ Michael L. Powe American Academy of Physician Assistants
A modifier is required on the claim to identify these services to inform policy and help ensure program integrity — FS (Split [or shared] evaluation and management visit). Documentation in the medical record must identify the two individuals who performed the visit. The individual providing the substantive portion must sign and date the medical record. Split/shared facility services may be billed for encounters in any facility setting, including the emergency department and skilled nursing facilities.
Practices should focus on how to calculate the “substantive portion” of the visit. This is a unique approach to billing that will determine which practitioner bills the service and how much revenue the practice receives.
Calculating the “substantive portion” and how to bill In 2022 – calculate the substantive portion of the visit based on time or the performance of documented key components. In 2023 – calculate the substantive portion of the visit only based on time
To calculate based on time, both providers will need to document the time spent on the activities that qualify for time-based coding that was established for office/other outpatient visits (99202-99215). All activities must take place on the same day as the encounter with the patient. 1. Preparing to see the patient (e.g., reviewing tests, external records) 2. Face-to-face encounter time; exam, counseling or educating a patient, family or caregiver 3. Reporting test results to a patient by phone 4. Ordering medications, tests or procedures 5. Documentation work performed after encounter on the same day 6. Care coordination (when not separately reportable) 7. Getting and/or reviewing separately obtained history 8. Referring the patient to and communicating with other health care professionals (when not separately reportable)
The encounter should be billed under the name and NPI of the clinician that spends the greatest amount of time (i.e., more than 50% of all activities) Always append the new -FS (Split/Shared evaluation and management visit) modifier to the billed E/M service code
What to consider when choosing your billing options for 2022 ?
Per CMS, the clinician who bills the visit must perform the component in its entirety in order to bill under their NPI The billing provider must also personally document what’s required for that component While the component-based billing is an option for 2022 to assist practices in the transition to the time-based model that is effective Jan. 1, 2023, your practice should consider if the effort of training the providers and staff on the component-based coding is worth it for the brief time this option is available.
While CMS created the key component option for 2022, there are two statements in the final rule that may make timebased billing more attractive A face-to-face encounter is not required. The billing clinician doesn’t have to see the patient. In response to several comments, CMS stated, “The substantive portion could be entirely with or without direct patient contact and will be determined by the portion of the time, not whether the time involves direct or in-person patient contact.” This means that if the physician spends 20 minutes on activities that do not need to be performed faceto-face, such as ordering, interpreting test results, conferring with other physicians, or coordinating and the NPP spends 15 minutes with the patient getting a history, performing an exam and counseling the patient, the physician will be the provider/NPI for this service. Reference: https://rtwelter.com/blog/2022/01/07/cmsrevised-split-shared-visit-policy-changes-for2022/
PONDER FIRST At work, we can never really say we know everything there is to know, even if you've been at it for such a long time already. There is always room to grow and improve. Asking questions is one of the most important keys to learning. But along with asking questions, one should also have the initiative - the initiative to do some thinking first and bring your own ideas of potential solutions and answers too. It is important to show initiative to explore and find answers on your own, too. Don't forget to review and remember what you have previously learned. This is essential to help you grow professionally and promote positive work relationships. It is always best to remember to Ponder First, Ask Later.
Wrong provider credit in critical care patients in Medicare insurance (shared service) Always refer to your First ask yourself, "For the rulings given, does this chart have physician billing credit?" if none, who did the most work up? If it's undetermined, who is the last to see MD?
emails for updates and sample accounts that might be the same scenario with your chart. Take note of the rulings and the sequence on how to determine the correct provider in an account.
For critical care services, the substantive portion of the visit is determined by who spent the most critical care time with the patient. So if the MLP declares 30 minutes of critical care and the doctor declares none, credit has to go to the MLP. But if the MLP declares 20 minutes and the doctor declares 25 minutes, combined there is enough time (45 minutes) to support 99291 and credit is given to the doctor as their critical care time is greater than the MLP's.
