With so much confusion and misinformation out there, finding the right answer to this question is not always easy. But the effort is worthwhile because taking learning to code correctly can save you time and money.
This discussion took place live on my Back to Busy Summit in early June to address how to keep building our private practices now in COVID-19. The full webinar is available on-demand now.
Many of us lack training on how to properly code. In academia, they have billing departments that take care of coding matters, so doctors can focus on patients, rounds, families and medical students. But when you enter the real world, no one is coding for you.
And if coding isn’t done properly you’re missing out on money.
Dr. Charlotte Akor is a pediatric ophthalmologist, coding expert and author who wrote books about what wishes she had known when starting out in the field. When Dr. Akor started her medical journey, she says, “No one shared the best codes to choose and which ones pay you most. They gave statistics, but no one gave the information on how to increase the statistics or even understand them.”
Patients are not coming into the office as frequently these days so the fee for services has taken a huge drop. It’s important not to leave money in the hands of insurance companies, but rather claim it for ourselves when we deserve it.
Physicians often feel burnt out because of patient volumes and hear that if they are not seeing enough patients or bringing in enough revenue, it’s time to bring on more patients to make up for it. In reality, a lot of times if you just coded more appropriately, you could probably see the same or even fewer patients while making more revenue.
The most confusion that leaves the most money on the table is the 99214. Whether you are a specialist or primary care, it’s imperative to clarify exactly what a 99214 means. First, Dr. Akor recommends having the table of risk printed out from the CMS 1997 guidelines. Dr. Akor says, “Make sure you understand your table and risk because when the new 2021 billing guidelines come in, that’s the only way you will be choosing your code correctly if you understand the medical decision-making complexity.”
Dr. Akor takes a deep dive into how doctors can better use the table of risk in medical coding in the Back to Busy Summit. Register to hear this and dozens of other strategies for private practices now.
1. Don’t sell yourself short
No matter how simple or complicated the patient’s reason for coming in, as a physician you are being paid to use your brain and experience to treat the patient. If you go to the mechanic, you want a mechanic that gets it right whether it takes five minutes or three days. As a physician, you are selling yourself short if you think just because a procedure or treatment is easy, you don’t deserve as much payment. The table of risk answers the questions for you with facts rather than emotions. As Dr. Akor puts it, “Insurance companies are banking on the fact that you are undervaluing your work.”
2. Work smarter, not harder
A key to coding correctly is to create good shortcuts and have templates in place. Physicians often just put enough in notes to get to that 99214 to see the next patient. Then, you’ll have to keep seeing more patients to make up for the difference when instead, you could create shortcuts and templates into your notes that allow you to move more efficiently and bill the proper code.
3. Avoid insurance fraud
Everyone knows that over-coding is a fraud, but under-coding can be fraud, too. Giving family and friends the 99212 discount is fraud, it’s just insurance companies are happy with that sort of bill because it saves them money by not giving you the money you earned.
4. An audit can be a good thing
You may think that getting an audit sounds like a nightmare, but having an audit can ensure that you are coding correctly. Dr. Akor says, “You can audit for documentation and also for the disease process. Making sure when you are billing you are coding based on the medical decision-making complexity and documentation match.” Auditing yourself or hiring someone to help you make sure you are getting all your money is beneficial.
5. Study the table of risk
Study the table, learn these complexities now so you will be prepared when the 2021 policies change. By taking the time to learn the table of risk, you won’t be leaving money on the table and it will make life easier for you and enable you to see more patients.
There is a lot of confusion for proceduralists and those who do surgery when it comes to the modifier 59. Physicians who don’t know how to code appropriately lose money when they see a patient and do the procedure that same day.
Dr. Akor says insurance companies have different rules, so make sure to check with each company about their policies. For companies that require you to use a modifier to let them know you completed the exam and procedure at one time, you will only get paid for one if you don’t use the modifier. “It never hurts to check and make sure that your billing staff knows all updates because policies change.”
Understanding the proper coding procedures is complex, but getting paid for what you earned makes it worthwhile. Take the time to learn how to code properly, ask questions and refer to experts like Dr. Akor. “You have to be the captain of your ship because the only person who cares about your money is you.”