421- Clinical efficiency
- Information back to referring providers
- Performance and reputation compared to peers
- Salary
- Free time
- Environment (yup as in save the dolphins)
Integrating E & M Coding into Surgical Training
Multiple studies across various subspecialties have reported resident uncertainty
in clinical billing [ 1 – 2 ]. Furthermore, educational programs for system-based
practice are not routine among US training programs [ 3 – 4 ]. One study showed
82% of residents felt inadequately trained and 85% labeled themselves “novices”
at coding clinical encounters [ 5 ]. When queried, 70% of general surgery program
directors believed their own residents were inadequately trained in business prin-
ciples [ 6 ]. This is true despite the fact that 87% of program directors agreed that
residents should be trained in practice management. The good news is that instil-
lation of programs to teach coding and billing has shown great success in improv-
ing billing where average E & M codes increased by about one tier in both
established new patient visits [ 7 ]. The key is active educator involvement and
someone to take the initiative to get quality programs implemented. The occa-
sional guest or outside lecturer on E & M coding seems wholly inadequate as the
concepts are abstract and quickly forgotten unless reinforced in the clinic itself. A
strong surgical educator will review and correct resident documentation and make
a point to review this skill set in a semiannual review. Surgical mentors should get
into the habit of asking what and why residents would bill encounters as a stan-
dard part of every clinic presentation.
Ethical Billing (Bake Me a Cake with a File in It Please)
I have less than zero interest in undergoing a government audit, having a patient
complaint about excess charges, or going to prison. Fraud is “a deliberate act
intended to obtain improper payment.” Abuse is “a repeated act that may not be
deliberate but results in improper payments.” Innocent errors will not result in crim-
inal or civil penalties. However, penalties will be imposed if the offense is commit-
ted with actual knowledge of the falsity of the claim, reckless disregard, or deliberate
ignorance of the falsity of the claim. Physicians and their staff have a duty to make
sure that claims are filed accurately.
Medicare estimates that primary care providers routinely under-bill by 45%.
Considering that E & M coding is the sole revenue source for these providers, this
is astonishing to me. Medicare also states that both overbilling and under-billing
constitute fraud.
23 Evaluation and Management Documentation, Billing, and Coding