Missed Laterality Modifiers on procedures
Please keep in mind
Ask yourself, does the procedure performed need a laterality modifier? Is it a fracture/ dislocation procedure
that laterality modifiers are only appended to certain procedures and certain insurances.
which was performed to
You may use the Payer
reduce the bone? Is it a foreign
Rules for the insurance
body removal which was done in orifice? If yes, verify the insurance if it's qualified for the
ruling and the facility coding grid for specific instruction.
Some medical practices incorrectly believe that modifiers in medical coding are unnecessary, but they are an important part of avoiding abuse, non-compliance, and fraud. No medical practice wants to face huge HIPAA fines. But it’s also good to note that modifiers in medical coding often cause more mistakes; in fact, it’s one of the biggest causes of billing error overall. Most modifiers in medical coding are designed to represent the item or service given. However, they all fall into one of two levels (one for each level of HCPCS codes): Level I are updated annually by the AMA (American Medical Association). Level II are updated instead by CMS. Both levels are two-digit modifiers.
Wrong provider billing because of typographical error °Keep in mind that many providers in one facility have the same given and/or last name.
° Double check the entered name in the system if it matches with what was in the chart.
° Try to enter the last name of the provider to avoid getting the wrong one and NEVER neglect the pop up error when the provider is not on schedule. This can help you to check again the entered provider.
Insurance companies may scrutinize bills more closely, but they often don’t discover administrative errors or inconsistencies. Many, therefore, end up overpaying. The truth is that medical bills are often riddled with inaccuracies, many of which go unnoticed until after a provider has been reimbursed—if the mistakes are detected at all.
economic warriors have finally returned to their on-site job. Surver says that most employees still prefer to continue working in the comfort of their homes - sitting cozily in their jammies, drinking coffee, and enjoying music in the background. The work-from-home setup
remotely have affected the employer-employee and leader-team members relationship.
Coming back to the office is solely beneficial to employers, it has significant benefits for the employees as well. And on top of these benefits is “ getting back to your people”. This return has something to do with rebuilding connections, engagement, and a sense of belonging. While homeworking is also an advantage for the employees, there are some key business drivers that can be pulled off when people are working together in the same physical location. That is why many employers are offering this new work model, the “hybrid” setup.
The hybrid work model offers a good balance between the ups and downs
downsides of a traditional work setup is more exposure to illnesses that can lead to a lower employee show rate. A work-from-home setup consumes less time for the employee - the time they save on commuting can be used for personal errands, saving us from filing for
company. However, it has its own share of downsides and a big part of it is technical issues. And here’s why employers have to be stern and set objective-specific rules for the home-working people.
Going back to the office does not mean going back to normal where we can gather close to one another, share food, have a little chat, and not minding about wearing masks and distance. No country, state, or company can say that they’ve 100% recovered. But
ensure the safety of their employees. Many have to invest in medical equipment, accordance
protocols. But of course, safety isn’t the sole responsibility of the employers,
JAB well done! Vaccination Rate
Iloilo - 98% Manila - 95%
No bogus, declare your health status. Scan QR code by the door.
When physics says "leave it to me, you won't have to touch any.." Kudos to our foot pump alcohol dispenser. 20
Temp check three times a day keeps the doctor away.
When you spend your happy days doing things like work or play, is there something you should do before you're on your way?
Small talk over coffee is still good. Just keep your distance. Ditch that high five and do that "elbow bump".!
In life, change is inevitable. In business, change is vital.
CODING ZILLAS 24
I started out as a trainee under the Coding Team and with great effort and determination; I was regularized and welcomed as part of the Coding Department. It’s not that easy nor difficult, actually. As long as you are willing to learn and enjoy your work, everything will be aligned. Having to be named as one of the top performers feels so great. Having a positive mindset in every situation, such as meeting the required target quota and accuracy, are some of my
ways to be on the top.
a tenured and I believe that optimism creates positive results. Being experienced coder, finding a solution readily is one of my advantages. Being a top performer doesn’t mean being a 100% accuracy rate. Mistakes are inevitable. We should take those errors as your motivation for improving and lifting your performance. When confused, ask your TL, that is one of their roles, to guide and sharpen their team members. Coding is a learning process. Changes are constant, but as long as you love your work, it will just be a habit.
