Using faculty development to solve a problem of evaluation and management coding: a case study

Compliance with billing and coding rules put forth by the Health Care Finance Administration (HCFA) is a challenge for practicing physicians, including those in academic settings. The authors, members of the academic practice at Wayne State University School of Medicine, Department of Family Medicine, designed and delivered a comprehensive curriculum as part of the practice's faculty development initiative surrounding the coding challenge. The authors defined outcomes expected on the way to achieving 100% compliance with HCFA's guidelines. Their curriculum covered topics of coding theory, chart auditing for coding, team building, effective meetings, and structured problem solving. The curriculum was delivered from January to May 1998. Chart audits of 251 charts (office notes) from before the intervention and 263 charts from after the intervention were performed to evaluate differences in coding accuracy. Errors were significantly reduced. The total error rate dropped from 50.2% to 31.1% (p < .05). Overcoding errors were reduced by one third (29.1% versus 19.7%), while undercoding errors were reduced by half (16.3% versus 8.4%). Other errors fell from 4.7% to 3%. The approach of defining and developing work teams and then using standard quality improvement tools may be an effective way to improve compliance with HCFA billing and coding rules. In addition, faculty development can be incorporated into the process of solving a problem that faces a faculty.