That’s great, because every time a foot drags it leaves money behind: The slower the learning, the longer it takes to master a new system or protocol and perform efficiently, and the longer it takes to see a positive return on investment. For pricey purchases like an EMR, negative mindsets can cost big.
When you’ve got a change coming — a new process or service, a large purchase, a different work flow — start the attitude adjusting early, during the research that leads to the change. Get input. Encourage physicians and staff to voice everything that’s wrong with buying some piece of technology, renovating the reception area, or the like. Write it all down and take it seriously; this is more than just giving someone an opportunity to vent. While much of it will be “I-hate-change” bluster, you’ll likely find a gem or two of worthwhile advice as well. When it’s time to implement, you’ll have more staff on board — much more than if you wait to inform everyone that the roll-out date is this Thursday.
Such careful staging worked for Hawthorn. “I even have doctors who log on and look at their denial reports,” says Nivison, and jokes, “I take great pleasure in saying, ‘I told you so.’” Well, he’s earned that right, with all the money saved.
You’re not well informed
Does anything change more often than insurance regulations? And what’s going on legislatively? Were you ahead of the learning curve for getting an NPI number, or did you find out the day after Medicare’s long-publicized, March 1 deadline because all your fee-for-service claims to CMS bounced?
The sheer volume of need-to-know info is surely daunting. “It’s virtually impossible to submit claims and get them paid time after time,” says Woodcock. “You’re going to have situations every day where the rules change, or such-and-such insurance company pays differently in this state than that state. The algorithm is almost too difficult for a human being to grasp. Every time [a claim] is denied, that costs you money. If you don’t notice it, you lose the money.”
Luckily, there are also a myriad of ways to stay informed:
- E-Newsletters — Our own free, opt-in e-newsletters (PEARLS, Administrator’s Desk, Tech Doctor, and PEARLS on Coding) will help you stay on top of the shape-shifting world of medical management. There are many other worthwhile e-newsletters as well, including MGMA’s Washington Connexion, and many of the “Fierce” newsletters, to name just a few.
- RSS feeds — Many Web sites now offer direct feeds that will automatically push information you want directly to you.
- Alert services — Think of an alert as a cross between an e-newsletter and an RSS feed. It only comes when it’s got something to say. For example, The Verden Group offers an alert service to apprise you of important regulatory changes with insurance companies. The alerts can be tailored to the payers you contract with. Or check out Modern Healthcare’s alert service, which covers a broader swath of must-know healthcare news.
- Professional societies — Many medical societies these days have super Web sites that strive to keep their members informed. They also make it easier to get involved in advocacy campaigns.
CPT’s code 99213 is by far the most popular E&M code. Sometimes, it’s the right code to choose. But the higher-paying 99214 should be getting much more play. Many doctors don’t really understand the rules of coding, and, largely because of fears of being audited, they choose a lower, less flag-raising code. Since E&M codes are the mainstay of primary-care coding, this play-it-safe mentality costs their practices a fortune. Consider that if you collect the $21 difference between a 99213 and a 99214 just twice a day, every day, for a year, you’d bring in nearly $11,000 in additional revenue.
The key to solving this is to educate yourself so you can confidently code as highly as appropriate for every patient visit. And it does matter, financially speaking.
So the point is this: Provided you know what you’re doing, you have total control to code at higher levels — legally. And you should. It’s your money; why shouldn’t you collect it? But it’s on you to code correctly. Otherwise, payers will happily — and lawfully — keep what’s rightfully yours. They don’t care if you undercode, and indeed, why should they?
Three factors determine an E&M code: the amount of history taken; the level of detail of the exam; and the level of decision-making.
The chart on page 36 (though far from a complete rubric for properly determining a visit code) illustrates how to classify your patient exams.
Don’t let semantics and numerical positioning confuse you. A straightforward office visit, or 99213, falls in the middle of the five “established visit” codes. But it’s vital to remember a 99213 is not meant for visits that require a moderate — read, “middle” — level of medical decision-making; that’s 99214 territory. Unfortunately, this is a psychological track hurdle that many physicians fail to clear.
It’s also absolutely essential that you comprehend the difference between what you charge and what you get. A good way to illustrate this is to look at the results of Physicians Practice’s annual Fee Schedule Survey, which provides a baseline off of which you can bounce your own fee schedule. For example, in 2007, the reported average amount on Southeastern physician fee schedules for a 99213 was $94.12. For a 99214, it was $131.23.
Here’s the kicker: It’s what you are paid by the payers that fills the practice coffers, not what you write in your fee schedule. According to our survey, payers reimbursed on average just $44.14 for a 99213 in the Southeast region — less than half of what physicians there were hoping for.
So the most expeditious way to emerge from a 99213 rut is to fully understand what’s going on coding-wise; code appropriately — and as highly as possible — and get paid what you deserve.
Shirley Grace is an associate editor on staff at Physicians Practice. She can be reached at sgrace@physicianspractice.com.
This article originally appeared in the October 2008 issue of Physicians Practice.
