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!