10 Things Hospitalists Need to Know about Billing and Coding Challenges

Dr. Shaheen Faruque March 14, 2020 CME modules, Coders, billers and insurance

In today’s environment of value-based purchasing, reimbursement penalties and ever shrinking healthcare dollars, reimbursement for hospitalist service is facing major challenges. In this blog, I will outline the billing and coding challenges hospitalists face everyday. I will also discuss the remedies to make a hospitalist’s note not only billable but adequately reimbursable as well.

1. Complete all ten(10) Society of Hospital Medicine’s billing and coding CME modules at your earliest convenience. Once completed, this blog will make more sense to you.
2. To make a note billable and reimbursed, hospitalists will have to prove beyond a reasonable doubt in plain English language documentation for the coders and insurance reviewers to understand very clearly what role the hospitalist played in the comanagement of the patient on that day.
3. Clarification :Being a Hospital Admitting or Attending does open you to malpractice risk but does not make your note automatically billable.
4. Hospitalists do a lot of things for the patient and families in terms of discussion, reviews, communication and collaboration but do not get enough credit for it as they do not think it is important to document these elements.
5.Coders, billers and insurance reviewers do not have clinical training or exposure. They follow a template or a protocol to audit the note. If a hospitalist's note did not fit into that template and meet the requirements, that note is either down coded or becomes non-billable.
6. Verbiage in documentation: Use plain English to document. Explain any medical term you are using if this is not a common word. Remember who is reading your note from a reimbursement perspective.
7. Co Management: Consult & be consulted judiciously if you want to be paid well. Weigh risk and benefits. Define clear boundaries as to who is managing which problem so that both get paid and paid well.
8. Communication : Document clearly what you discussed today with which specialist and what has been agreed upon in terms of patient management. Feel free to discuss reimbursement issues. Remember both specialists and PCPs are facing similar reimbursement problems.
9. Use the term monitoring, counselling and educating patients frequently.This takes your note to a higher level of coding. Review previous admission notes, tests, abnormal labs and office records and document adequately to improve the medical complexity of your note.
10. Smart phrases: Discuss and create a list of simple but well documented smart phrases in your EMR for common diagnoses, which will greatly decrease your documentation time while maintaining quality of your documentation.

Shaheen Faruque, M.D