My first email from Dr. Henry Rosevear, a Colorado urologist and long-time WCI reader, came two weeks before the WCI conference in Park City last winter. He offered me free access to some lectures he had been delivering in person around the country and had recently packaged up into a video format and asked me to help get the word out about it. Needless to say, I was a little preoccupied with the upcoming conference. As important as his work is, we were swamped. So I put him off for a few weeks. Weeks became months and here we are in mid-June by the time I finally got around to this project.
Henry is a private practice urologist who realized not only that coding and billing was really important, but also that he knew little about it. So just like I started seeking out information about personal finance and investing, he started seeking out information about coding and billing. He attended courses, read up on it, and started applying what he learned to his practice. Soon he had boosted his income by thousands of dollars per year.
I'm sure Henry is a great doc and I know he has transformed himself into an expert on coding and billing, especially for surgical subspecialists and urologists in particular. However, he isn't necessarily a marketing genius. Nobody knew about this great resource he had put together and he didn't have a popular blog, huge email list, or significant social media presence to let them know. I guess that's where I come in.
When I finally got around to watching his videos myself, I was amazed. I thought I was pretty good at documenting in order to maximize coding and billing. It turns out I don’t even qualify as a rookie in the field. I learned all kinds of things about coding in the course that I wasn’t previously aware of. I made a few suggestions. He moved the course off of his site and over to the Teachable platform, which those of you who have taken Fire Your Financial Advisor or the Online WCI Conference are familiar with. He set me up as an “affiliate partner” (so if you buy his course through the links on this page I get paid too.) He added a useful handout and I put together three short videos myself and added them to his course in an effort to make the course more applicable to a wider range of physicians, particularly emergency docs and similar specialties.
Henry Rosevear, MD of Five Roses Urology
I often advocate that doctors play both offense and defense when it comes to their finances. Offense means getting paid more. Defense means both protecting your assets with insurance and other asset protection techniques AND reducing your taxes, investing expenses, and spending in order to have more money available to invest. We spend a lot of time at The White Coat Investor talking about defense, but not nearly as much as we should talking about offense. And when we do talk about offense, it’s often a side gig or passive income or investment income that we’re talking about.
Henry’s course is all about offense. However, it is heavily focused on making your main gig, your doctoring gig, more profitable. The better you document, code, and bill, the more you get paid. But the best part is that you are getting paid more for the same work. There is no additional overhead associated with it. It all goes in your pocket as profit, at least if you’re in business for yourself. It’s not about gaming the system. It’s not about cheating to get more money. It’s about getting paid for the work you’re already doing. It’s about beating insurance companies at their game of refusing to pay or delaying payment for the work you did.
Learning to document, code, and bill better obviously has a direct effect on your income if you own your own practice. Likewise, if you are in a partnership that is set up as an “eat what you kill” kind of situation. However, even if you are in a different type of situation, knowing this stuff still has value. For example, you may be an employee but have your bonus dependent on how many RVUs you generate. If you document +/- code better, you will generate more RVUs and be paid more, even if it is indirectly. Even if you are just a salaried employee of a hospital or contract management group, there is still benefit to learning the coding system and doing it well. At the end of the day, your value to your employer is the money you can generate for her. The harder and more efficiently you work, the more money you generate. But improving your documentation and coding allows you to generate more money without working any harder or more efficiently. It’s like free money for those who took the time to learn the rules of the game. When you are worth more to an employer, especially if you can get your hands on that data, the better position you are in to improve your job security and negotiate a raise or even an initial contract at a new employer.
