inpatient billing

[meerkat111]

Hi, I am soon to start my job as a hospitalist. I never had to do inpatient billing and coding. Does anyone know of any resources for this?
Thanks!

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[chessknt]

The happy hospitalist has some decent articles. Honestly just find whoever your billing person is and ask the MDM and risk matrices and a breakdown of admission and follow-up code components and you'll be off to a good start.

 

[jdh71]

Hi, I am soon to start my job as a hospitalist. I never had to do inpatient billing and coding. Does anyone know of any resources for this?
Thanks!

There really isn't that much to know. Document. Document. Document. Happy hospitalists is a good place to start. But you're only going to bill a few codes.

 

[chessknt]

E/M coding (which is the entirety of internal medicine) is a steaming pile of **** created by a subcontracted Harvard economist who ran out of grant money and relied on the input of essentially only surgeons, then consumed and **** back out again by insurance actuaries to come up with arcane nonsensical rules that somehow value every single patient you admit in to one of three (or 4 if you count critical care) categories-easy, medium, and hard.

The original study that lead to E/M codes in their current state was done in the '80s and asked anesthesiologists and surgeons what they thought their equivalent procedure was to admitting someone in acute CHF exacerbation with respiratory distress. Their answer? Ob anesthesia in a C-section on a healthy woman. That's right--the sickest patient you can ever take care of is equal to a routine OB anesthesia case. This is why PCPs got screwed, hospitalists lose hospitals money, and EM makes so much money--you need massive volume to make up for the pittance CMS pays on E/M codes.

 

[end stage fibro]

I found E/M Univeristy very helpful. I've used the free one extensively and bought the inpt course with CME money, though I've yet to login

I'd say roughly 80-90% of your admissions will fall under level 3 billing...it's not that hard to get.

 

[meerkat111]

Thank u all, for your responses. I have some time to spare as kids are in school and husband is busy working.

 

[Doc_Mcstuffins]

I found E/M Univeristy very helpful. I've used the free one extensively and bought the inpt course with CME money, though I've yet to login

I'd say roughly 80-90% of your admissions will fall under level 3 billing...it's not that hard to get.

Second the E/M university courses. There's about 5-6 courses from there that you should take. Basic E/M course, H and P course, Hospitalist course, observation course, consult course.

 

[bananas85]

i second EM university . i bought the whole course and it was worth it. You dont learn anything in residency (at my program). Buy the program review it a few times. it takes a while but you get the jist of it.

 

[Doc_Mcstuffins]

Related question to billing. How often does your admin/billing people ask you to go back and make addendum to your H and P notes to include something so it can get a higher code? Certainly a periodic review is fine and I understand they are focused on bringing in money but I've started moonlighting at a new hospital and for my first few shifts, they want me to go back and make an addendum on almost all of my notes (10 plus notes) since a simple thing was left off. That's fine and I'll gladly do it to get a Level 2. I'm also new so a review of my notes is understandable.

But I've been also asked to do addendum on one patient to document more in medical decision making to get a Level 3. It's a busy hospital and I'm alone at night admitting and cross covering. Ill certainly try to improve my notes but if they continue to ask me to update my notes after every shift so that they can get a level 3 billing, is that unreasonable of them? At other places I worked we got quarterly review of our notes but they wouldn't have us go back for every note they noticed (so far they have asked me to do an addendum to a few subjects in all of my few first shifts). Also, I'm a moonlighter, does that make a difference? Thanks

 

[gutonc]

Related question to billing. How often does your admin/billing people ask you to go back and make addendum to your H and P notes to include something so it can get a higher code? Certainly a periodic review is fine and I understand they are focused on bringing in money but I've started moonlighting at a new hospital and for my first few shifts, they want me to go back and make an addendum on almost all of my notes (10 plus notes) since a simple thing was left off. That's fine and I'll gladly do it to get a Level 2. I'm also new so a review of my notes is understandable.

But I've been also asked to do addendum on one patient to document more in medical decision making to get a Level 3. It's a busy hospital and I'm alone at night admitting and cross covering. Ill certainly try to improve my notes but if they continue to ask me to update my notes after every shift so that they can get a level 3 billing, is that unreasonable of them? At other places I worked we got quarterly review of our notes but they wouldn't have us go back for every note they noticed (so far they have asked me to do an addendum to a few subjects in all of my few first shifts). Also, I'm a moonlighter, does that make a difference? Thanks

You'll learn what you need to get a L3 and, unless you're admitting a stable diabetic for ortho to see in the morning for their broken hip, pretty much anything, even a CPRO Obs can be a level 3.

 

[rokshana]

Related question to billing. How often does your admin/billing people ask you to go back and make addendum to your H and P notes to include something so it can get a higher code? Certainly a periodic review is fine and I understand they are focused on bringing in money but I've started moonlighting at a new hospital and for my first few shifts, they want me to go back and make an addendum on almost all of my notes (10 plus notes) since a simple thing was left off. That's fine and I'll gladly do it to get a Level 2. I'm also new so a review of my notes is understandable.

But I've been also asked to do addendum on one patient to document more in medical decision making to get a Level 3. It's a busy hospital and I'm alone at night admitting and cross covering. Ill certainly try to improve my notes but if they continue to ask me to update my notes after every shift so that they can get a level 3 billing, is that unreasonable of them? At other places I worked we got quarterly review of our notes but they wouldn't have us go back for every note they noticed (so far they have asked me to do an addendum to a few subjects in all of my few first shifts). Also, I'm a moonlighter, does that make a difference? Thanks

this should tell you something about the quality of your notes and that you are missing things on a regular basis...like gutonc said, there is rarely a reason that you shouldn't bill as a Level 3...if you are billing a level 1 for admission, then your ED is sending you people that shouldn't have been admitted to begin with...unless you are babysitting a pt for another service, you should be able to document for a level 3...

if they are asking you to add things that you didn't do, that's a different story but you probably are really doing the work, just not documenting it.

 

[DrSnips]

Try printing a pocket card with the billing criteria for level 1, 2 and 3. Cross out the parts for levels 1 and 2, you won't be needing those. Proceed to meet the criteria for level 3 for every note.