When Practices Merge, ProFee Coding Guidelines are Key

When Practices Merge, ProFee Coding Guidelines are Key

A significant trend in the healthcare space is acquisitions and mergers. Smaller practices are joining together into larger systems. This helps them take advantage of economies of scale and the greater ability to provide consumers with value-based care. In 2018, only 31% of physicians were independent practice owners, compared to 48.5% in 2012. With many healthcare firms pushing toward consolidation, integrated ProFee coding guidelines are key to team success.

profee coding guidelines

ProFee vs Facility Coding

With mergers and acquisitions, the differences between facility and ProFee coding becomes abundantly clear. As we’ve explained before, facility coding and professional coding have distinct uses, reflecting the different roles of providers and payers in care. Facility coding is useful for measuring the usage of resources in the overall health system, such as medical equipment and nursing staff. By contrast, ProFee or professional coding focuses on the care provided by a physician during a particular visit or procedure. Unfortunately, many companies underestimate the different roles each play, and think that in a merger they can easily be combined. However, due to the central differences between facility and ProFee coding, this often isn’t the case.

There are a few key differences to key in mind. One important difference is in work cultures. For ProFee coders, their pay is directly dependent on their work output and their accuracy in applying the relevant CPT codes. Because of this, it’s important that ProFee coders are as accurate as possible; ‘close enough’ is not good enough. In addition, ProFee coding is often a manual process, although this can vary. Lastly, professional coding often involves more specialization. This is due to the amount of codes and guidelines that coders need to memorize, as well as the need for ProFee coders to thoroughly understand their area in order to ensure maximum accuracy.

Ensuring Smooth Mergers

Keeping in mind these differences, there are a few tips you can keep in mind to smooth the merger process for your facility and ProFee teams. All of these involve thorough planning and guidelines.

First, it’s important to take into accounts risks when going into a health system merger. Due Diligence Audits and support/mentorship systems can identify potential weaknesses or inefficiencies, and work to correct them. Along the same lines, creating standardized coding policies and guidelines can ensure everyone is on the same page. This is especially important if your merger partner had very different policies than your own. This can ensure everyone follows the same standards.

In addition, there are some general tips for mergers than will be helpful to keep in mind. For instance, a formal integration strategy will be a big asset. This helps you understand your teams’ synergies. The strategy can also show how your coders can merge their goals in pursuit of a common vision. Additionally, you can use the transition period to align the workplace cultures and systems of your various coding teams, enabling them to function together as part of an integrated whole. For instance, the UC San Diego Health system developed techniques like single-path coding workflow, which uses automation and speech recognition to streamline the coding process for radiology. A merger is the ideal time to investigate these methods and see if they can work for your new system.

Profee coding mergers

Additional Resources from YES

With ProFee coding being a very specialized process, it’s important to have experts on your side to help you out. YES is proud to offer a wide variety of resources to assist in all your medical coding needs. Enroll in our specialized ProFee Coder Training. If you want to learn more about how you can develop and grow your ProFee coders’ accuracy, you can review this our article on the topic. Lastly, if you’re considering a merger and want to prepare your coding team, reach out to our ProFee Auditing team and we’ll be happy to help!

YES HIM Consulting

profee coding guidelines

Subscribe to our Newsletter


  • By clicking Submit, you agree to YES HIM Consulting's Privacy Policy and Terms of Use.