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After all is said and done, if you bill appropriately based on your medical
decision- making, specifically risk within decision-making, you will never go wrong.
If you make a level 5 risk decision, bill level 5 – you simply need to ensure your his-
tory and physical exam meet level 5 criteria as well.
Billing Excuses: Ignorance Abounds and the Dog Ate My Billing Ticket?
Here is the list of the most common reasons I have heard people justify their poor
billing:
- “My attendings told me to bill all level 2s and 3s” – Seriously? I guess the people
at the print shop had a penchant for symmetrical ink use on the billing sheet, so
they decided to include level 4 and level 5 as bonus options? I hear this so often
I could vomit. It vexes me. I am very vexed. Not only are the “attendings” igno-
rant to billing rules they also pass on bad habits to learners. Arguably, physicians
are some of the brightest and most industrious humans we have, yet they can’t be
bothered to learn this stuff? My vexation is your gain (whispers of billing super-
hero doesn’t it). Read on. - “People who bill at high levels are just trying to game the system.” In the immor-
tal words of either Ice T or Gandhi – “Don’t hate the playa.” The billing system
(to my amazement) is actually quite logical and fair. If one bills based on risk
within medical decision-making, you are charging appropriately – not too much
or too little. In addition, you can be rest assured that any flaw, omission, or tardi-
ness your billing contains will happily be unpaid by payers. - “I don’t want to overcharge the patient” – I would argue that there are better
avenues to provide charity care. Additionally, a patient will often have the same
co-pay for clinic visits regardless of level billed. Finally, the true cost of health
care stems from the proverbial $32 box of tissues and the paradoxical effect of
improved primary care increasing prevalence of chronic nonfatal disease and
nursing home costs (shout out to my med economics prof). - If I charge level 3 instead of 4, my attending does not have to come into the room
to see the patient. I wish I could somehow produce a tritonic fog horn sound
singing “la-zy” for you right now. - I’m too lazy to learn how to document properly – refreshingly honest, but once
again nauseating. Improper documentation is bad care and leads to medical
errors. Once I understood the billing system, my notes became... wait for it....
Wait for it ... hold ... Hold... NOW ... SHORTER. I stopped babbling with
useless diatribe (in hopes of meeting billing criteria). Show of hands for who
reads the 22-point med list and 18-point problem list from a consultant?
Anyone? Bueller? Anyone? Here’s a concept; list only those things that are
necessary to the patient’s problem and your plan. That’s what the billing system
encourages and wants you to do (you’ll see this later on in the history section).
My notes are so short now; I have saved over a million trees and dolphins (see,
you can save the environment), and my notes are gloriously beautiful and
readable.
T.S. Köhler