Brace yourself as Shannon unravels not just the fascinating history of NAMAS, but also dives into a discussion about the significance of proficiency in E&M. You won't want to miss her insights about NAMAS Documentation and Compliance tips that serve as a resourceful tool in the medical coding industry.
Now, who said auditing had to be dull? Let's venture into an exciting conversation about the crossroads between auditing and the future - Artificial Intelligence. While AI is gradually shaping the auditing process, it's far from replacing the human touch. Shannon and I delve into the essence of staying updated as an auditor and embracing our strengths, and interestingly, the specializations that make us unique.
Hang in there, because the best is yet to come! Shannon unveils the projects NAMAS is currently working on. So gear up for an enlightening conversation with Shannon and Victoria who will navigate you through the evolving landscape of medical coding and auditing!
Brace yourself as Shannon unravels not just the fascinating history of NAMAS, but also dives into a discussion about the significance of proficiency in E&M. You won't want to miss her insights about NAMAS Documentation and Compliance tips that serve as a resourceful tool in the medical coding industry.
Now, who said auditing had to be dull? Let's venture into an exciting conversation about the crossroads between auditing and the future - Artificial Intelligence. While AI is gradually shaping the auditing process, it's far from replacing the human touch. Shannon and I delve into the essence of staying updated as an auditor and embracing our strengths, and interestingly, the specializations that make us unique.
Hang in there, because the best is yet to come! Shannon unveils the projects NAMAS is currently working on. So gear up for an enlightening conversation with Shannon and Victoria who will navigate you through the evolving landscape of medical coding and auditing!
It's time for the Contempo Coding Podcast Discussions knowledge and insight to help you succeed in the medical coding industry. And now here's your host, victoria.
Speaker 2:Hey everyone, welcome back to the channel. I am here with Shannon Daconda. Shannon is the founder and president of NamUs, which is the National Alliance of Medical Auditing Specialists, and she's the president of coding and billing services for doctors management, correct, yes, yeah. So Shannon actually developed the CPMA certification, the training and the study guide for that, and launched a wide variety of different educational products and web-based education solutions to help coders, to help auditors to manage their efficiency, and I think that's actually how I became familiar with NamUs was years ago when I saw the medical auditing credential come through the AAPC. When it first came out, I think I got an email or an alert of some kind and I'm like, oh, I would love to get a medical auditing credential. Like, what's the material out there? And it was still through NamUs at the time. So there's that transitional period. So I'm like, oh, okay, there's a whole other organization out there for medical auditors, awesome. So can you tell us about how NamUs was formed and the relationship between NamUs and doctors management?
Speaker 1:Yes, absolutely. And, by the way, thank you for having me here and thank you for your viewers for paying attention to me. So, yes, absolutely. So when I started at doctors management almost 20 years ago now, I was doing medical auditing for the company and I recognized, hey, there's a certification body and a training body for coders. Who's out here for auditors? And it was kind of scary because when I approached doctors management about this crazy idea, they're like, well, what if we train a bunch of auditors and then no one needs us for auditing services? And I was like, well, hopefully that's not going to happen, but hopefully, if we train them well enough, it's just going to matriculate throughout the industry. So that's kind of what happened. So we started off. The first ever CPMA boot camp I did was in Memphis, tennessee, and we had two people, but it was. It was starting small and then building, and the relationship between doctors management and NamUs is NamUs is a division of doctors management, so doctors management is a full service physician consulting firm.
Speaker 1:We've been in business since 1956. We do everything to help physician practices OSHA, clia, HIPAA, hr, accounting. We have a GPO. We go into physician practices and say, hey, where are you right now, where do you want to go? And we help physician practices get there, we don't just find a solution, we help them get there. And where we plug and play with that is, we do regulatory compliance. Okay, do you need coding? Do you need auditing? Do you need a compliance plan? Do you have an appeal from a commercial insurance or a payer that you need to appeal? So that's kind of how our in fits into it. And then, of course, with NamUs, we're training people to be able to fill those shoes as well.
Speaker 2:Oh, that's amazing. So you don't so much do. It sounds like full revenue cycle management. You're really more so on the compliance. End of things, Correct.
