Education, Audits, and Feedback Are Key to Billing Success


The intricacies of billing and coding typically aren’t taught in physician residency training programs.

“Residents want to learn how to take care of patients. They’re not really focused on learning [Centers for Medicare & Medicaid Services] rules,” says Balazs Zsenits, MD, FACP, SFHM, medical director of the Rochester General Hospitalist Group in Rochester, N.Y. As a result, “there’s a knowledge gap” between newly minted physicians and experienced practitioners when it comes to documenting their work.

To bridge that gap, some hospitalist groups offer training on the business side of medicine during physician orientation, as well as provide constructive reviews of hospitalists’ progress notes on a periodic basis. Some hospitals provide seminars in proper documentation.

“I’ve seen a lot of hospitals do ‘lunch and learn’” sessions on documentation requirements, says Angie Comfort, RHIT, CCS, a director of HIM Solutions at the American Health Information Management Association. The goal is to facilitate reimbursement for the hospital from patients’ insurance providers.

“If more specific documentation is not in the record, the coder must ask the physician for additional clarification,” Comfort says. “Without the clarification, sometimes the conditions are not able to be coded.”

The HM group in Rochester, which employs 46 hospitalists, provides about six hours of billing compliance education for new hires during orientation and holds regular, topic-based presentations at weekly staff meetings.

Physicians “need timely information as we submit our own charges, and we set up our productivity bonus so that it depends on our billing accuracy, not just volume,” Dr. Zsenits says. Using an internal Web portal, physicians can look up billing codes and explanations. “They realize the risks involved if they don’t do it right,” she says, so they also accept feedback from reviews of their patient charts.

Easy-to-access information is key to helping hospitalists learn coding requirements. “We have a Web-based documentation education module, so the provider is able to log on from home,” says David Grace, MD, FHM, senior medical officer at The Schumacher Group’s hospital medicine division in Lafayette, La. The practice management company employs hospitalists in 12 states.

Its initial module takes about an hour to review. For those who are already proficient in billing and coding, a test-out option lasting 10 to 15 minutes is available online as well. Pocket cards are provided as a reference thereafter.

“Documentation and coding is a complex entity, and certainly we don’t expect them to remember all the details after one educational module,” Dr. Grace says. “They do have access to be able to go back to it for a refresher whenever they want.”

Internal coding experts audit about 20% of the hospitalists’ work, and audited physicians are provided feedback on compliance. The Schumacher Group also uses a proprietary template to help hospitalists capture the important data points in their patient progress notes.

“Physicians are under a lot of scrutiny by regulatory agencies,” says Peter Thompson, MD, chief of clinical operations at Apogee Physicians, a national hospitalist management company based in Phoenix.

At new hospitalist orientation, called Apogee University, providers spend several hours learning the rules for documentation. The group follows up with regular reviews of hospitalists’ notes through an audit system. A program director “breaks down the components that make it a compliant note or not,” Dr. Thompson says. Audits are performed monthly on every physician.

“It takes a commitment to knowing what the requirements are,” he adds. “And it takes repetition and it takes practice to make something a habit.”

Susan Kreimer is a freelance medical writer in New York.

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