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Primary care billing

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  • Primary care billing

    Not really a finance question.

    I am recently out of residency 1 year and currently work as a hospitalist but I am trying to learn the ins and outs of a primary care private practice.
    Family member has large volume practice but I don’t think billing is being done efficiently. A lot of things could probably be done to make sure we get from reimbursed appropriately.

    So What I am currently focusing on is maximizing billing. It’s something we didn’t really learn in residency unfortunately. What resources can I use? I want to learn which diagnoses to use, what is and isn’t going to get me money, what to ask and document for example: counseling on smoking cessation, depression screening, advanced care planning, all of that. Anything I can read or watch to help me with this? I tried just googling but it seems all over the place and I really just need some recommendations.

    billing company is is being used, is an in house biller better?

  • #2
    Try the E&M resources put out by CMS via MLM. Google it and you'll find the PDFs. That's appropriate coding. You may want to try a subscription for a few months to Encoder Pro or something similar. Or purchase a current CPT coding book. Most of those are dedicated to procedures but the initial part of it is E&M. You may want to see if they have an E&M specific one and do side-research on specific codes. As a FP you won't have nearly the number of codes to account for, which can be a good thing. The billing side of things is a whole different story. Someone needs to package your coding, submit it, track receipts, etc. As to whether or not it's better to have in house is another debate entirely. That depends on key performance indicators such as net collection %, days in A/R, and then also the basic "how much are you going to cost, benefits included" equation.


    • #3
      Is the assumption you will be joining the family members private practice correct?
      Don’t give up! There have been threads about efficient note taking and efficient records needed to support appropriate coding that translates to billings that determine collections. Keep digging and understand the process. Start with what is currently happening and considered what needs improvement.
      Ignorance speaking, what codes are available for FM, what services are provided and what isn’t being billed? Hopefully a FM doctor will chime in.
      Good luck.


      • #4
        Welcome to the board.

        Welcome to private practice... I'm 4.5 years in practice & have been involved with medical billing since ~2005. I'm still learning. What I have & currently use:

        --Specialty specific diagnosis & procedure code booklets.
        --Medicare/CMS articles, especially the NCD & LCD articles. For me, those pretty much tell me what codes go together, the salient points of documentation, limitations to frequency & coverages.
        --I read a daily newsletter specific to my profession, where other doctor email in about all kinds of thing. Occasionally there are coding inquiries. But that also lead me to a subscription based coding website.
        --I don't know if I can link to them, but a web search for medical coding forum & poking around there can give a lot of guidance for coding, modifiers, etc...
        "Oh look another bajillion point declin-Ooooh!!! A coupon for pizza!!!!" <--- This is what everyone's IPS should be. ✓✓✓


        • #5
          I'm a new graduate as well currently doing primary care in a group practice and had same concerns about billing. Perhaps the resource I'm about to recommend doesn't address all of your interests (best documentation to maximize reimbursement for advance care planning and how to guarantee completing quality measures etc.). I invested in an E&M course called E&M University ( which cost me $199 but had everything I needed for the outpatient side of things to maximize my billing. It gives you a demo before purchasing so that you can see if you like it first. It also offers free resources like pocket guide and summary of key points to remember. Not sure if this is what you are looking for.


          • #6
            In addition to above, I recommend FPM- family practice management’s articles and coding resources. I strongly recommend planning your chronic conditions templates for 99214’s. Do Medicare annual wellness visits at the same time as office visits. Code for smoking cessation. Our compliance person says you can’t code depression screening unless it takes 8 minutes, so don’t bother. I personally haven’t dropped the ACP codes but you can. Don’t forget CCM - chronic care management. It isn’t hard to enroll and the wrvu for a care plan is pretty good- it the tracking and resources after can be hard.

            finally, I don’t work with many Medicare advantage plans but it’s really worth it to get health care complexity codes on your problem list. Garden variety diabetes isn’t the same as diabetes on insulin with triopathy. Htn Vs hypertension with microalbuminuria. Some payors will pay differently for complexity. And when you do your AWV put ALL your codes in - contributes to complexity based reimbursement each year.