Speaker 1:So with revenue cycle. We audit revenue cycle which is a whole nether conversation, because rarely do we talk about auditing revenue cycle and we do consulting on revenue cycle.
Speaker 2:But do we do it? Do you manage the billing day to day now? No, I think it's a great organization. I love being part of NamUs. I think there's a lot of benefits to membership of NamUs all the different educational opportunities, even the little email that comes in the weekly tips. I got to write the weekly compliance tip for NamUs a few weeks ago. I was so excited about it. It's amazing.
Speaker 1:Well, what's interesting about the audit tip? Or we've actually changed the name to documentation and compliance tip, and the reason we changed the name is really that's what it is. It's not just auditing, it's about documentation. But what's interesting is I was just sharing this with someone else our tip used to be once a month and it used to only be a member benefit. Then it changed to biweekly, then it became weekly and I was the only one writing the tips and then it was like, okay, I can't keep up. So then we started adding in more and more people and now it's like this amazing, and we took it outside of just being a member benefit, because our passion is solid grounded education that is beyond surface. We want to take you deep.
Speaker 2:So if you're not familiar with the NamUs website, you can go on the NamUs website, sign up. You don't even have to be a paid member and you can get all the compliance tips. Yes, I love that. So your organization offers a lot of different services auditing, training, education. Can you talk about the importance of each of those services and how they kind of contribute to that overall success of a healthcare organization?
Speaker 1:Yes. So first of all, I think one of the things in our industry we really have to start focusing on is proficiency. I think a lot of times we have people who are designated as billers, coders, auditors, and we are the gatekeepers of compliance. I have said that for the last 20 years, but a lot of times we're not proficient in what we do and that's where we come in. So like, for example, the test we do with our E&M boot camp. We give our test. It is 10 encounters that you are auditing and we just want to know can you audit? So with our tests, we're not testing you on abbreviations or medical terminology. We're giving you 10 encounters and saying here, please audit these. And I think that's what's important in our industry is can you audit?
Speaker 1:The next step beyond that is where I'd like to go next, which is can you write a report, can you articulate your findings? Because that is the next step of an auditor. Is that provider, educator? And then hopefully, maybe you want to grow up and be a consultant. But all of that kind of comes back around into the services that we actually give as well. We do perform coding audits, audit reviews, we do provide consulting services, and in doing that, we have to have experts. If we're going to be the experts teaching experts, then we certainly have to have experts providing the service.
Speaker 2:Yeah, kind of inception. The experts teaching the experts.
Speaker 1:Yeah.
Speaker 2:So there's a lot of just amazing talented people that work at NamUs and I'm sure your team of auditors are amazing as well. The ones that I know, like Stephanie, allard and Sean, are just like phenomenal. But there's so many different interpretations of the medical coding guidelines things like what is a systemic illness? When does prescription drug management count? How do you assure that the team at NamUs, when they're doing these audits, that they're staying consistent, that they're staying up to date in that kind of reviewing documentation on the same level? That is an amazing question.
Speaker 1:So we do have a lot of team meetings. We have our own curriculum, of course, and our curriculum is taught by all of us, so making sure that we are always all instructing as well as performing audits. So, having someone who doesn't perform audits anymore and is operating independent of actually doing work, they become segmented and don't actually. They don't have that attachment to real world anymore. So I think it's very important that we all keep immersed. Also, people who just audit and aren't instructing, they don't stay connected. So we try to make sure that our team is connected in every way. This year, two of our team members we took additional layers and it was painful for them, but Scott and Stephanie wrote curriculum. They wrote our risk adjustment boot camp curriculum for us from the ground up and that was number one getting them outside of their comfort zone. But it was also taking their talents, taking their knowledge base and now taking it another level to outside people and saying, okay, let's take these experts and portray their knowledge another level down. So that's kind of how we keep the knowledge flowing internally is. So this year, when it's time to do curriculum updates, we'll do the curriculum updates. Then we'll push the curriculum out to our team. We'll have some meetings, things that are, and then if something comes up, we'll have.
