Business of medicine course at your med school?

[PL198]

If they fail to teach basic sciences, how are they bestowing degrees?

The fact of the matter is that the academic leadership has abdicated the purse-strings, destroying their independence in the process. They need to fix that mistake.

I'd say at the bare-minimum, cover medical billing and reimbursement.
Teach people how they get paid.
Show them the costs of how much a daily CBC/Chem7 is.
Show how many patients a primary care doc needs to see in a day just to cover overhead.

Because kids buy BRS, which is good enough to pass basically any basic sciences course at any institution IMO. It's like the whole NP thing. Their actual efficacy doesn't get known, because the kids are going to cover their a** regardless and get brs/RR/whatever it takes to actually learn the material. I just don't see any reason for a school to do this, as I'm pretty sure many people would make the argument that private practice is against the spirit of medicine(I do not agree with this at all, but I can absolutely see people saying this). I can't really see any of the people that say medicine is a "calling" or the only profession where people have a duty to their patients, and then teaching kids how to make money. Doesn't make sense to me. They don't want kids thinking about the money yet anyway, it's all just "follow your heart," and "where could you serve best."

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[dyspareunia]

What? You think you are presented an objective look at things such as ethics, national healthcare, etc? Really?

No, I definitely agree with you on those points. I don't think, however, that med schools are purposely keeping us from those things for the purposes of pushing us to become uninformed or dependent on other individuals to run our businesses.

They're focused on teaching us the important stuff (science, clinical skills, etc) and also making sure we aren't overloaded with stuff ---> stress, depression, suicide.

 

[Scottpilot]

Speaking of the importance of doctors fighting for themselves and learning about billing: http://www.medscape.com/viewarticle/824858_1?src=stfb
Remember, if you don't learn this stuff, there are more than enough people willing to take advantage of you.

Even if unintentional. The Doctor I work(ed) for lost nearly $100,000 in one year because his surgeries weren't billed correctly, or prior-authorization wasn't obtained from the health insurance company. I'll tell you what...he learned the basics of billing real fast after that!

IMO, it's better to learn the basics of billing and running a practice before you have to learn the hard way.

 

[michaelrack]

Several people have pointed out that there is a difference between selecting the correct billing code (I believe they talking primarily about the CPT code), and learning about medical business. I think that the basics of selecting the correct CPT code needs to be taught at all levels of medical education (or at the latest, starting at MS-3)- all doctors need to know this to prevent accusations of medicare fraud. Some CPT codes are used by most specialties ( ie 99213- level 3 outpt f/u), but many specialties have their own unique codes (ie, psychotherapy add-on for psychiatry), so this topic needs to be reinforced during residency.

Actual billing could be an elective in medical school, or could be some type of didactic in residency- Many doctors would benefit by knowing more about the process of submitting a claim, network status, deductibles, copay vs coinsurance, how to get a medicare # for a new clinic (even the doctor is billing through his individual NPI #), etc.

 

[Espadaleader]

Things like RVUs coding, direct payment medicine, capitation, what is a payer? What is risk? ACO, HMO payment reform, healthcare expansion, GME, Medicare reimbursement (The "Doc fix", the public thinking optos make 10 million a year because they charge Medicare 10 million, how to objectively assess Obamacare (you can be as liberal as can be and hate Obamacare), health technology (Monitoring, google glass etc.), healthcare quality (NP's saying they're cheaper) Let me repeat that. Healthcare quality (NP's saying they're cheaper. The only way we can advocate for ourselves is to have business acumen.

What's funny is most people on this forum are arguing to not have these courses. Lol. The typical primary care doctor oversees 10 million in revenue from a panel of 2,000 patients. Each patient with an average cost of 5,000. We have a role in lowering costs. We are the providers.

Business of healthcare is the most important thing we should learn in medicine. For real. It's not about "making money", It's about understanding markets in order to make the best decisions for the population and individual patients to lower costs and improve care. We need to know business to fight for our patients and what's best for them.

 

[dadaddadaBATMAN]

Things like RVUs coding, direct payment medicine, capitation, what is a payer? What is risk? ACO, HMO payment reform, healthcare expansion, GME, Medicare reimbursement (The "Doc fix", the public thinking optos make 10 million a year because they charge Medicare 10 million, how to objectively assess Obamacare (you can be as liberal as can be and hate Obamacare), health technology (Monitoring, google glass etc.), healthcare quality (NP's saying they're cheaper) Let me repeat that. Healthcare quality (NP's saying they're cheaper. The only way we can advocate for ourselves is to have business acumen.

What's funny is most people on this forum are arguing to not have these courses. Lol. The typical primary care doctor oversees 10 million in revenue from a panel of 2,000 patients. Each patient with an average cost of 5,000. We have a role in lowering costs. We are the providers.

Business of healthcare is the most important thing we should learn in medicine. For real. It's not about "making money", It's about understanding markets in order to make the best decisions for the population and individual patients to lower costs and improve care. We need to know business to fight for our patients and what's best for them.

