We Will Coveraapcperfect.s3.amazonaws.com/a3c7c3fe-6fa1-4d67-8534-a3c9c83… · Communication...
Transcript of We Will Coveraapcperfect.s3.amazonaws.com/a3c7c3fe-6fa1-4d67-8534-a3c9c83… · Communication...
9/24/2012
1
Documentation Feedback Strategies -Communicating with your Doctor Communicating with your Doctor
Brenda Edwards, CPC, CPMA, CPC-I, CEMC
AAPCCA Board of Directors, Region 6
We Will Cover
Questions and worries
Self-assessment
Communication styles
Personality stylesPersonality styles
Coder-Physician Alliance
Situations
9/24/2012
2
“To effectively communicate we must realize that we are all different in the way we perceive the world and use this understanding as a guide to our communication with others.”~ Anthony Robbins
Dibertriglycerhemofibromyalgianosis
4
9/24/2012
3
Describes human body in science-based manner
Clear and precise way to communicate
Why do providers use medical terminology instead of plain English when speaking?
Clear and precise way to communicate
Universally accepted form of medical terminology
Understand disease and associated medical jargonDifferent names/same body part Common term, i.e. head, arm, etc. Slang term like "pinkie" Obscure "medical term”
It is so that there is NO mistake when doctors are conveying information about a patient to each other
Coder frustration Physician’s documentation “isn’t clear”
What the Heck…
Physician s documentation isn t clear
Physician documents an excisional biopsy of forearm
The physician was trained to refer to “excisional biopsy” or “shave excision”
CPT has a code for Excision Biopsy Shave BUT NOT ONE FOR ALL OF IT!!!
9/24/2012
4
Fears
What if I mispronounce a medical term?
What if she erupts and I sit there speechless?
What if he doesn‘t find me credible?
What if I am asked a question and don’t know the What if I am asked a question and don t know the answer?
What if I am unable to get my point across?
The easiest solution is COMMUNICATION
Don’t Panic! It’s OK!
Talk to your provider Look at CPT, CDR and any other resources together Explain “CPT descriptions are not the same as what you are telling
me” “Help me to understand what you did or what you
meant”meant
Use medical dictionaries and references
Use internet search for unfamiliar terms Credible sources
9/24/2012
5
Communication Cornerstones
Coder Self-AwarenessWh t I l b t ? What can I learn about me?
Style of CommunicationLearning and Personality Style
Understanding the Mind of a PhysicianTypical personalityThe making-of a physicianThe making of a physicianWhy a physician thinks as he/she does
The Coder-Physician Working Alliance Mantras for successCommunication that WORKS
Coder Self-AwarenessUnderstand your unconscious motivation and needsSt th d kStrengths and weaknesses
Increased awarenessNatural listening and response styleSee beyond communication obstaclesModify responses
9/24/2012
6
Your beliefs in causes of events in life Internal Internal “Luck” is when opportunity meets preparation I create my own luck—I work to generate opportunity and
prepare myself for it Keep the end goal in mind Less stressed out—control their choices/circumstances
External External “Fate” and forces outside my control have direct power over
what happens to me You can’t control luck At the mercy of outside events Little/no control of situations
0 1 2 3 4 5 6 7 8 9 10 11 12 13
Internal Locus of Control
“Luck” is when opportunity meets preparation. I create
External Locus of Control
“Fate” and forces outside of my control have direct power meets preparation. I create
my own luck because I work to generate opportunity and prepare myself for it.
y pover what happens to me. You can’t control luck.
