One struggling group practice turned its fortunes around by improving its billing procedures.
The cost of practicing medicine continues to outpace reimbursements. It looks like a no-win situation, with one of few options for specialists being to lower their hefty malpractice premiums by dropping high-risk procedures. The ob-gyn department at Albert Einstein Medical Center has chosen a different path - maximizing collections with better billing.
At one time, we were our own worst billing enemy. Doctors were sloppy about completing paper charge tickets, for example, or even submitting them at all. They often omitted modifiers from CPT codes and failed to carry out diagnostic codes to the fourth or fifth digit for greater specificity. Sometimes it wasn't clear which codes had been circled, frequently resulting in the wrong ones being submitted on the insurance claim. All this led to denials and underpayments. Doctors habitually undercoded, too, leaving rightfully earned dollars on the table.
We also committed the sin of failing to verify the health plan eligibility of every patient, which resulted in more denials. Unfortunately, doctors and staff alike were sometimes lackadaisical in fixing such mistakes. When we did bother to resubmit a corrected claim, we often missed the filing deadline.
When we reviewed the numbers for our deliveries, surgeries, ultrasounds, antenatal testing, and outpatient visits, one thing was clear about our revenue crisis: We couldn't ask doctors and staff to perform more services without sacrificing the department's already fragile morale. Therefore, we instituted a system that would allow us to bill correctly for what we were already doing.
A STAFF RETREAT HELPED LAUNCH THE TURNAROUND
To improve our business operations, we organized a day-long "billing retreat." The department, scattered over 12 clinical sites, was closed except for emergencies and labor-floor coverage. We made attendance mandatory for all faculty, residents, nurse practitioners, physician assistants, medical assistants, office managers, and billing personnel.
We repeatedly stressed that the financial health of the department depended on a team approach. Producing clean, comprehensive claims is everybody's job - from the receptionist who verifies insurance coverage to the doctor who selects CPT and diagnostic codes. We explained the difference between a 99213 and a 99214 office visit and coached providers on the use of modifiers like –25, which should be attached to an E and M code when you perform that service in conjunction with an unrelated procedure.
Instead of being a one-time event, billing education has become a routine part of our professional lives. Any doctor or midlevel who experiences a spike in denied claims receives counseling to improve his billing and coding practices. An office manager reviews claims submitted by all new providers, in fact, until their coding accuracy hits 95 percent.
Another key to tightening up our operation was implementing an electronic health record (EHR) system that gives doctors a computerized charge ticket. Doctors access the system in the exam room using wireless, hand-held computers. With just a few stylus taps on the screen, they select their diagnostic and CPT codes and capture their charges. There's no more uncertainty about what code they've chosen. The program lists the most frequently used codes for easy reference, but the entire catalog can also be searched. When doctors perform multiple services that require a modifier, they can choose a pop-up menu of the most common ones, accompanied by explanations of when they're needed.
DIMINISHED DENIALS AND INCREASE IN CHARGES
At first, doctors fretted that the new EHR system would slow them down and reduce their productivity. That's why it was so important to test the system at a beta site, which was my office. This trial run, which started in 2003, allowed us to identify and correct technological glitches, as well as create a "favorites" list of diagnostic and CPT codes along with descriptions to expedite the selection process.
My beta experience allayed fears that the new system would hurt productivity. I continued to see the same number of patients as before. However, I generated more charges because of more accurate coding.