Does the Use of Standardized History and Physical Forms Improve Billable Income and Resident Physician Awareness of Billing Codes?

Sprtel, Scott J; Zlabek, Jonathan A

doi:10.1097/01.smj.0000149388.95575.72

Cited by 14 publications

(14 citation statements)

References 7 publications

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“…11 Furthermore, investigators reported that the use of lectures combined with specialized history and physical examination forms might improve billing accuracy, thereby increasing billable income. 12 However, none of these studies reported the reliability of these curricular interventions, nor did they estimate an actual savings.…”

Section: Discussionmentioning

confidence: 99%

A Reliable Billing Method for Internal Medicine Resident Clinics: Financial Implications for an Academic Medical Center

Kapa¹,

Beckman²,

Stephen³

et al. 2010

Journal of Graduate Medical Education

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Background The financial success of academic medical centers depends largely on appropriate billing for resident-patient encounters. Objectives of this study were to develop an instrument for billing in internal medicine resident clinics, to compare billing practices among junior versus senior residents, and to estimate financial losses from inappropriate resident billing. Methods For this analysis, we randomly selected 100 patient visit notes from a resident outpatient practice. Three coding specialists used an instrument structured on Medicare billing standards to determine appropriate codes, and interrater reliability was assessed. Billing codes were converted to US dollars based on the national Medicare reimbursement list. Inappropriate billing, based on comparisons with coding specialists, was then determined for residents across years of training. Results Interrater reliability of Current Procedural Terminology components was excellent, with κ ranging from 0.76 for examination to 0.94 for diagnosis. Of the encounters in the study, 55% were underbilled by an average of $45.26 per encounter, and 18% were overbilled by an average of $51.29 per encounter. The percentages of appropriately coded notes were 16.1% for postgraduate year (PGY) 1, 26.8% for PGY-2, and 39.3% for PGY-3 residents (P < .05). Underbilling was 74.2% for PGY-1, 48.8% for PGY-2, and 42.9% for PGY-3 residents (P < .01). There was significantly less overbilling among PGY-1 residents compared with PGY-2 and PGY-3 residents (9.7% versus 24.4% and 17.9%, respectively; P < .05). Conclusions Our study reports a reliable method for assessing billing in internal medicine resident clinics. It exposed large financial losses, which were attributable to junior residents more than senior residents. The findings highlight the need for educational interventions to improve resident coding and billing.

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Section: Discussionmentioning

confidence: 99%

A Reliable Billing Method for Internal Medicine Resident Clinics: Financial Implications for an Academic Medical Center

Kapa¹,

Beckman²,

Stephen³

et al. 2010

Journal of Graduate Medical Education

View full text Add to dashboard Cite

show abstract

“…Substantial improvements in accuracy may be achieved from single billing lectures, 15,19 but these projects were unable to raise the performance of residents to that of independent practitioners. 21 Successful implementation of clinical practice changes must offer advantages to individual providers, in addition to benefits for the larger practice group or health care system. This project and others like it 3 benefited from the use of repetition and experiential learning, techniques used successfully for many topics in clinical education.…”

Section: Figurementioning

confidence: 99%

Education in medical billing benefits both neurology trainees and academic departments

Waugh

2014

Neurology

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The objective of residency training is to produce physicians who can function independently within their chosen subspecialty and practice environment. Skills in the business of medicine, such as clinical billing, are widely applicable in academic and private practices but are not commonly addressed during formal medical education. Residency and fellowship training include limited exposure to medical billing, but our academic department's performance of these skills was inadequate: in 56% of trainee-generated outpatient notes, documentation was insufficient to sustain the chosen billing level. We developed a curriculum to improve the accuracy of documentation and coding and introduced practice changes to address our largest sources of error. In parallel, we developed tools that increased the speed and efficiency of documentation. Over 15 months, we progressively eliminated note devaluation, increased the mean level billed by trainees to nearly match that of attending physicians, and increased outpatient revenue by $34,313/trainee/year. Our experience suggests that inclusion of billing education topics into the formal medical curriculum benefits both academic medical centers and trainees.

