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Coding, documentation and dollars
1Loyola University Medical Practice Plan, Maywood, IL.
Insights
Physicians often face reimbursement issues due to poor documentation. Health Information Management (HIM) professionals can help physicians improve documentation to secure rightful reimbursement.
Area of Science:
- Health Information Management
- Medical Practice Administration
Background:
- Physicians frequently encounter under-reimbursement or demands for refunds due to inadequate service documentation.
- This documentation gap significantly impacts the financial health of medical practices.
Purpose of the Study:
- To highlight the critical role of Health Information Management (HIM) professionals in assisting physicians with accurate medical documentation.
- To foster a collaborative relationship between physicians and HIM professionals for improved reimbursement outcomes.
Main Methods:
- Analysis of the current challenges in physician reimbursement related to clinical documentation.
- Identification of opportunities for HIM professionals to provide expertise and support.
Main Results:
- Physicians' documentation practices are a primary barrier to receiving appropriate reimbursement.
- HIM professionals possess the necessary skills to address these documentation deficiencies.
Conclusions:
- There is a significant opportunity for HIM professionals to act as allies to physicians, enhancing their ability to obtain and maintain deserved reimbursement.
- Proactive engagement by HIM professionals can mitigate financial losses for medical practices and improve revenue cycle management.
Abstract:
Physicians would like to get reimbursed for the services they perform. Unfortunately, many of them are not very good at documenting what they do. The result is that physicians are being reimbursed far less than what they should be or are being asked to refund reimbursement for services they cannot substantiate. The financial impact to the physician's practice can be enormous. For many years, physicians have viewed HIM professionals as adversaries. There now exists the opportunity for HIM professionals to become allies with physicians by helping them obtain and maintain the reimbursement they are entitled to. Physicians have the need, and HIM professionals have the knowledge and skill. It is up to our profession to show them what we can do.