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

While hospitalists dedicate substantial time to documentation, incomplete or inaccurate coding causes large, preventable revenue losses. Recent updates to evaluation and management guidelines allow visit level to be determined by either the complexity of medical decision-making or total clinician time, including documentation. However, limited training means physicians may underutilize these updates, contributing to financial shortfalls.

A 5-part curriculum delivered in 15-minute virtual sessions over 6 months was designed to improve documentation, billing accuracy, and reimbursement without adding work for faculty. It combined brief didactics with interactive cases or "billing rounds," an electronic health record smart phrase, a concise reference "cheat sheet," and targeted feedback to the lowest performers. Pre- and postcurriculum surveys and billing data analysis measured changes in confidence and objective performance.

Fifty-six hospitalists participated (42.9% completed presurvey and 37.5% postsurvey). Respondents reported increased confidence in billing from pre- to postcurriculum. The proportion reporting very or completely confident increased: overall billing (25% to 57%), admission notes (38% to 81%), progress notes (33% to 76%), discharge summaries (46% to 95%), and billing critical care (29% to 52%). Objective documentation and coding improved substantially over 6 months: more discharge summaries included time statements, critical care encounters were billed more often, and higher-level evaluation and management codes were used more frequently, generating over ∃150,000 in additional revenue. Overall, work relative value units increased 77%.

This curriculum led to gains in documentation quality and reimbursement, demonstrating that tightly targeted, workflow-embedded billing education can close key revenue-integrity gaps.