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BILLING EDUCATION FOR TRAINEES:
EVERYONE WINS
Jeff Waugh, MD, PhD
Fellow in Pediatric Movement Disorders
Massachusetts General / Boston Children’s / Harvard University
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THE PROBLEM Over two audit cycles in 2011, our largest insurer markedly increased the stringency of audits
For Residents and Fellows: - 97% of all inpatient notes were downcoded - 53% of all outpatient clinic notes were downcoded Mean outpatient value lost : $232 per note Inpatient notes lost 71% of billed value
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ELIMINATING OUTPATIENT DOWNCODE
1
0
20
40
60
80
100
Before In-tervention
April '12
June '12
Fall '12
% of “Correct” Notes
Over one year, we reduced downcodes from 54% to zero.
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HOW DID WE DO IT?Three key changes:
- Identified group weaknesses - Identified individual weaknesses - Found incentives that benefitted both trainees and
department
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WHERE DO THESE ERRORS COME FROM?WHAT DO THEY COST?
Conservative savings estimate: $23,892/individual/year
x 26 fellows + residents: $621,200 per year
ROSNot newMedical Dec MakingPhysical ExamUndercodedOvercodedHistory
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A BULLETPROOF ROS
1.Family fills it out while waiting2. Clinician reviews, signs, and dates it3. Admins scan into medical record
4/12/12
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SYSTEM CHANGE + EDUCATIONELIMINATED GREATEST SOURCE OF LOSS
93%
% of ROS meeting “Complete” criteria
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HOW DID WE DO IT?Three key changes:
- Identified group weaknesses - Identified individual weaknesses - Found incentives that benefitted both trainees and department
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DO TRAINEES CARE ABOUT THE BUSINESS OF MEDICINE?
A Survey of Residents and Fellows:- Anonymous, Internet based survey
- 24 responses: 8 fellows; 16 residents
Survey results: Residents and Fellows stated that they Had not been adequately trained in the business of medicine: (100%)
Would like feedback on their own billing performance: (76%)
Could adjust their billing to fit the visit level: (46%)
Several residents added that they recognized their knowledge gap, but had no one to teach them.
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IDENTIFIED INDIVIDUAL WEAKNESSES
One-on-one sessions with every trainee, 3+ notes each
Utilized a very powerful force: righteous indignation Rather than hours of tedium, trainees learned the few points that needed polishing
Emphasized that clinical care and clinical billing are separate but dependent skillsets – one is useless without the other
strengths
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HOW DID WE DO IT? Three key changes:
- Identified group weaknesses - Identified individual weaknesses - Found incentives that benefitted both trainees and department Primary motivator of trainees: saved time - Notes go faster when you know the rules
- Low code? Titrate dictation accordingly - Shifted learning from day one of 1st job to progressive throughout residency
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CORRECT NOTES USE FEWER WORDS
Words used per noten = 76 notes, 3+ for each trainee
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MEASURING SUCCESS: INCREASED NOTE LEVEL
Fall 20113
4
5
June 20123
4
5
Average Level: 3.4 Average Level: 3.8 We improved average level by 11%,
Improved average note value by
16%
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MEASURED IMPACT OF INCREASED LEVEL
44 clinics per year x average of 4 hours (patients) per clinic x $96/note in improved mean level x 26 residents and fellows
$438,000/y in improved billing, just from resident clinic. Spillover benefits?
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THANKS TO: Scott Pomeroy, MD, PhD
Frank Davis, MHA Angeliki Medrano, CPC, CPMA
Please Contact me with Questions: