There Is a Better Way to Make More Money Than Filing Iffy Top-Dollar Claims
It’s probably happened to you more times than you could count. You’re seeing a patient for “routine” reasons, only to discover you’re dealing with quite a complicated case.
Have you had enough physician coding training to code visits like those correctly?
Do you code the visit as it deserves, confident you can back up your judgment?
Or are you tempted to stick with a level 3 code because it’s the norm for (so-called) “routine” visits, and you don’t want to appear to be overcoding?
Doctors Who Bill Medicare For Top Dollar
You don’t have to take a medical coding course to know overcoding is a problem, especially in the Medicare system.
In recent years, independent investigative news site ProPublica has been shining a critical spotlight on providers who routinely bill for patients’ office visits at the highest level Medicare allows.
For example, the site reported one Alabama physician billed 4,765 office visits at level 5 in 2015—more than any other U.S. doctor—and received almost $450,000 in Medicare reimbursement.
And an OB-GYN in Michigan billed almost 201 Medicare beneficiaries’ visits at the highest level, the site states, and got paid “for an average of eight such visits per patient” in 2012.
ProPublica says its analysis of publicly available Medicare data revealed over 1,200 health professionals billing “only at the highest level” in both years, and another 1,800 doing so at least 90% of the time. In contrast, only 4% of office visits nationally were billed at the top rate in 2012.
But Dwayne Grant, an HHS regional inspector general, told ProPublica he doesn’t think it’s “very probable” that some providers treat only the sickest, most complex patients. And several physicians ProPublica points to have faced complaints or disciplinary charges.
According to HHS, providers are billing with high-level E/M codes more often and Medicare is paying more for E/M services, which are 50% “more likely to be paid for in error than other Part B services.” So it’s no wonder billing outliers like the doctors in ProPublica’s reports get scrutinized. Persistent patterns of top-dollar billing seem like logical places to look for fraud.
But do news stories like these make you too reluctant to code your patients’ visits as level 5, or even level 4, when those levels really do apply?
After all, you don’t want to end up the target of a medical coding audit—let alone an exposé on a major website like ProPublica.
MDCodePro Strengthens Documentation and Medical Coding for Doctors Like You
Deliberate undercoding isn’t the right choice. It’s just substituting one extreme for the other, plus it’s unethical and illegal.
The best way to avoid seeming like anything but the responsible, conscientious practitioner you are isn’t to hedge your coding but to hone it.
And better coding begins with better documentation. The more your notes and charts comply with the E/M coding guidelines, the more confident you will be that you can fully justify any CPT® code your patient’s complexity actually warrants—and the more legitimately earned revenue you’ll receive as a result.
The MDCodePro app will help you do it.
With MDCodePro, you get a manageable and memorable approach to the often bewildering E/M documentation rules so you can use them as helpful guides for quality patient care and practical tools for securing all the revenue you’ve earned.
The hundreds of doctors who’ve started using MDCodePro’s proven physician coding methodology have seen their annual income go up, on average, by $30,000.
Thanks to MDCodePro, they’re not afraid to bill Medicare and other payers top dollar when their patients’ complexity calls for it and their documentation supports it.
You don’t have to be, either. Fill out this form now to find out how our medical coding training for physicians can help keep you fully compliant and fully reimbursed.