Any resident who joins me in clinic will hear me talk about billing. It isn’t the most important thing I can teach them–seeing a variety of medical issues, learning nuances of outpatient medicine, practicing efficiency: these are what they want to learn, and what they should learn. However, I had little education on billing as a resident, which really came back to bite me in my first job, and I would like to help them avoid this in their own practice.
If you know how you get paid (which you should!), you need to make sure you get paid appropriately. I think it’s also important for employees to get credit if they are working hard. My first job became quite unpleasant after a few years, mostly due to my ignorance of proper medical billing practice.
At the time, I was working for a community hospital which, to be frank, didn’t know how to run an outpatient office well. Case in point: our phones were cut off one day, because the central finance office (where our bills had to be forwarded) didn’t pay the phone company. Try running a doctor’s office without a working office phone!
Anyway, my first year’s salary was supported while I built a practice. After that, I was paid a salary, with a bonus for productivity, i.e.: seeing patients, billing, and generating collections. I was very happy to get a bonus nearly every quarter (sometimes the finance office was slow, and I received a bonus for 6 months). As my practice grew, my bonuses grew as well, eventually reaching about 30% of my base salary.
I thought I was doing a good job. I was busy, with full schedules every day. And getting a very nice bonus based on hard work.
However, administrators started berating me for not being productive enough. They thought I should be bringing in much more money. I couldn’t figure out how I could see many more patients in a day to meet their expectations.
I didn’t realize the problem until I moved to my new job and was finally taught about billing a visit properly. It turns out I was consistently under-billing; most of my level 3 visits (uncomplicated follow up visits) were really level 4s (more complicated issues, and billed at a higher level).
I was already doing more than enough work, and didn’t need to be berated for not working harder. I needed to be smarter about describing what I was doing (that is, billing appropriately).
In retrospect, my former employers were probably missing about $25,000-$30,000 annually because of my ignorance. Had I learned earlier about this, my old employer could have gotten a good deal more money each year: probably much, much more than it would cost to hire a good coder to coach me.
Back then, the Internet wasn’t quite what it is now. It wasn’t nearly as easy to get information for free on coding, or even to figure out where to spend money to learn about this stuff. While writing this post, I hopped over the White Coat Investor site to look for billing information. Here is a list of resources that I wish I had had access to at my first job:
- The Happy Hospitalist has some free lectures.
- E/M University has online lectures.
- Code Blue Coding has online lectures, and seems to do in-person teaching as well.
- The AMA sells books on coding.
- Paul Firth has an online course.
- As does Henry Rosevear at 5 Roses Urology.
[To be clear: I haven’t taken any of these courses, and can’t vouch for their quality. I have no financial relationship with any of these courses; if you purchase them, I don’t make any money. This list is for your information only.]
I’m older now, and had the privilege of working with an excellent coder who taught me how to bill properly for the work I have done. I do very well, and so far have not had issues with administrators telling me I have to work more to meet their targets. I am very grateful for finally getting this necessary education.
Even though my students don’t always want to hear it, I will keep bringing up the subject when we work in clinic. I would prefer that they not have to go through the same experience of being asked to work harder, just because they aren’t getting the credit for the work they are already doing.
How did you learn about billing for your work? Do you feel residency is the right place to teach it?