Two Quick Tips for Better Coding and Billing, and Happier Physicians

We hear stories about physician burnout from documentation fatigue, high patient volumes and more. I’m here to share that the physician burnout stories are true.

I know this because I personally know an exhausted physician’s assistant. She spends between eight to 10 hours in the clinic treating around 50 patients, then brings home about 3-4 hours of paperwork. She takes her computer home to fill in gaps of documentation from each patient visit to be sure she’s properly paid for the work she performed.

My sister-in-law isn’t the exception, she’s the rule. This is how PAs and physicians live and work. But when so much time is spent by doctors on patient care and documentation, they’re likely missing out on money owed to them.

According to a recent MedCityNews article, medical billing has become so complicated that physicians are forgoing millions of dollars of earned payments. With some 70,000 ICD-10 codes used to identify patient illnesses and injuries, and another 7,000 or so CPT codes to cover medical services and procedures just for outpatient services, along with other requirements to process a bill, it’s increasingly difficult to ensure a bill is accepted and reimbursed in a timely manner. Those delays cost both doctors and their patients, in terms of dollars and health.

Here are two tips for better coding, billing and ultimately, happier physicians:

Employ a documentation expert

Someone at the First Coast Billing Group team used to be a medical scribe in the emergency room and for a spine surgeon. The spine surgeon did his documentation based strictly on information his patients provided. But since billing is so specific, he had a lot of denials. His documentation lacked specificity and it wasn’t in sequence, all things that insurers look for. Practices should seek out someone who is familiar with proper documentation to ensure proper codes and decrease denials. A documentation expert can also QA auto codes to watch for down coding and upcoding. Automation is a beautiful thing but human intervention with a keen eye for proper documentation understands codes for what’s most appropriate versus highest reimbursement.

Know your insurers and their payment policies

Along the same thread of down coding and upcoding, practices and billing groups should watch for insurance companies that are underpaying for procedures. For instance, we conducted a review of credit balances from a client billing out procedure 70450. Insurance company came back and said procedure should’ve been coded as 70496. Yet the insurer didn’t request the chart to further investigate or provide support for their decision. One of these procedures is more expensive than the other which over time can significantly impact bottom line if the less expensive is chosen.

It takes someone who is well versed in insurance appeals to manage situations like this. Investigation needs to be done in the right way and extreme patience is required during the process.

And this is different from the work a collections agency does in that it involves writing, investigation, calling and more. But knowing your insurance policies and watching for underpayment can make a huge impact on your reimbursement rates.