9/24/2012
7
Locus of Control
Internal—more likely to
Tolerate vague situations
Learn from their mistakes
External—more likely to
Prefer “black and white”rules
Suffer from depression
Prefer skill games based Prefer chance games based
Locus of Control
Life is 1% what happens to you and 99% how you choose to feel about it
Frustrating situations Write down every option in your current situation You have choices, even if you don’t like them Evaluate and decide on best course of action
to meet your goal Practice expanding your mind to all open
possibilities Replace “I HAVE to”” or “I NEED to” with “I CHOOSE to”
9/24/2012
8
Style of Communication
Learning and Personality StylesAggressive AssertivePassive Passive-Aggressive
Assertive—Face to Face
Truthful
Handle problems
Relate thoughts, ideas and feelings in direct manner
Handle problems head on
Separate emotions from problem
Value personal rights f lf d
Doesn‘t have to be “right”
“I’m ok, you’re ok”
Actively engaged
Self-assuredof self and group
Value collective intelligence of group
9/24/2012
9
Aggressive—“You’re Wrong, I’m Right”
Relate thoughts, ideas, Emotionally engagedgand feelings in indirect manner
Has to be “right”
Uses antagonistic language (name
y g g
Antagonistic
Argumentative
Self-serving
Demands personal g g (calling, mockery)
Insincere
Self-important
Demands personal rights
Does not believe in collective intelligence
Passive—Sticky Note Communicator
Unworthy Does not relate thoughts, ideas and feelings
Unconfident
Avoids problems
Forfeits personal rights
Not part of the collective
g
Avoid dealing with direct confrontation
Doesn‘t feel they have right to opinion
Not strong enough to assert opinion p
intelligenceopinion
Intentionally disengaged from situation
9/24/2012
10
Passive-Aggressive
Calculating Relate thoughts, ideas, and
feelings in indirect manner to g
Self-serving
Demands personal rights—”show” them they’re wrong
Deals with problems in roundabout manner
feelings in indirect manner to be proven right
Often say nothing to protect their rights
Show resentment in non-verbal ways (pout, complain,
Conniving
Side lines collective intelligence
blame)
Rights are important in a roundabout way
Seems unengaged
Few people are One StyleDon’t Label a Personality as BAD or GOOD
Passive Aggressive
Quick decision has to Passive Issue is inconsequential Conflict will not change outcome Boss is not right but still the boss Differing core belief has no impact
on
Quick decision has to be made
Emergency is happening
Being right is crucial Evokes sense of
competition on team Passive-Aggressive
Decision needs to be delayed Makes sense to wait for tempers to
cool
9/24/2012
11
Understanding the Physician’s MindTypical personalityTypical personalityThe making-of a physicianWhy a physician thinks as he/she does
Analyzer—Let Me Examine That Working
9/24/2012
12
Communication
Use facts
Show source document on rules
Use rationales
Organized, detached and calm
Professionally impersonal
State facts concisely
Supporters—Why Does That Work?
9/24/2012
13
Communication
B i Be genuine
Be personable
Be pleasant
Create calm environment
Create familiarity
Focus on personal values
Listen with care/concern
Creators—What If It Worked Like This?
9/24/2012
14
Communication
Be engagede e gaged
Be excited
Be flexible
Embrace change
Focus on imaginative ideas
Talk about potential
Directors—Take it Apart to See How it Works
•Antagonistic •Controlling•Dynamic•In-charge•Overwhelming•Overwhelming•Persistent•Results-driven•Self-assured•Self-confident
9/24/2012
15
Communication
Focus on accomplishment
Focus on outcome
Forfeit control
Make no excusesMake no excuses
Set milestones and timelines
Take responsibility
Which Represents You?Analyzer Supporter Creator Director• State concise
facts• Use reference
materials from respected sources
• Show things in organized, formal way
• Use analogies• Explain benefits
associated with each issue
• Empathize on points of frustration
• Show correct ways to do things
• Point out where problems are and typical fix
• Ask for feedback
• Provide supporting documentation and suggest a direction
• Focus on positive
• Do not attempt to justify rulesformal way to justify rules
9/24/2012
16
Stereotypical Physician Personalities
Anesthesiologist Dominating
Internists Introverted
Extroverted Less sociable Skeptical Vigilant
Family Practice Agreeable
o e ed Organized Persistent Self-reliant
Gynecologists Goal-oriented Agreeable
Altruistic Imaginative Rule-conscious Trusting
Conscientious Persistent Scrupulous Sympathetic Trusting
Pediatricians Agreeable Easy going
Stereotypical Physician Personalities
General Surgeons Curious Decisive Dominant
Easy-going Extroverted Less conscientious Pleasant
Psychiatry Dominant Dominant
Opinionated Unemotional Need variety Social
Dominant Tolerant Egotistical Less sociable Abstract thinker Tender-hearted
9/24/2012
17
How a Physician ThinksPatient above all else, including CODING!
