Bob Matthews

May 15, 2018

Opportunities That We Could Miss Seeing - Reflections on 15 years of E&M CodeRight

Medisync Blog

Medical group leaders increasingly report that they are under pressure for improved financial performance from their groups. Physician income erosion has continued for 17 years and will not abate any time soon.

Two of the greatest assets that a leader can bring to a leadership team are focus and a keen eye for new solutions. Successful leaders isolate the “vital few” variables that matter most and focus their organizations on those. Recognizing that past solutions are going to get new results, great leaders try new solutions.

Let me give an example: revenue. We all need more revenue, most of us desperately. Most of us have negotiated – or accepted -- the best rate that we can get for our services. That leaves two variables for improvement – performing more services or generating higher revenues per encounter.

Years ago, when MediSync’s partner groups were struggling under horribly low rates imposed by commercial carriers we determined that any time we provided a 99214 but documented or coded as a 99213, it was a disaster. We lost $30+ on that encounter! (If that was true twenty years ago, it is far truer today.)

Like most groups today, we desperately needed every dollar we earned. Like most, our primary care docs were billing predominant 99213s. That was, and remains, the most common code. We wondered, is it the right code?

We ran a test. We asked different doctors in informal settings, “What is a 99213? or a 99214?” Quickly we concluded that they didn’t know. After all our coding education, after coding and compliance, they still didn’t know.

Imagine operating a restaurant in which the waiters regularly charged the salad price when serving a steak. Not likely to be in business for long.

We then set a goal: “Let EVERY episode be correctly documented and accurately charged.” As a concomitant, we stated that there would be no “hanky panky,”no upcoding, no extra services, just what the doctors were already appropriately doing in the exam room with their patients.

To achieve that goal, we invented a new and unique method for doctors to confidently know exactly what had to be documented and exactly what code was accurate. We tried and tested it with our own doctors and then with doctors from some other groups.
The results were consistent. We were shocked when we found how many 99214s a PCP does. Far more than 99213s. And, for the record, there are virtually no 99212s in real clinical practice.

When E&M coding is done correctly (i.e. the code matches what happened in the exam room), PCP revenues (not charges, revenues) improve by $15,000 per provider per year on average. Oh, and audit risk is reduced and doctors spend less time documenting.

I just completed my (E&M CodeRight) training.

I will admit I was somewhat chagrined and annoyed that I was going to have to go through more “coding” training, since I have found this to be minimally helpful in the past, and usually left me more confused.

The MediSync training was extremely well presented, clear, and immensely helpful in understanding coding. It is abundantly obvious that primary care has been leaving hundreds of thousands of dollars (or more?!!) on the table each year due to incorrect coding.
Furthermore, this training made me realize that there was an incredible amount of documentation that I was doing (that I thought was necessary to justify my coding, but not contributing to the problems at hand) that was not necessary and was a waste of valuable time.

This has been a win-win scenario, in that my production has increased and I have become more efficient. I have discussed this training with my group, and the universal agreement was that this was the best coding training we have ever received.

Randy (Surname omitted at client's request), MD

After testing this extensively in our own groups, we began to offer E&M CodeRight. Over 175 groups – many of the most famous groups in the country – have deployed E&M CodeRight.

And doctors actually like the program. First, they earn more money and/or wRVUs. Second, they feel confident and in charge. Before, they didn’t.

Again and again, group leaders are surprised. “How come we’ve had coding and compliance and we didn’t get these results,” they ask? The fault isn’t in our coding and compliance teams. What we discovered was that (1) we needed to craft the entire program from the doctors’ point of view. How do they see patients? Structure their visits? (2) We have physicians train other physicians in very small groups. Coders can know the rules but they don’t think like doctors do.

If you need more revenue, try a free analysis of what the upside from E&M CodeRight would be for your specific providers given their specific habits and patterns. If you like the number, you can talk to all the CEO, CFO, CMO and other leaders from groups you know and respect and they will tell you, “It works.”

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