- The HPI and Problem Based Billing
- Requirements of the Physical Exam and Review of Systems
- Inpatient Coding and Billing By Time
- Real World Examples
The second part is all about modifiers and includes the following lectures (if you don't know what modifiers are, you REALLY need to take this course):
- The Concept of Bundling and Modifiers to Unbundle
- The Global Period and How to Get Out of It (Part 1)
- The Global Period and How to Get Out of It (Part 2)
- Less Commonly Used Modifiers
The third part is the section I did and includes:
- Documenting Your Way To Financial Independence
- Documenting ED Evaluation and Management Codes
- Documenting ED Procedure Codes
The Five Roses Online Medical Billing and Coding Course
I was lucky; I actually received several great lectures during residency on documenting, coding, and billing and I've continued to learn about the subject throughout my career. But most docs get about as much on coding and billing as they do personal finance and investing in medical school and residency. Here's your chance to make up that deficit. For just $249 and 2-3 hours of your time, you can learn the mysteries behind your paycheck, and hopefully make some changes that bring you more income – more income to pay off student loans, more income to invest for financial independence, and more income to spend on what makes you happy. This is a great investment in your earning potential. Taking the Five Roses Urology Medical Billing and Coding course is an investment you won't regret. And, just like with our other online courses, we're offering a 7-day no-questions-asked refund. If it has been less than 7 days since your purchase AND you have watched less than 25% of the course, you may email [email protected] and obtain a 100% refund of your money.
Buy the Five Roses Online Medical Billing and Coding Course today! Enter code “WCI” at check out to receive 10% off for the next 7 days.
What do you think? How did you learn to document, code, and bill? How much have you been able to boost your income by learning about the business side of medicine? Comment below!
I am wondering if this course would benefit someone in my situation:
1) We are in an “eat what you kill situation” but our department has 2 dedicated coders specifically for radiology (they have taken certified medical coding courses etc)
2). As a radiologist not sure if there is potential to add modifiers etc that would be available to other clinical specialties
Otherwise this does sounds like it would be a great benefit to clinicians (especially if it changes the way they document things to optimize billable events)
Thank you for the comment. I agree that that there are certain specialties who will find more utility out of this course than others. For example, a pathologist should NOT take this course. A pure diagnostic radiologist would also not get much utility out of this course. On the other hand, a more interventional radiologist would find benefit as you are bound by the same global and bundling rules that the rest of us “proceduralists” are. A good medical coder is worth their weight in gold; but they are required to bill based on the documentation that you provide and this course will help you understand what the docmentation requirements are for various billing situations so that your coder can correctly, legally and ethically maximize your billing.
Does this course also cover routine inpatient and outpatient E&M? Does it cover critical care?
Thank you for the comment. It covers routines inpatient and outpatient billing but it does not cover critical care billing as that is not something I do very much of. Clearly that is something that I should add when I improve the course.
Jim talks about critical care billing in his ER section. I’m not sure if that would be the same coding as inpatient critical care.
It does for the most part.
Very very similar. Basically the same for a hospitalist. 30-75 minutes is one code, then every 30 minutes afterward. You can even get paid your regular code if you see them in the morning and then a critical care code if they start crashing in the afternoon.
Worth it for outpt, clinic only, RVU based Internal Med?
1/3 of the course details precisely how to optimize billing in the outpatient clinical setting. It takes less than a handful of patients who you simply code a 99204 instead of a 99203 to make the course worth it. When I made these changes in my own clinicaly practice, I increased by billing by tens of thousands of dollars so yes, I believe this is well worth it for any physician who sees patients in an outpatient clinical setting.
As a family medicine doc, I’m learninng that we underbill 99214. I’m told undercoding is just as fraudulent as overcoding. I think I was taught to fear level 4 and 5 visits as a resident.
I agree. We all were taught to bill by feeling. Thoughts like, “that was an easy visit, it must be a level 3.”
But that is wrong. Billing is a system, a set of rules that we are suppose to follow and the course teaches you using real world examples how to bill properly.
I’m interested in improving my coding but I don’t perform any procedures. I am an ID consultant and generally I’m seeing complex cases that I feel are level 4 or 5 and want to make sure my documentation reflects this. On the outpatient side I tend to bill more level 3s and 4s and again want to make sure that I am not systematically under-billing. Would I benefit much from this course?