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“…[5][6][7][8][9][10][11][12] Even program directors and educators have acknowledged the importance of practice management education, although many feel that this subject is difficult to teach. 11,13,14 A variety of teaching methods for practice management have been studied, ranging from lecture series to educational weekend retreats, with varying degrees of success. 8,[14][15][16][17][18][19][20][21] The purpose of this study was (a) to determine the current level of knowledge of surgical resident physicians on topics relating to billing and physician remuneration, (b) to compare the accuracy of residents' billing with the accuracy of the billing of staff physicians already in independent practice and (c) to explore resident and staff physician experiences and opinions regarding practice management education during residency training.…”

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confidence: 99%

How accurate are we? A comparison of resident and staff physician billing knowledge and exposure to billing education during residency training

Austin

Schroeder

2019

cjs

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Background: Practice management is an overlooked and undertaught subject in medical education. Many physicians feel that their exposure to billing education during residency training was inadequate. The purpose of this study was to compare resident and staff physicians in terms of their billing knowledge and exposure to billing education during residency training. Methods: Senior residents and staff physicians completed a scenario-based clinical billing assessment. Posttest surveys were completed to determine exposure to practice management and billing education during training. Results: A total of 16 resident physicians and 17 staff physicians completed the billing assessment. Overall, the billing accuracy of respondents was poor. Staff physicians had a greater percentage of correct billing codes (55.3% v. 37.5%, p < 0.001) and underbilled codes (6.2% v. 3.4%, p = 0.009), with fewer missed billing codes (38.5% v. 59.1%, p < 0.001), compared with resident physicians. The percentage value of correct billings was significantly higher for staff physicians (71.5% v. 56.8%, p = 0.01). In the posttest survey, 100.0% of residents and 79.0% of staff physicians desired more billing education during training. Conclusion: In general, staff physicians billed more accurately than resident physicians, but even experienced staff physicians missed a substantial amount of potential revenue because of billing errors and omissions. The majority of the residents and staff physicians who participated in our study felt that current billing education is both insufficient and ineffective. Incorporating practice management and billing education into residency training is critical to ensure that the next generation of medical trainees possess the financial competence to required to manage a successful medical practice. Contexte : La gestion médicale est un sujet souvent oublié et trop peu enseigné durant les études de médecine. Beaucoup de médecins ont l'impression que la formation sur la facturation offerte durant leur résidence était insuffisante. L'objectif de cette étude était de comparer les connaissances sur la facturation et l'exposition, durant la résidence, à la formation sur ce sujet des résidents et des médecins membres du personnel. Méthodes : Les résidents seniors et les médecins membres du personnel ont effectué une évaluation de facturation clinique à partir de mises en situation. Ils ont répondu à un sondage après le test pour déterminer leur exposition à la formation sur la gestion médicale et la facturation durant leurs études. Résultats : Au total, 16 médecins résidents et 17 médecins membres du personnel ont fait l'évaluation de facturation. Dans l'ensemble, l'exactitude de leur facturation était faible. Les médecins membres du personnel avaient un pourcentage plus élevé de codes de facturation corrects (55,3 % contre 37,5 %, p < 0,001) et de codes de facturation insuffisants (6,2 % contre 3,4 %, p = 0,009), et avaient moins de codes manquants (38,5 % contre 59,1 %, p < 0,001), comparativement aux médecins résidents. L...

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Does the Use of Standardized History and Physical Forms Improve Billable Income and Resident Physician Awareness of Billing Codes?

Abstract: The use of history and physical examination forms, combined with a brief lecture, significantly increased the percentage of highest billing codes, which increased billable income. Resident awareness of documentation requirements significantly improved.

Cited by 14 publications

References 7 publications

A Reliable Billing Method for Internal Medicine Resident Clinics: Financial Implications for an Academic Medical Center

A Reliable Billing Method for Internal Medicine Resident Clinics: Financial Implications for an Academic Medical Center

Education in medical billing benefits both neurology trainees and academic departments

How accurate are we? A comparison of resident and staff physician billing knowledge and exposure to billing education during residency training

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