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Professional Medical Coders Increase Hospitalist Group Reimbursement


 

What is the hospitalist’s optimal role in professional services billing? According to Leonard Noronha, MD, who was until recently a hospitalist practicing at the University of New Mexico (UNM), “physicians often find E/M (evaluation and management) coding rules confusing and frustrating,” leading to delinquent or tardy bills. Yet some feel apprehensive about turning billing and coding decisions over to professional coders because the physician retains legal responsibility for the accuracy of coding.

In a poster presented at HM12 in San Diego, Dr. Noronha described a 2010 decision by the academic group at UNM to have coders assign service levels to physician visits, retrieving the data from typed progress notes in the medical center’s newly implemented electronic health record (EHR). There were concerns that this new approach might lead to decreased revenue, but in practice, it led to both increased charges and collections (18%) and faster bill submissions (to 14 days from 16 days). The UNM hospitalists are incentivized to submit daily patient lists and to respond promptly to documentation completion requests.

“Working in a community hospital setting for five years and then in an academic practice for four years exposed me to a variety of approaches,” Dr. Noronha says. “My opinion is that coders have degrees and professional certifications and, thus, are capable of taking on this responsibility.”

Physicians still need to review submissions within specified time frames, and the system is yet to incorporate regular audits to ensure the quality of the coding.

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