I’ve read ID notes and I agree most should be level 4 or 5 visits but if you have never taken an audit sheet and looked at one of your notes to ensure that you cover all the required documentation for a level 4 or 5 visit than the course is worth it.
Jesse,
I would highly recommend that you take a course to fully understand the nuances of E&M coding and billing. Coding should never be based on how you “feel”, but what you did and DOCUMENTED.
Does the course apply for outpt psychiatry?
The advantage of the billing system is that it applies equally to most all phsyicians. As a psychiatrist seeing patients in the outpatient world, you talk to patients, you do exams and you prescribe medicines just like the rest of us so understanding what is required from a documentation standpoint to ensure optimization of billing is the same.
I was given access to E/M University during residency which was helpful and was wondering how different this new course compares, specifically for outpatient primary care. Thank you!
https://emuniversity.com/
I can’t say for sure as I have not taken that course, but the basics of billing and coding haven’t dramatically changed in the last few years so I doubt there would be much new in this course versus that one. Have you done any recent auditing of your billing? My group has done audits of our billing and there is a trend to underbill over time as doctors forget the details of how to bill and start to bill by a gut feeling instead of by protocols as they worry about overbilling so a refersher course may be useful.
I dunno WCI.
Maybe he is a “marketing genius”
He reached out to you, didn’t he?
Well, there are a lot more selling now than before, so I guess so! At any rate, I see it as a course that can help a lot of docs financially (which is goal number one) and that I could get paid for selling (goal number two.) So that aligns well with my mission here. It seemed a no brainer to team up.
Is it beneficial for an orthopaedic resident? We do the billing in our orthopaedic resident clinic but otherwise, we don’t receive any lectures or training on billing.
This course is perfect for you.
I’m a urologist. I see patients in clinic, I do surgery in an asc and in a hospital both with inpatients and outpatients, I see patients in the ER and do inpatient rounding and consults. The course is designed to cover all of those topics. For physicians who do any of those things, this course will make you a better, smarter, more efficient biller.
When I reached out to Jim about bringing this course to this website, he correctly pointed out that his expertise was in the ER and added additional courses on that area.
While this course will help all physicians regardless of how long they have been practicing, for senior residents just entering the work force or for younger doctors new to the real world, this course is even better because it is those first few years of real work when you “learn” how to bill and you establish your billing habits.
This course is perfect for an orthopedic resident or orthopedist or anyone who does procedures. I can’t speak to non proceduralists but it probably would help them as well.
In residency we were responsible for picking the correct code in clinic. We had a yearly one hour lecture on billing and it was terrible.
This course taught me that I had E/M billing all wrong. It paid for itself in the first week. I had been systematically under coding patient visits. I had been charging 99202 and 99203 when I should have been charging 99203, 204, 205. The difference between a 99203 and 99205 on a Medicare patient is over 100%.
As Dr. Rosevear says in the course, good medical care creates good medical billing. All of my review of ER records and viewing outside films and radiology reports increases the level of the office visit which I had not realized before. A good physical exam, which can be completed just by looking at the patient and examining a body part, should be documented as well and is easy to do.
Some of the procedure billing my coders take care of, but I spot check them occasionally to make sure that everything is correct. Having the know how to talk codes and modifiers with them really helps me know that I am getting paid correctly.
Thank you for the positive feedback. Courses like this exist and spread via word of mouth and I appreciate your insights into the course.
This sounds great! ACOG puts on coding conferences and I’ve been debating going, however it’s 3 days out of town and it’s just hard to justify spending my time off away from my family. I’m very interested in getting out of the global period
We have an entire lecture just on the global period as I can tell you from first hand experience that the judicial use of modifiers will dramatically increase your revenue during this period.
And the fact that the course can be done from home…even better!
I’ve tried to start coding for services provided, like smoking cessation counseling, MOCA or 25 modifier. Several patient ms come back disputing he charge, they didn’t ask to be counseled on nicotine cessation or nutrition. Have you had a problem with patients disputing your charges? What’s your response?