I can only speak for myself, but I don't think many of us are against having the courses. What I'm against is adding them to the current pre-clinical workload (or the even more severe 3rd year workload). Based on your status, I'm assuming you'll be starting in the next few months.

Feel free to tell me when you're six months in if you'd like to have another course in "medical business" added to your schedule. Then recall that what you're going through is the easiest part of medical school, aside from the last few months.

 

[username456789]

Add to the fact that residents don't do billing themselves

Huh?

I absolutely do coding/billing as a resident. Every single day.

 

[Espadaleader]

I can only speak for myself, but I don't think many of us are against having the courses. What I'm against is adding them to the current pre-clinical workload (or the even more severe 3rd year workload). Based on your status, I'm assuming you'll be starting in the next few months.

Feel free to tell me when you're six months in if you'd like to have another course in "medical business" added to your schedule. Then recall that what you're going through is the easiest part of medical school, aside from the last few months.

Hey. I am not suggesting that these courses be "added" onto whats already there, instead, I am suggesting that these courses be integrated into the curriculum. Schools could make room in the curriculum for them. I don't think it would be good idea to add them onto existing courses. I hear you when you say you don't want more demand. Sorry if I wasn't clear.

 

[Anastomoses]

Hey. I am not suggesting that these courses be "added" onto whats already there, instead, I am suggesting that these courses be integrated into the curriculum. Schools could make room in the curriculum for them. I don't think it would be good idea to add them onto existing courses. I hear you when you say you don't want more demand. Sorry if I wasn't clear.

I think they should be optional + in 4th year.

 

[DermViser]

Huh?

I absolutely do coding/billing as a resident. Every single day.

Derm is very much the exception to the rule in this. Most other residents in various other specialties, esp. inpatient heavy ones, are not the ones circling the CPT code.

 

[michaelrack]

Huh?

I absolutely do coding/billing as a resident. Every single day.

You may be coding (selecting CPT and probably also ICD codes), but I seriously doubt that you have much other involvement in the billing process. Are you following up on the status of accounts receivable? Are you negotiating and/or signing contracts with insurance companies?

Learning coding is important, but that's only half the process of billing- every doctor needs to understand coding, but there a lot of doctors who don't know much about the other parts of billing, and that's ok.

 

[dadaddadaBATMAN]

Hey. I am not suggesting that these courses be "added" onto whats already there, instead, I am suggesting that these courses be integrated into the curriculum. Schools could make room in the curriculum for them. I don't think it would be good idea to add them onto existing courses. I hear you when you say you don't want more demand. Sorry if I wasn't clear.

I read into your post more than was explicitly stated, and decided to get all snooty. I'm mildly addicted to misinterpreting people on the internet and arguing with them about things they don't say. Sorry about that.

A couple of things from my experience: I have learned to be wary of that word "integrated." The reality is that there is only so much time, and during that time you need to cover a certain amount of topics. So to learn additional information, you either take away a current subject or spend less time on all the subjects.

The word integrated makes it seem as though you can eat your cake and have it too: you can learn what science you need, and also learn business aspects of it. That almost never seems to be the way it actually works though.

Whenever someone adds something to our curriculum, there are miles of red tape to wade through. Instructors need clear objectives, proof that the information is necessary, ways to measure those objectives, etc. Even making minor changes takes forever. As an example, it took several months (and a half-dozen meetings) for one of our student representatives to change the way student organizations sent out emails. Student org. emails are only about non-mandatory events (like residency panels, lunch talks, dinners, etc.).......... and it still took months to change.

Adding stuff into the actual curriculum would probably be a nightmare.

Which is why I would want it to be an elective, extra-curricular activity, or some other less regulated form. That way instructors could just concentrate on the material they think is important, instead of going through endless hoops to end up with a meaningless class.

Making it an elective also filters the population (leaving out the people who don't give a crap) and makes so we can take it when we have time.

Tldr: Sorry for being a d***, integrated = , make business an elective for people who care.

 

[Scottpilot]

From my experience, its not so much the "big picture" stuff that doctors are unclear about (i.e. obamacare, the "Doc-fix," HMO vs PPO vs EPO, direct payment vs. capitation vs. P4P, group vs individual NPI, Medicare assignment vs. non-assignment, UPIN #, co-payments, co-insurance, premiums, covered benefits, etc)

Rather, its more the implementation of these into everyday practice and more specifically how it affects the patient (and thus you as a practice).

What I think is especially lacking is knowledge about what codes (and thus procedures) are mutually exclusive or bundled. Or what ICD-9 will cause an automatic denial for specific CPTs. Or can you perform a certain procedure the same day as an office visit or is it necessary to get pre-authorization.

Or how to deal with denials, because I can tell you from experience, most billers have no clue where to start when the denial states "in your appeal, explain why 'abc' was medically necessary, make available 'pertinent' chart notes, and give evidence of said 'abc.'" Sadly to say most billers are "too scared" to bring it to the doctors attention, or the doctor is "too busy" to deal with it. Thus it typically falls on one of the "back-office" staff members to write an appeals letter. BTW, unless you have an extremely experienced and/or motivated back office staff, they probably have no clue why 'abc' was performed, why it was medically necessary, or what evidence supports 'abc.' They aren't doctors.