Speaker 1:You talked about systemic illness. I presented at a pediatric EMR clinic excuse me conference and I had a pediatrician help me with that systemic illness and the way he helped me understand it was great. So I went back to our team and gave our team that same example in one of our team meetings. So all of that are things that we always try to do with each other is we are a team, we're synergy, we know people come to us and with our ask the expert as part of our membership benefits, people are always sending in those questions and asking us things. Those questions get bounced around on us. So I have to tell you it really sharpens your skills internally because there aren't many questions we haven't been asked. So it really helps us stay acute.
Speaker 2:Yeah, I think oftentimes, training is sometimes the best way to learn as well. Sometimes, if I'm learning a new concept, what I'll do is I'll read like a couple of paragraphs of text and I'll go okay, I'm gonna pretend that I'm explaining this back now to someone and that helps me retain the information.
Speaker 1:That's actually a great idea, because if you can then give out what you've learned, then you've definitely retained it.
Speaker 2:What do you think are some of the most important skills to have as an auditor and what would you recommend that someone who's interested in a career in auditing do to prepare for that? Like the starter up coder, they just got their CPC, or maybe they have a year or two experience and I wanna be an auditor. What should I do?
Speaker 1:So I think the first thing to do is understand what really is the difference between coding and auditing. What do you think is the difference between coding and auditing? See, this is where the tables get turned, and now I'm gonna interview Victoria.
Speaker 2:I don't like this part. Well, I think with auditing you have to be able to articulate your reasoning. I think that's a big part of it is being able to not just produce the code but the thought process behind it and the support of why it is that code. And I get into this argument sometimes with well, not argument. But I've had situations, I'll say, in the past where as a manager, I was maybe interviewing someone for an auditing position because I used to manage a team of auditors educators at Lancaster General Health, and people would say like, oh yeah, I've audited in the past and I'd go oh well, how did you formulate your correct action plans? Did you do the follow-up education? How did you do your reports? And then you find out that it was really more that they were going through edits in the system, which is important and quality work and a great stepping stone, but not the same as doing a formal audit process, absolutely.
Speaker 1:Now, before I answer your question, I'm gonna ask you another question Coding validation. Do you consider that auditing? And before you answer that, let's lay the groundwork. Coding validation is my doctor assigned an E&M code and I am going to validate if that code is correct before the claim goes out. Is that auditing or is that coding?
Speaker 2:I think that's. I would refer to that as quality assurance. It's a stepping block to auditing, but not quite what I would title a formal auditor, Do you?
Speaker 1:see why I led you down this rabbit hole. No, why? Because you said if I am a coder and I'm wanting to go into auditing, what are some steps? Okay, validation is a great step Because a lot of times, when you're internal and you're put in that validation role, what they really want is you to start giving those physicians, those providers, some feedback to prevent those codes from having to be changed. So a lot of times that's a good step.
Speaker 1:The real difference I agree with you the difference between coding and auditing as analysis. Really, auditing could be viewed as cheating because we have the codes right. A coder has to look at that note and figure out the codes. An auditor gets the codes. We just have to make sure the codes were right. But sometimes that's harder because we have medical necessity which there are no rules for. There's so many great areas. And then sometimes we have the go back and forth with the provider or the physician on why it's right or why it's wrong.
Speaker 1:If you're looking to make that next step, the first thing I have is a lot of times people are like oh, I'm scared to take that next step in auditing. Well, first of all, stop being scared Because in reality there is no difference between coding and auditing except analysis. You can be an auditor without having to give a physician or a provider feedback. There are roles and positions where you don't have to be forward facing. So I think that's it is.
Speaker 1:Do your due diligence of understanding. Then do things like listen to free educational resources or get our audit to our documentation and compliance tips. Be a part of our membership where you're getting that weekly education. That's next level. What you have to do as an auditor is people. All of a sudden, you're this auditor and people start asking you, start questions. They start asking you questions about credentialing an incident too. So you have to expand your knowledge base because you are gonna get hit with questions that you're like I didn't know getting an A not a CPCA, but an A behind my name of an auditor. I'm going to get hit with all of these different kinds of questions, yeah.
Speaker 2:I used to go to yoga and my yoga instructor would always say honor where you're at. And I think that's a valuable tool when you're starting out as an auditor to stop yourself and not guess and not make an assumption of the answer. But if you're not 100% sure, just say you know what. I will get back to you on that. I have to look at some things first. So we all need to have that grace period when we're going in so you don't have to know everything starting out Exactly.