Being an accomplished coder inspires me to perform great. What pushes me to do more? Having to grow professionally wherein hard work and determination come in. Having the values set by the company’s mission and vision makes me feel delighted and motivated. It comes from the success of everyone involved and the company itself.
“I’m driven to even do better. The taste of triumph after a setback keeps my fire burning no matter what”
The past 8 years of my life have been well-spent because of Worldsource. For me, God blessed me through this company even during pandemic. Being a mother of two in a work-from-home arrangement has been a big challenge and the uncertainties of this unprecedented event has brought me stress during the early days.
Aiza Magundayao But with the continued support of my family, colleagues and leaders, I was able to cope up easily and embraced the new normal set-up. Accepting an excellence award is a bonus and I am every grateful for it. I know I am capable of everything with the right attitude and mindset at work.Always give all the best for the clients, our team and Worldsource.
" Whatever you do, work at it with all your heart. "
I have had the pleasure of working at WordSource Inc. for almost 9 years now. As part of the QA Team, I am given the ability to provide good quality results to the client by imparting my knowledge and expertise with chart audits, and internal and external reviews. Considering the importance of long-term goals and making sure that daily effort put at work can contribute towards achieving your goal.
Harold Anniversario Being determined and applying extra effort through exceeding the required target productivity, and keeping high quality are the keys and ways to help my team and my department in achieving our goal. In my line of work, errors and mistakes can lead to ineffectiveness and, as a human being, I believe this is just normal. However, it is important to consider these as an instrument to learn more and be determined towards reaching your goals. Make every day an opportunity to learn and enhance your coding/audit skills. Here are some of my tips to consider. I highly recommended constant communication with your leads when confusion about coding updates strike and being keen on details to provide quality results.
“Failures and goofs motivate me to do more and be on the top.”
I am pleased to work with WS and happy about the work culture. I usually be very cautious while coding the charts and concentrating more on the guidelines part as it differs for each facility. I feel happy and enjoy coding which makes me maintain consistency all through the months. Team comfortability makes me perform better and the quick responses from our SME/TL make me perform well and better day by day.
Keerthana Ravi I used to maintain my hourly tracker accordingly so that my entire day's production gets completed timely and I get time to spend with my family as well. Overall I feel blessed working with Worldsource and Team.
“Choose a job you love, and you will never have to work a day in your life,"
I am happy about the working atmosphere and the great culture followed in Worldsource. I always think to perform well and I wish to be a Top performer always as it is one of my aims and ambitions. I will not get disturbed while coding whereas I do focus only on my work which makes me score high among others.
Overall I am happy and excited to be part of Worldsource and Team.
If you can, you can - but if you can't, then you can't."
Learn to love and enjoy the work you have, the people around you, and the things God has blessed you. The past two years have been undeniably challenging, everybody on the team had their own share of pain; but through the darkness and uncertainties, there is only one thing you can do as a leader be the beacon and share your light.
Katherine Sabillo To my Team, there will be more obstacles ahead, some may lead to difficult decisions. Things may be permanently changed. Our outcomes are uncertain but one thing is sure: our best opportunity to realize a positive result will depend on the actions we take now.
We influence the effort of everyone in our organization, and their actions will have an enormous impact on the outcome. We, the leaders, are made for this. Our team will look up to us for direction, strength, and confidence. Things can be bad at times, but keep your focus on facts and actions, keep the respect and work together as one.
" Change is not a loss, it's a chance to learn new things and to grow."
Team in the Coding Department is a proof to all the hard work that was shaped and guarded
teamwork, diversity, integrity, growth and excellence.
I am grateful and proud of all your achievements and may this
experiences not limited for our customers but also for our very own WS community.
