Medical Coding Done Right: Improving the Bottom Line
Medical Coding Done Right: Improving the Bottom Line
Coding medical visits has become extremely complex over the years. However, there are some basic principles that can easily be applied to every patient visit to maximize reimbursement and allow clinicians to be compensated for the work that they have already done.
There are many factors that impact a code, including whether or not a problem is new, whether the problem is stable or unstable, what further assessment is being done to confirm the suspected diagnosis, and other factors, such as prescription management and social determinants of health. By documenting several of these elements, which most physicians have already considered in their decision-making, a visit that may have previously been coded as a 99213 can easily support a 99214 or even a 99215 code.
The difference in revenue for clinics when coding accurately—we like to say “coding for opportunity“—can be highly significant and can allow for improved compensation for clinicians and staff. It can also support clinics being able to purchase additional equipment and technology that can provide an additional revenue source to the clinic.
The relationship between clinicians and their coders is also critical. It is important for clinicians to be open to suggestion, and for coders to not simply downcode a visit because it is easier to do so than to approach the clinician to request that they alter their documentation to support a higher code. This kind of downcoding can result in a loss of hundreds of thousands of dollars per clinician per year. Let’s not do that.
Health e Practices has developed a program called Code Mastery that involves 4 one-hour-long didactic sessions presented to your clinicians via Zoom over the course of one year. These sessions are led by Jill Arena and me, an Internal Medicine specialist with over 32 years of experience, to help clinicians learn how to code for opportunity and avoid leaving money on the table for the insurance companies. This program has no upfront cost, and helps to improve clinicians’ confidence in their coding abilities, which also ultimately improves the bottom line and the esprit de corps.
Please check out the Code Mastery program here: https://healtheps.com/codemastery/ or contact Dave Beatty at Dave@healtheps.com for additional information. We would be happy to have a conversation with you to demonstrate how this program can truly benefit your clinic.
Anne M. Hirsch, MD, FACP