Speaker 1:And even once you get there. I had a call with a potential client the other day and she's like, well, the person we'd want to do this project, she's like we really like for you to come, but what we really want is somebody who knows interventional cardiology. And I'm like that's not me. I am very humble in saying it is not me. So it's like you said be comfortable where you're at also, even once you get. Wherever you are in your career. I know I know E&M, I know I know ophthalmology and other specialties. Know your specialties, know your strengths, but also be comfortable saying you know what. That's just not me.
Speaker 1:I had another group who asked me if I would do a full day coding session on ortho and I'm like sure I could do that. E&m 25 modifier compliance. We can build a great session. They're like no, no, no, no, no, no. We want you to do like head to toe coding, coding like muscular skeletal dive into like, and I'm like, yeah, no, not your girl, I don't. You know, there were days that I used to do those types of in depth coding, like getting into the toe bones and things like that. That's just not me anymore. So know where you want to focus your career. Everybody needs to be a guru in some area. Yeah, to specialize yes.
Speaker 2:Yeah, because you can't know everything. Yes, you can. You can have a good foundation, but there's there's no knowing everything in medical coding.
Speaker 1:Absolutely.
Speaker 2:So we're at the beginning of this AI revolution and I feel like we're starting to kind of see almost new versions of the same things. We've always seen the copy and paste, the mismatch information in the documentation you know cloning but now instead it's oh chat, you bt wrote the note and we just kind of pasted it in and didn't. It didn't look at it. So I think you know, with some of these new technologies that we're seeing, we're going to start seeing a bit of a shift as well in what we're doing is auditing. So how do you kind of see some of these new AI technologies shifting the audit process?
Speaker 1:I think it's going to be. Look, I think people are going to portray the AI can do a lot of the auditing role way before it will be able. Think about it this way how many EMRs right now, for the past 10 years, have said their EMR can code your physician service with their EMR wizards the wizard, yeah, the wizard, yeah. And how many times are those EMR wizards wrong? I talked to a physician just yesterday at our booth who said you know, we use a certain EMR, which will be kind and remain unnamed, and their EMR. They have gone into and created an algorithm, the EMR owner, and taken different diagnoses and deemed them chronic or acute, exacerbated or not. So if I say a patient has diabetes with hyperlipidemia, that is automatically going to make it chronic with exacerbation. So their algorithm does that. Really, who can say that diabetes with hyperlipidemia is always chronic and exacerbated? So my point is we've already had this type of AI in our industry. I think we have to embrace AI as coming in some form or fashion with chat, gpt and I love Grammarly. I don't know if any of you love Grammarly. I love Grammarly and you can tell it to rephrase or rewrite something and it's great. But nine times out of ten it's going to take it out of context or put it in a different phraseology. That's out of out of the tone of what I need. So it's not there yet.
Speaker 1:Yeah, what I think is a great way for our industry to walk into AI. I've said for years, if we could take a dictaphone and sit it in an exam room, most physicians would support every level of service they ever bill. Maybe AI has its place with scribing. Maybe there are different ways to adapt AI into our industry. But I think, as coders and auditors, where maybe we begin with AI is coding validation. Maybe if AI comes in and it does code a level or suggest a level, maybe then we are needing more auditors in our industry to then come behind those codes and say this is correct, this is not correct, and know when to override those codes. So that's what? If I had my wish for AI in the future and a proper adaptation of AI into our industry, I think that's what it would look like. I think there could be a place given the right way. But I don't. I definitely don't think it's flip a switch. Everything starts coming in through like a coding wizard. That's just automatic.
Speaker 2:I have to tell you so one of the issues I had at one of my organizations with the coding wizard is they had and I don't know if you've ever heard of this in any organization you've worked with the ITIS rule. They called it, where if any patient came in this was developed by our coding director any patient came in, out patient office visit, and it was in any kind of ITIS a RINITIS, a sinus ITIS, a conjunctivitis it was automatically a level three.