I’m honest and straightforward with the patient. I tell them what we talked about. I show them the audit sheets and let them compare my notes to those. I didn’t create the billing system, I just try hard to apply the system correctly.
And make no mistake, underbilling is as wrong as overbilling. Why? Underbilling especially if done on purpose can be considered as an inducement to refer. The goal of the course is to teach you the billing system so you bill and document correctly.
We occasionally get this in the ED, but it’s a little different since there isn’t usually an ongoing relationship, at least with that particular doc. Receiving the bill is also the impetus for a lot of complaints about the medical care. Hard to tell how many are people looking to get a discount/get out of paying the bill, but the timing correlation is certainly there. Our medical director deals with it all.
MrsPardoxWealth,
As a urologist, I too, code for smoking cessation.
I document what I did, including the smoking cessation. When the work was performed with documentation to prove it, you have done all you needed to do.
We do some smoking cessation too. I think you have to document that you spent at least 3 minutes doing it.
Is there any CME that comes along with this course?
No it doesn’t include CME.
It should as I’ve given these lectures at various courses for CME and I’ve given these lectures to residents at grand rounds for CME but even though I tried, I can’t find a certifying agency to make this course include CME. If anyone knows of an agency that would help, please let me know.
I can tell you that I found at least one but it wasn’t cost effective to offer CME for the online version of the conference.
One consideration is that some of us have required CME money to spend each year or we lose it. So while I would spend twice what you’re asking if I could use my CME money (not able to go to a conference this year so having trouble using up my CME money), I might be more hesitant to spend $250 of my own money. Sounds like you’ve looked into it, but just a thought.
Really great idea for a lecture series, glad you’re offering this!
I noticed that a lot of people used “CME money” for the online WCI conference despite us not offering CME for it. Check your guidelines and you may be able to get it through.
A wonderful secreatry at a major teaching hospital helped me write acgme “approved” learning objectives for the course which I am more than happy to email to anyone who would like them. They may help you get the course approved.
I’m just gonna submit mine as an expense and see what happens. Worst case scenario they just say no.
I am considering taking this course, but as an ophthalmologist I have concerns if this applies to my profession well. Especially because we have the ability to use eye codes or E&M codes. Can you provide any insight before signing up. Thanks!
I didn’t see anything about eye codes, but why not give it a try? As long as you ask for it within 7 days and have watched less than 25% of it, you can get all your money back.
Thanks, Ill give it a try
I am very curious about what you think of the course and look forward to any comments you have on it.
Thanks, I am 3 years out of residency, but I still just never really felt comfortable with bundling etc. I went to a code quest meeting once and it was geared toward administrators etc. It was honestly the most boring 8 hours of my life, so the bar is set pretty low. I am sure your course will be much more entertaining
No promises that this stuff is entertaining. But you’ve sat through a lot of boring stuff in your life and if you knew it would be worth tens of thousands to you over your career, I’m sure you can suck it up for a couple of hours!
That’s actually funny because I have taken that same course. I also took courses by some very famous billers and it was my disappointment with those classes that led me to create my own. It’s just over two hours long and uses real world (albeit urology driven) examples to show you how the system works. It doesn’t matter if you are a urologist or not because the concepts that I will show you will make you a better biller.
As an ENT I have a very high outpatient surgical volume & clinic office visit/procedural volume…are specifics of my specialty addressed or would it just be general information for all specialties? Thanks!
The course is not ENT specific. Most examples are urology-specific.
The White Coat Investor is correct. There are no ENT specific examples in the course but the course is specifically designed for surgical specialties like yours. The course endeavors teach doctors who operate and see patients both in the inpatient and outpatient world what documentation is required to maximize billing. I guarantee that after the course you will be a better biller which is why the course is backed by a money back guarantee. As long as you ask for it within 7 days and have watched less than 25% of the course, you can get all of your money back. There is nothing for you to lose.
That is nice that someone realized the coding and billing was important. Maybe it would be good for a physician to learn more about their billing and coding. That is something I would want to have if I were a physician.