What’s the most cost-effective way you can increase your income? Usually, it’s improving your coding, according to consultant Keith Borglum.
In a 2009 article in Medical Economics,* Mr. Borglum suggested an investment in eight to 10 hours of training could yield a 10 to 50 times annual return on investment. So if you spent $1,000 to $1,500 today on a classes for someone in your practice, you could see $10,000 to $75,000 in higher annual income, using Mr. Borglum’s math. TMA Practice Consulting recommends training two to three hours at a time. After that, the student suffers from information overload.
A 2005 article in Family Practice Management supports this notion. In the article, physicians and staff in a North Carolina family medicine residency program described how they enrolled an employee in a course to become a certified coding specialist. With her newfound knowledge, the specialist began prebilling audits of selected notes in faculty physicians’ medical charts. Her initial review of about 3.25 percent of all patient charts resulted in a net benefit (some notes needed upcoding, some downcoding) of more than 10 times the cost of the course. After that, her ongoing audits of about 150 charts per month yielded $500 per month of income. She also regularly reported to and met with physicians so they could learn from her findings
Various studies have estimated individual physicians can forego tens of thousands of dollars a year by undercoding. Many physicians undercode not only out of fear of penalties for overcoding or unbundling but also because they don’t fully understand how to bill for evaluation and management (E&M) services. For example, some physicians document E&M visits only on time spent, although the complexity of the visit could warrant a higher-level code than indicated by time. But when coding staff don’t know what actually occurred in the exam room, they code for the lower-level visit.
Physicians and coding staff also need to stay current with coding changes to avoid delayed and denied claims and to bill the appropriate amount with confidence. “Other income is lost under capitation by miscoding elective services or carve-outs, or lack of awareness of coding for supplies and drugs, resulting in those factors inappropriately being bundled into the cap rate,” Mr. Borglum said.
Visit www.aapc.com for information about coding certification, check with your local community college, or search online for reputable certification course.
Or, schedule a two-hour on-site Coding and Documentation Training session, where a TMA practice consultant will teach you how to audit your own records and avoid coding and documentation errors. Contact TMA Practice Consulting today to request a training proposal for your practice at (800) 523-8776 or practice.consulting[at]texmed[dot]org. Physicians who participate in the training can earn 2 AMA PRA Category 1 Credits™. Your practice also might benefit from an in-depth Coding and Documentation Review, or a check-up.
* “The Case for Coding,” published Oct. 9, 2009, is no longer available online.
Published Nov. 28, 2017
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