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

Area of Science:

• Medical Education
• Health Economics
• Clinical Documentation

Background:

• Inaccurate medical coding leads to substantial revenue loss for hospitals.
• Physicians may underutilize updated evaluation and management guidelines due to limited training.
• This contributes to financial shortfalls in healthcare settings.

Purpose of the Study:

• To assess the impact of a novel curriculum on hospitalist documentation and billing accuracy.
• To improve reimbursement without increasing physician workload.
• To address revenue integrity gaps through targeted education.

Main Methods:

• A 5-part, 6-month virtual curriculum was developed, featuring didactics, interactive cases, EHR tools, and 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:

• Participant confidence in billing and documentation significantly increased post-curriculum.
• Objective measures showed improved documentation quality and coding accuracy.
• Generated over $150,000 in additional revenue and a 77% increase in work relative value units.

Conclusions:

• Workflow-embedded billing education effectively enhances documentation quality and reimbursement.
• Targeted training can successfully close revenue integrity gaps in clinical settings.
• This approach demonstrates a feasible method for improving financial performance in hospitals.