Billing and Coding Rounds: Turning Daily Encounters Into Dollars and Sense

Area of Science:

• Healthcare Management
• Medical Billing and Coding
• Physician Education

Background:

• Inaccurate medical coding leads to significant revenue loss for hospitals.
• Physicians may underutilize updated evaluation and management guidelines due to limited training.
• This impacts financial performance and revenue integrity.

Purpose of the Study:

• To assess the impact of a concise, workflow-embedded curriculum on hospitalist documentation and billing accuracy.
• To improve reimbursement without increasing physician workload.
• To address revenue-integrity gaps caused by coding inefficiencies.

Main Methods:

• A 5-part, 6-month virtual curriculum was developed, featuring didactics, interactive cases, EHR smart phrases, and targeted feedback.
• Training focused on improving documentation, billing accuracy, and reimbursement.
• Pre- and post-curriculum surveys and billing data analyzed changes in confidence and performance.

Main Results:

• Physician confidence in billing and documentation significantly increased post-curriculum.
• Objective measures showed improved documentation (e.g., time statements), increased critical care billing, and more frequent use of higher-level E/M codes.
• Generated over $150,000 in additional revenue and a 77% increase in work relative value units.

Conclusions:

• Targeted, workflow-embedded billing education effectively improves documentation quality and reimbursement.
• This approach can successfully close revenue-integrity gaps in hospital settings.
• The curriculum demonstrates a feasible method for enhancing physician billing practices and financial outcomes.