How do psychiatrists seeing 50+ patients a day not get flagged by auditors?

[B52slinger]

I had dinner earlier this week with a group of local psychiatrists recently as part of a CME event. I spoke privately with an older gentleman who looked around mid-60s who told me he's seeing 20-30 inpatients AND 30-40 outpatients PER DAY. He told me he's been working 7 days a week and managing this workload for over a decade. Work ethic is one question (though some people are just workaholics) but how the heck has he not been flagged by insurance auditors? I'm not a snitch or anything but just genuinely curious how this is possible without getting into trouble for billing that many encounters per day.... surely billing 60-70 99214's/99232's every single day would trigger some kind of response?

I didn't ask him personally because I didn't want give him the slightest impression I was going to even possibly report him and create some unnecessary drama/beef.

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[nexus73]

I would bet he's not billing any therapy.

There are some systems that lend themselves for whatever reason to these uber "efficient" doctors. I'm not sure if these systems are built or if they organically develop. But basically systems where extremely brief face to face interactions are accepted as the way things are done. Maybe good nursing and social work support? Maybe a doc who had a 20 patient census got abandoned with no support and all of a sudden had to see 40 patients to keep an inpatient unit running. Then realized, hey this is doable if I spend basically no time with each patient. And that somehow became the new normal.

I'd assume outpatient is set up more like primary care with multiple rooms so the doc can drop in and out quickly, and likely a lot of "diagnosis" based entirely on symptom screening questionnaires.

And from what I've heard some (most?) of the Johhny-come-lately telehealth companies are pill milling stimulants in a similar fashion, with np's carrying panels of 1000-2000 patients, which is insane for mental health, no pun intended.

And obviously the quality of care is likely very poor.

You can bill 99213 and 99214 based purely on complexity. As long as you're not billing on time you would technically be following the guidelines. I would guess if your volume was that high, you'd be at higher risk for some type of investigation.