One of the great benefits of a combined EHR/PMS is the ability to run reports, to know what is going on in your practice. Yet few physicians take the time to use the data being collected in the process of medical record documentation and billing to check up on the health of their practice. In the process, they may be leaving money on the table or pinning a target on their backs.
What you code, the level of evaluation and management code you choose is going to determine your revenue. Yes, you are using the tools of your system to make sure you capture the documentation to support the level of code billed, but don’t stop there. See if you are under coding or over coding, leaving money behind, or making yourself a target of an audit.
Use the reporting tools of your EHR/PMS to report the volume of codes that you have billed for each level of service, such as 99211, 99212, 99213, 99214, 99215.
Now go to your specialty society and ask them for a report of the normative distribution of E&M codes by your specialty. And compare.
Many physicians have fallen into the trap of under coding, fearing audits. While a few are still treating billing codes in a cavalier manner.
Neither is appropriate.
If you see that your pattern of coding is different than the normative distribution, then did deeper. Have you become too fearful that you are cheating yourself of legitimate higher levels of coding, thus losing money you have properly earned? On the other hand, is your coding pattern higher than the norm, leaning towards levels 4 and 5? If so, your coding pattern may be making you a target for an insurance company’s audit.
Under-coding, then consider your coding and documentation, and be less restrained in your coding – just make sure your documentation is solid.
Over coding – don’t immediately down code yourself. Consider having your records reviewed by a certified procedural coder, to make sure that you are documenting properly, and that your diagnoses support the services, and the services warrant the level of care provided. If you are on solid ground with your documentation and diagnoses, then continue. You may still be inviting an audit, but if the reality is that you are providing and documenting a level of service commiserate with your billing, you can stand up to such scrutiny.
The lesson is to use the reporting capabilities of your systemg more about your overall practice.
You may be leaving money on the tabl to understand how you compare in your specialty, and then if you are different, don’t immediately change your pattern of coding and billing, but review reality and code and document appropriately.
And while you’re at it, get a report off your system of the diagnoses and the procedures that you are billing, and compare them as well to what your specialty society says is normative. Is there anything that sticks out for greater review? Again, there may be risks of audit in differentiation, and lost revenue opportunities to be considered.
With an EHR/PMS, you should be learning.
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