Of course why is this even important?

If it's not done right, you get to watch your accounts receivable and denial log continue to climb. And I'm not sure how many have experience how irate and down right PO'd patients get over a $10 dollar co-payment, let alone a denial for anything over $100. Some patients pay. Some don't. Some get sent to collections. What it does take up is a lot of your staff's time..and thus your money. More importantly, you and your office become the "big, bad doctor," on yelp (or other social media), or through word of mouth in the community. When that happens, then you get to watch your patient recall list go up.

I think billing/medical business should be a required course either in 4th year or residency, and it should be taught by someone who has practical experience. Medical practice isn't just about treating diseases. As physician leaders, we need to know how to efficiently implement and oversee all financial concerns, and how these affect the one group of people that keep us in business...the patient.

tl;dr: In my experience, it's not the theoretical knowledge, but rather that implementation and every-day use of that knowledge that is a problem. How to deal with mutually exclusive/bundled codes, same day procedures, pre-authorizations, and denials, and how these affect the patient (and thus your practice) is important knowledge. Why? Patients like to argue over even a $10 co-payment. After-all, many are paying thousands in premiums and don't understand why they have to pay more, or why things get denied.

 

[Espadaleader]

The input here is awesome. I've been on Wikipedia and other sites looking up these things.

 

[NickNaylor]

Huh?

I absolutely do coding/billing as a resident. Every single day.

Interesting. Even in the out-patient derm clinic the residents don't fill in the billing forms - the attendings do.

 

[DermViser]

You may be coding (selecting CPT and probably also ICD codes), but I seriously doubt that you have much other involvement in the billing process. Are you following up on the status of accounts receivable? Are you negotiating and/or signing contracts with insurance companies?

Learning coding is important, but that's only half the process of billing- every doctor needs to understand coding, but there a lot of doctors who don't know much about the other parts of billing, and that's ok.

Correct. You pretty much nailed it here. Although to be fair, for even most attendings they do what they need to do - right CPT and ICD code and then leave it to who it needs to go to to carry on the chain. If there's a mistake, it will come back to the attending to redo anyways.

 

[DermViser]

Interesting. Even in the out-patient derm clinic the residents don't fill in the billing forms - the attendings do.

By billing, I believe he is talking about circling the specific CPT code/ICD code for that particular outpatient visit. We do the same as well. It's much easier to do this on an outpatient vs. an inpatient. That being said, most hospitals are switching over to EPIC so any circling will disappear anyways.

 

[username456789]

Interesting. Even in the out-patient derm clinic the residents don't fill in the billing forms - the attendings do.

At my institution, the patients are my patients (not me seeing another attending's patients) and I'm the one filling out the billing forms. Attendings fill out the billing form when seeing their own patients (sans resident).

 

[DermViser]

At my institution, the patients are my patients (not me seeing another attending's patients) and I'm the one filling out the billing forms. Attendings fill out the billing form when seeing their own patients (sans resident).

But those patients are officially assigned to an attending (whom you work with) and are just allocated to your schedule right? Bc officially a resident can't bill for the hospital esp. Medicare.

 

[username456789]

But those patients are officially assigned to an attending (whom you work with) and are just allocated to your schedule right? Bc officially a resident can't bill for the hospital esp. Medicare.

Yes, an attending precepts those patients with me and the RVUs are theirs. But I am the one recording the billing (with no oversight by the attending, actually) as well as the clinical note (which is signed by the attending). Of course, we have a billing department that audits these things.

In all other senses, though, those patients are "mine." I am their dermatologist. Their biopsy results or lab results come to me, and I call them with the news. When the patients call in with questions/concerns/new problems, the message is sent to me and I am the one who calls them back after clinic. They follow up with me in my clinic based on my schedule; the attending precepting me for their follow up visits may very well be a completely different one.

This is different than many residency programs in dermatology, which usually involve residents seeing an attending's patients on a given day, with it being a crapshoot whether that resident ever sees that patient again in follow up.

 

[PL198]

I'm just laughing thinking of the things a medical school would throw into their business instruction, such as the idea of imposing a tithe on the profession.

 

[Mt Kilimanjaro]

Don't most schools have a Business of Medicine SIG or something similar to fill this gap?

Anybody have any good self-study resources for the nuts and bolts of running a practice, billing, etc?

 

[michaelrack]

Correct. You pretty much nailed it here. Although to be fair, for even most attendings they do what they need to do - right CPT and ICD code and then leave it to who it needs to go to to carry on the chain. If there's a mistake, it will come back to the attending to redo anyways.

Agree. I am in a unique situation and do more than most attendings. Last year when my BCBS payments stopped coming in, I spent many hours working on it (along with the billing company I outsource claim submission to). When Medicare asked me to revalidate, I was the one who did it through the PECOS system.