Admin Tips

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• Use The Abbreviation Log to validate any non-standard medical abbreviations used on medical record entries and other office documentation.
• Use The Authorized Signature Log to validate provider signature/initials and credentials. All providers of services (MD, DO, PA, ARNP) should complete it.
• Update The Authorized Signature Log when providers are added to the practice. Always store it at your office for future audits, reviews, and requests.
• Use The MCS User’s Guide for reference when entering and tracking authorization requests.
• Before submitting a new request for authorization, always make sure there is not an existing authorization for the same service. See The MCS User’s Guide for more information.
• Use one of the following criteria for finding an existing request for authorization on the MCS: request number, member name, or member ID number. See The MCS User’s Guide for more information.
• If you need to give a referral for a care manager to assist with patients with psych/social issues, call the triage line at 303.605.1530 and select Option 2.
• If you need to direct admit skilled nursing facility referrals, call 303.605.1530 and select Option 2.
• If you need a registered nurse to help provide disease education or info on a patient who has been in a hospital or skilled nursing facility, call 303.605.1530 and select Option 2.
• To access all Care Management services and resources, call 303.605.1530 and select Option 2.
• When a Secure Horizons member changes their primary care provider, be sure to use The PCP Change Fax Form.
• When admitting patients directly to a skilled nursing facility, be sure to follow the steps provided on this SNF Admit Guide.
• Use the SNF Admit Order Form when admitting patients to a skilled nursing facility.
• Made up of nurses, social workers, triage coordinators, and census coordinators, the Care Management Department at PHP offers a variety of services and resources to primary care practices.
• Did you know that there is a standardized process for informing each PHP practice of admits, current inpatients, discharges, and prior authorized inpatient procedures? Learn more about Care Management's services.
• PHP has designed a Personal Health Picture® to assist patients, families, and their healthcare team organize past and current health issues, including conditions, medications, advanced directives, immunizations, hospitalizations, and more. For access to the Personal Health Picture, call 303.605.1530 and select Option 2.
• There are specific criteria and procedures for transferring or disenrolling Secure Horizons members from your PMG or IPA. See the Patient Term Process document for details.
• At the beginning of the year, CMS clears out all ICD-9 codes for your patients. As a result, all conditions must be treated and submitted again each year as no ICD-9 codes will roll over from the previous year. See all Secure Horizons members at least one time per year and capture all pertinent diagnoses.
• Screen patients with the following risk factors for osteoporosis: female, advanced age, Caucasian or Asian, thin or small-framed body, positive family history, low calcium intake, early menopause (before age 45), sedentary lifestyle, nulliparity, smoking, excessive alcohol or caffeine intake, high protein intake, high phosphate intake, certain medications (when taken for a long time), or endocrine diseases (hyperthyroidism, Cushing’s disease, acromegaly, hypogonadism, hyperparathyroidism).
• When encouraging smoking cessation, use the five R’s of intervention (Relevance, Risk, Rewards, Roadblocks, Repetition) for those patients not ready to quit. If the patient does not currently use tobacco, the physician can prevent relapse (if the patient recently used tobacco) or encourage continued abstinence.
• If your patient has a minimum of five total symptoms of depression, your patient meets the requirement for the diagnosis of Major Depressive Disorder per DSM-IV.
• The rule for disease interaction is that anytime throughout the calendar year CMS sees any combination of these codes on any one patient, they automatically apply the additional RAF score for you; it is not something that your office will need to keep track of. If you have any coding-related questions, please contact Michelle Ramirez, CPC at 303.256.1567.
• When treating patients who have a diagnosis of osteoporosis, be sure to report this condition once per year.
• Metastatic cancer risk factors are far greater than primary site risk factors. Be sure you are coding appropriately. See Neoplasm Coding
• In order to correctly report a diagnosis of cancer, first determine whether the patient’s cancer has been eradicated or is currently being treated. For patients with no history of active cancer taking prophylactic cancer drugs, the reported diagnosis should reflect the reason for the prescription. Please contact Michelle Ramirez, CPC with questions at 303.256.1567.
• Please remember to fully document your patient’s status and submit the codes as appropriate. The V codes that currently do not risk adjust may do so in the future based on utilization of the codes.
• When documenting a stroke or late effects of prior stroke, use codes 430—434 for acute CVA, and identify the type—embolic, ischemic, and hemorrhagic.
• When documenting atrial fibrillation, if other conditions are present and documented, code for these conditions separately (e.g., hypertension, heart failure, and diabetes mellitus).
• The PHP coding team has several reports that your practice may find useful in determining missed coding opportunities. The team is available to come out and do an analysis and/or to provide these reports to your providers and staff, and offer helpful suggestions. Please contact Michelle Ramirez, CPC with questions at 303.256.1567.
• Key points to remember are: always code to the highest level of specificity, specific documentation allows for specific code selection, and truncated codes are no longer recognized by CMS.
• It is important that all documented diagnoses are submitted at the time of the patient visit to allow for more real time reimbursement.