5 ways to succeed as a new provider, guaranteed

Being a physician is an incredibly rewarding and fulfilling profession. I’ve been a physician for over 20 years and I still find joy in my work because I’ve learned to adapt to the changes we are experiencing in the medical field. And, I’ve use the tips I’m sharing with you to operate the best medical practice and provide the best health care possible.

Know the “99″ codes like the back of your hand.

The “99″ codes are the 99202 codes through 99205 codes, and 99212 codes through 99215 codes. As the medical industry transitions to EHR, one thing I’ve learned is that the computer is only as smart as the information you give it. This means you cannot rely on your EHR system to inform you of the correct code to use, because it is usually incorrect if you haven’t thoroughly completed your chart note.

For example, some EHR templates require that you click the information into the system, and can only read that information – if you use the templates properly. But, if you manually input the information, sometimes the EHR system cannot identify the information you are using and will not record a meaningful 99212 through 99215 code.

The bottom line is that you must get in the habit of properly documenting your patient encounter and providing the information that the EHR system requires to create a detailed chart note. In the end you are the one who is responsible for providing the code that properly reflects the visit.

Form solid working relationships

Having good working relationships with billers and coders can make your life much easier as a new provider. Having billers that you can directly connect with to ask pertinent questions will prevent you from wasting your practice’s resources. And, in this day and age of cost containment, if you do not treat your workplace as if you were the owner, you will be losing tons of money for the practice and at some point this transfers back to you in terms of your income and your reviews.

Make friends with a biller and coder that you can reach easily, so that you can address questions that come up in office visits or otherwise and prevent the loss of practice revenues as a result of improper coding. Ultimately, this provides an ongoing stream of revenue for both the practice and of course yourself.

Never stop learning

You may be a newly minted physician, but you are never finished learning. Education is one of the most important issues to keep abreast on. We are required to continually learn in the field of medicine, and you need to consider billing and coding as part of that education requirement. If you had a mandatory CME to get your license, you would accomplish this no questions asked. But providers tend to overlook the importance of a powerful billing and coding education because it is not a required course for our training. Ironically, if you don’t understand how to properly bill and code your activities in practice you are going to find it very, very difficult to make a suitable income as a physician. Act like a medical billing and coding education is mandatory, because then you will be ahead of the curve and your practice will flourish.

Know your role

Caring for patients is a personal and intimate profession, but if you’re going to succeed as a provider you need to be a provider of health care services first and foremost. Don’t make financial promises to patients. You will find that many patients will ask for a discount or free services. And because we providers sincerely care about our patients, we tend to give a financial break to every patient to expresses a need. My point? Stick to medicine! You have a billing team who can work out financial issues with patients. Always defer to the business office to work out any financial arrangements, even if you are the owner.

Go above and beyond

If you want to be successful in any profession, you have to go above and beyond the call of duty. Usually providers do this easily as it relates to providing patient care, but again we fall off the wagon when it comes to revenue generating opportunities.

One way you can set yourself apart from other new providers is by learning the additional codes that will make you more revenue for the work you are already doing. For example, smoking cessation counseling is an under used code that is an excellent revenue generator when discussed during an office visit. The problem is most physicians aren’t even aware that it exists. Besides, you probably already encourage your patients to stop smoking…why not get paid for it!

In my practice I’ve seen these additional codes increase office visit reimbursements by 20 to 30%. Take the time to stay on top of these additional codes and the documentation required and you’ll be amazed at what it will do for your bottom line.

Adam Alpers is a primary care physician and blogs at Medical Billing & Coding for Physicians.

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  • http://www.speedecoder.com Cassie Kiehl

    This a great article that shows the importance of physicians understand the medical coding that affects them the most while also asserting that billing is better left to the back office. This is the perfect approach since the doctor is best suited to know what he or she did with the patient, and the medical billing should be able to take this information and prepare proper bills. I would recommend, though, also learning the ICD-9 (and soon (ICD-10) systems so that a physician does not miss including enough diagnostic information. Many times diagnostic information is required to justify the medical necessity of the procedure, especially in automated billing systems like Medicare’s.

    • Anonymous

      I definately agree with the need for the providers to have an understanding of the basics of the system. They,the providers, are the driving force for the office visit.  Without at least a basic understanding of the ICD-9 /ICD-10, the chances are greater that information will be missed and an opportunity to bill for office work that was performed (including an appropriate higher office visit code) will be lost. 

  • Angela Caffaratti, MD

    I tried the smoking cessation codes for awhile, but patients resented the extra charge to them even when they brought it up to me and discussed treatment options. I treat it for free now.

    • Anonymous

      There is a CPT code for smoking cessation (CPT 99406) – 3-10 minutes.  Your patient spends $3- $7 on a pack of cigarettes and then proceeds to complain about the smoking cessation you discuss with them. If I spend the time with the patient, there is a legitimate billable code and the industry as a whole is encouraging us to privide this service, I bill the code. I just don’t buy into the complaining of the cost of this counselling when the patient even begins to complain about paying for this part of the visit. Sorry, you are entitled to get reimbursed for this counselling, just document it properly and move on from there. (My opinion)

  • http://utilimed.wordpress.com Don Peterson

    As a practice management and ancillary service provider to family practice I wholeheartedly concur with Dr. Alpers here. All too often providers are unaware of what improper coding or insufficient indications (ICD-9′s) can do to deny or discount what revenues you are entitled to receive.

    I would add another point to this list: when your patients ask if a procedure you recommend or order for them is covered by their insurance please don’t just hand them the typical pat answer: “sure.”. In today’s health insurance world many of your patients have deductibles that are sometimes well beyond their means to pay. And if you tell them it’s covered they assume that means insurance will pay for it. Of course the procedure is covered but if the patient has not yet met their deductible the whole amount, less the contracted discount, will be out-of-pocket to the patient. Patient accounts receivables has become a huge threat to the financial viability of private practice often growing to in excess of 30 percent of total revenues. Since most of you are on cash accounting you are not always on top of accrual accounts like A/R until they become problematic.

    Do yourself and your patient a favor: have your billers check eligibility BEFORE you perform a procedure that costs more than the average office visit. Most insurances have web-based eligibility checking that’s fast and easy. Let the patient know exactly what his/her out-of-pocket will be and get them to agree that they will either pay you upfront or after insurance claims have been submitted. Collecting from patients who were unaware that a big bill was coming their way is always difficult.

  • MWE

    Why are the comments invisible?

    • http://www.kevinmd.com kevinmd

      Comments are slow coming over to the new site. Should be updated by tomorrow.

  • MWE

    Why are the comments invisible?

    • http://www.kevinmd.com kevinmd

      Comments are slow coming over to the new site. Should be updated by tomorrow.

  • Anonymous

    Excellent Point, It can help build better relationships with your patients if a small amount of communication is handled up front, however, remember if you the provider are not sure about the process, you will have difficulty passing this information along to your patients in a way that enables them to plan effectively

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