How coders can build a successful relationship with their physicians

by Sue Egan, CPC, CCD

All coders know that working with physicians is not always a positive experience.

It can be tough providing them education or getting responses from queries. Conversely, providers are busy and typically do not like anything to do with coding. When they hear coding they often take that to mean more work on their part.I have been working with providers for many years and the one thing coders always ask me is, ‘What is your secret for getting along so well with doctors and engaging them to change behavior?’

Building a relationship with your providers can make both of your lives easier. Outlined are a number of ideas that can facilitate building a strong relationship with your physicians.

• Documentation clarification inquiries for the hospital are likely to support physician billing. Communicate to the physicians that if the hospital is asking for documentation it will better support their billed services as well. Complete and accurate documentation will hold up to increased scrutiny by payers.
• Demonstrate why. When you ask a physician to change the way he or she documents in the medical record, show them why it matters. Show how accurate and complete documentation enables appropriate risk adjustments for the patients a physician treats. Remind physicians that good documentation can prove that the patients he or she treats really are sicker than others. This approach is more effective than stating the hospital will get a higher paid DRG.
• Knowing when to step away will help you keep a positive relationship with a provider.
  • Regardless of how important the material is you want to educate the provider on, if he or she has a patient that has just passed away, now is not the time to share?they won’t remember what you tell them. Let the provider know you recognize the situation and will reschedule.
  • If you know a physician is overwhelmed or is having a really bad day, then recognize that now may not be a good time and offer to reschedule.
• Be available. When approaching a physician for one-on-one education, be flexible in your availability. This could mean coming in early to meet with a doctor before his or her first case. If the physician can meet at lunch, do it. Recognizing the physician’s workload demands and being flexible will yield many benefits to the relationship.
• Be prepared. Physicians will ask you a question once, maybe twice, where you can say, ‘I don’t know,’ but chances are they won’t ask a third time. Be creative in your response. Instead, try saying, ‘You know, I just read something about that, let me go back and make sure I am giving you the most updated information,’ or ‘I just saw something on this, I am not sure if it was CMS or carrier directed. Let me find it and get back with you.’ Once you lose a physician’s trust, it is very difficult to regain it.
• Don’t waste their time. One of the biggest complaints I have heard from doctors is related to queries they deem as a waste of time. Make sure the query or question you are asking is
  • Addressed to the right physician/provider
  • Relevant to the patient care being provided
  • The information you are basing your query on is accurate
• Walk in their shoes for a day. Offer to round with them, where you can provide live audit and education to the provider. See how their days really are. In most cases, you will be amazed at how much they get done.
• Be a better listener. Some coding and documentation guidelines are not clinical in nature and providers can get frustrated by being asked to document things that aren’t clinically significant (e.g., family history for the 85-year-old patient). Sometimes your provider may just need to vent this frustration and while you may not have a resolution to offer, listening and understanding can go a long way in building rapport.
• Ask questions. Ask your provider how they translate a patient visit into medical record documentation. Questions that might solicit opportunities for improved documentation may include:
  • What questions are they asking when interviewing the patient?
  • What concerns do they have?
  • What is the patient experiencing? You can utilize this information to point out how the documented note can better demonstrate the patient’s current condition and treatment plan.
• Share the good as well as the bad. When a physician is doing a really great job documenting timely, accurately, and completely, give them a shout out. Or, when they answer queries timely, let them know. A quick note with a smiley face or even a gold star will be very much appreciated. Positive recognition given to one physician and not another often results in the physician inquiring how he or she can get recognition.
• Sports and (other interests). While engaging physicians in discussions such as sports is completely unrelated to coding and documentation, it can pay off significantly. Many providers are very loyal to their alma mater’s college football and basketball teams. Relationship building can be accelerated when you engage physicians in areas of personal interest. Gaining an understanding of a physician’s college coach, conference, and team standing, and discussing this information with a physician can go a long way to building a relationship. But sports isn’t the be-all, end-all. If you know a doctor has a particular interest (cooking, piano, horror movies, or painting) learning a little about that interest can go a long way. Expanding your knowledge is a good thing and building your relationship with that provider is a great thing.
• Empathy. It is important to remember that physicians are busy with competing priorities. Providers often get interrupted while they are dictating and/or documenting their notes, and when they leave something out of their notes, it is not intentional.

Recognizing that one of our major responsibilities as coders and documentation specialists is to make the physician’s job easier and their data as accurate as it can be is essential.

Avoid approaches that make them feel like they have done something wrong. Let providers know your job is ‘to make you look as good as you are.’

Editor’s note

Egan is an associate director with Navigant Consulting and has been working with providers, of all specialties, for more than 25 years. She works with providers to improve documentation as well as provide education and training related to CPT coding. Sue has lived in Charlotte, North Carolina, for the last 23 years, enjoys traveling with friends, and relaxing at home with a good book and her cats. Opinions expressed are that of the author and do not represent HCPro or ACDIS.

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