VS / PAM Coding Team
A trip to
PPSI Ribbon Cutting - 2012
1st Chr istmas 2012 Party
ik i R h wit y r a s r nnive 13 A I S 20 1st PP
2nd Year Anniversary w/ Pettigrew Family
2nd Year Petti Anniver grew sary Fami w/ ly
Vintage Christmas Party - 2014 as m t s i r h C a l l e h c a o C 016 2 y t r Pa
Work anniversaries are very important milestones for every employee. These are the moments wherein the employee takes a trip down memory lane to recall what they have achieved and look back on all the things they have experienced within their stay in the organization. It is truly amazing how fast ten years have gone by, but it has been that long since they joined us–when it all began.
Vintage Christmas Party - 2014 Coachella C hr Party - 20istmas 16
Mae Silao, Senior Quality Assurance Expert
And now, it's 2022
10 years ago, April 23, 2012 to be exact, I started out as a medical coder with no medical background. The training process was not a simple journey, every day is a constant learning.
I learned to be patient in anything, especially in struggling to meet my targets, constant change with updates, but I eventually made it as a regular employee. I failed the CPC exam twice, which made me almost lose my self-esteem. I passed on my 3rd take and I was so happy and always believed that God's timing is always perfect, we just need a little patience and a lot of faith. Now that I am a Senior Quality Assurance Expert, I learned to deal with different people, encounter a lot of pressures and stress, but I just take a breath and smile. I always work with a heart because I understand the feelings and the struggles of starting from the beginning. In my 10th year, I want to thank WS for the opportunity to grow and enjoy the beauty of life with my family with all the blessings the Lord has given me thru WS! The journey is not always easy but just stay strong and Keep the Faith! God Bless us all!
Ma. Emily Alvarado, Team Leader
10 YEARS.. wow! Looking back to the day when we first started Medical Coding training, it was here - in a small training room on the 3rd floor of AMK building. I was part of Batch 8 - composed of 15 trainees.
At the start of the training, I was really curious about what medical coding is all about but as we progress, I've learned a lot from our then trainer Ms. Jackie Brucal (now our Coding Client Service Manager) who had a big impact in my coding career. She guided us throughout the training period until regularization. As time passed by, batch per batch of medical coders are added, we grew bigger and bigger and from a medical coder; they promoted me as a Team Leader. Handling a team is a challenge, but it was also fun. It allowed me to know different types of people and it also enhanced my leadership skills. I am really grateful for the opportunity given to me and with that, CHEERS to 10 and beyond!!!
Paula Jesica Santos, Assistant Manager– Coding Department
Almost a decade?! That is how long I have been with the WS family. Through the years, I changed and WS was a big part of it. I learned how to speak up and stand for myself.
WS gave me a lot of opportunity to grow as a person, professional, and to share what I learned to others. I have seen the growth of this company from being 2 batches in Iloilo and now different batches to different departments and from using 1 room to now occupying three floors of the entire building. Here's to more experiences and growth! Thank you, WS! Hard work, Loyalty, and Diligence are some the foundations of great employees. And we can definitely say that they have all of these characters. This year is their tenth work anniversary, and there isn't any better moment than today to congratulate and wish them the best for many years to come.
WS Manila @ 13
WS Manila @ 13
Congratulations to Emily!
I'm excited to share with you a big change that will benefit the entire PETTIGREW/WorldSource family. Effective immediately, Emily is being promoted to CEO. Emily has shown exceptional leadership skills and knowledge of all aspects of RCM. She relates to clients and employees well and knows what we need to do to move to the next level. Please join me in congratulating her in this new role!
Emily has my full support as I continue as President and will focus my time on high value projects and corporate finance.
The future is bright! Thank you Emily!
Dave Young, CPA President
HERO'S CODE TEAM Richelda Macaraig
Suzette Rivera Kathrina Jordan Paula Santos Creatives Katherine Sabillo Rommel Alipala Mary Rose Agudos Contributors Arwin Nobleza Lyle Pangantihon Tim Montero Angel Lagañosa