Speaker 2:Wow an ITIS rule. Itis rule, that's what they called it, the ITIS rule. So any ITIS but not cellulitis. But it was just the weirdest thing and no one would put it in writing. Itis rule with an exception. Yes, so it was. It was just always a sore point with the coding team. The ITIS rule, that's funny. So what's next with Namus? Is there any exciting projects that you're working on for the?
Speaker 1:future. There are a lot of exciting projects on the horizon. So one of them that we've kind of released a sneak peek with is Terry Fletcher is working with us to release an audiobook. Okay, so that's really something new in our industry and she definitely has the voice for it. Yes, she does. We will have a audiobook being released very soon on TellHelp. Obviously that's one of her areas of expertise, of course, so that's going to be something new we're offering. Hopefully, within the next 14 to 16 months, we'll have one or two more credentials released more to come on those and I think something new that we're doing at our conference this year that is really outside of the thought processes of a lot of auditors and compliance professionals is we're trying to put a new focus on revenue integrity.
Speaker 1:When we think of revenue integrity, I think a lot of times we think of that from revenue cycle management perspective. Yeah, I think it's time that is auditing and compliance professionals. We stop thinking of it as other people's work. The average physician lost nine to twelve thousand dollars just an E&M reimbursement this year. I mean, just let that sink in for just a minute. Nine to twelve thousand dollars per physician, just an E&M.
Speaker 1:So let me ask you this, victoria if our physicians are losing that kind of reimbursement, how can they continue to pay coders, auditors, compliance professionals, revenue cycle management? I mean everything that they pay just for the sake of compliance, right? So you know, the whole thought process here is if we can get auditors and compliance professionals to be more astute and understanding revenue integrity, and I think revenue integrity has a lot of different definitions to different people. So that's where we're going to start. What is revenue integrity to you? So I'm really excited Christine Hall and Jennifer McNamara are going to do a session for us on revenue integrity at conference and maybe we'll see a boot camp spinoff on that next year.
Speaker 2:That would be very cool. Yeah, I never really thought about it like I toss the word around all the time. But really, what is revenue integrity? Because I always just kind of tie it in with revenue cycle management. But is it really different?
Speaker 1:In my mind completely, when we audit. Right now we've gotten so where we're so focused on productivity and auditing and quality. But are we looking at claim forms anymore? Who's looking at denial rates? Who's looking to make sure that we're getting paid what we're supposed to be getting paid? Who's looking to make sure all of these different things within revenue?
Speaker 1:And you know I shudder to mention this because some people will think it's wrong, but if your provider did do a service that they didn't bill for, will you know that if you're not looking at the claim form when you audit, but if you're not looking at the claim form and you're an auditor, you're missing that revenue integrity opportunity for feedback. So those are some of the things that we kind of want to pull together to say as compliance, as auditing. When we stopped this piece of auditing in daily work profiles, we're no longer maintaining revenue integrity. That piece is just kind of fallen by the wayside. It's time for us to pick it back up. If we're losing $9,000 to $12,000 a year, somebody has to make sure that the revenue we're not losing, we're holding on tight to it and we're spending it well, and I think who better to do that than auditors and compliance professionals?
Speaker 2:Absolutely. This was amazing. Thank you so much, Shannon, for coming and speaking with me today. I'm so excited to hear more about the services that NamUs is developing.
Speaker 1:But I have a question for you what's next? What's next for me? What's?
Speaker 2:next for you? So what's next for me is trying to get some more projects under my belt. I feel like I'm slipping a little bit on that because I'm so busy making YouTube videos, I'm so busy making TikToks and finding those little projects in between. Trying to get for that because I feel like I'm losing some of my touch on my day-to-day auditing. So I'm trying to get that back in. I'm working on some resources as well for myself to develop. I don't want to say study guides, but something along Coder study tools. We'll say working on those as well. But I'm loving the studio, I'm loving getting to come out to conference again and meet with people. So that's what I'm working on.
Speaker 1:Well, great yeah. So see, I got to interview Victoria just a little bit, not too much to make her feel uncomfortable.
Speaker 2:Well, thank you so much. I really appreciate you coming on today for the channel and for my viewers, and I will link below where you can find all the information on NamUs and how to connect with Shannon as well. Thank you, victoria, thank you everyone.