Why a Physician Thinks That Way
Coding doesn’t having an effect on patient outcome
Coding is low priority
No margin for error in caring for patientpatient
May not recognize coder’s work as a major priority
It is never about YOU (coder) unless you make it that way!
9/24/2012
18
Coder Physician AllianceI know my job
• I have facts on coding situations
I make coding rules easy
• My physician can focus on patient care
I am confident
• It is my choice to feel confident
I know my personality strengths and weaknesses
• I temper my delivery and response
I am a self‐starter
• I donʼt need praise
No one can make me upset
• Iʼm pleasant, calm and in control
I donʼt get my feelings hurt
• Coding is business and not personal
I ask for physician time wisely
• I understand my physician is often busy
Asking a question does not undermine my value
• Itʼs ok to say “I donʼt know”
I understand my physicianʼs personality
• I create positive conversations
Communication
7% happens in spoken words
38% happens through voice tone
55% happens through body language There is something about you I like:
Mimicking body stance of a person may subconsciously put them at ease Physician sitting with legs crossed, resting elbows on table
with head resting on palms sit across the table, legs crossed and elbows on table, arms flat or folded on table
Physician standing with hands on hips do the same
HAS TO APPEAR SINCERE
9/24/2012
19
Body LanguageYour Gesture Body Language
Arms crossed Defensive
Constant eye contact Aggressive
Fidgeting Bored/impatient
Hunched posture Lack confidence
Little eye contact Low interest/lack confidence
R bbi th L iRubbing nose or mouth Lying
Tapping Impatient or nervous
Touching face/hair Timid
Watching time Anxious to move on to something else
Verbal Attack
Words to soften the situationWords to soften the situation I understand that you are upset This is an upsetting situation for you, I’m sorry you feel this way I know this is distressing, would you prefer to have this
conversation later?
DO NOT allow yourself to be verbally abused End the conversation In some situations your best reaction is no reaction What you have to say is important to me, but I can’t hear
past your yelling. I feel afraid, may we continue this later when you are less angry?
9/24/2012
20
Diffuse Verbal Attack
Listen Don’t fight understand how they feel Don t fight, understand how they feel
Effective response: Tell me why you feel this way, I’m interested in your thought process.
Don’t need to hear you are “right” Reacting emotionally will not change situation or help you achieve
your goal Effective response: I agree with you that it is confusing. Sometimes
the verbiage is different from how the same term is used clinically the verbiage is different from how the same term is used clinically. Let’s review the guidelines to ensure you are coding accurately for the service you render.
Have thick skin Showing no response may diminish the attack Effective response: Unfortunately the rules on billing can be very
confusing, let’s look at them together.
Be kind
Diffuse Verbal Attack
I’m sorry Effective response:
I’m sorry this is confusing. I understand why you feel this way.
Agree You are right Effective response: I agree with you, the coding
rules are different from clinical rules.
9/24/2012
21
Give away control
Diffuse Verbal Attack
Give away control Put them in control of their actions Effective: Coding according to the guidelines is the best way
to keep from being targeted for an audit. Would you like to write a letter of appeal for this?
Divert negativityll th t l bl l h Allow them to place blame elsewhere
Effective response: The rules seem to have been made by somebody who has never practiced medicine. The good news is I can explain them so you’ll feel comfortable with your billing.
Initiating a Difficult ConversationAsk Is this a good time to talk?
Be Direct Short statement that gets to the pointBe Direct Short statement that gets to the point
Be quiet and listen Allow physician to respond completely, even if defensive
Sympathize Understand their perspective and make the effort to show it
Empathize Express you realize how hard it is it’s Empathize Express you realize how hard it is, it s hard for you too
Assess • Tell me more• Are you ready to expand on this?
Detailed conversation Explain rationale, reward, and risk
9/24/2012
22
Remember…
You don’t need to know the d fi iti f di l t definition of every medical term
BUT you do need to know where to find the information!
The end goal is flawless documentation that promotes proper
payment for all services rendered!
Be Empowered!