Intro to billing

[soccerusa]

Advertisement - Members don't see this ad

Hi all,

I'm starting this summer in a highly RVU incentivized environment seeing a mix of solids and liquids including benign heme. I've essentially no experience with billing. How should one brush up in the last months of fellowship to be able to bill accurately from the get go?

Most of my academic attendings have no idea what they are doing from how they've described it ("just bill everything a level 4 so you don't get asked about it").

Any ideas much appreciated.

Thanks all!

 

[gutonc]

Hi all,

I'm starting this summer in a highly RVU incentivized environment seeing a mix of solids and liquids including benign heme. I've essentially no experience with billing. How should one brush up in the last months of fellowship to be able to bill accurately from the get go?

Most of my academic attendings have no idea what they are doing from how they've described it ("just bill everything a level 4 so you don't get asked about it").

Any ideas much appreciated.

Thanks all!

It's not really all that difficult. And the "just bill 99214", while common, is lazy and stupid.

My first job out of fellowship had you meet with someone in coding during orientation to go over the "catch phrases" that will help you get paid for higher codes, and then again after 1, 3 and 12 months to review up and down coded charts and explain why. My current job did an audit at 6 months and I had a meeting with them to discuss it as well.

If you use Epic, one of the recent updates (it went live for us this week, we tend to be relatively early adopters so I think this is the last update of 2025) has an AI coding tool that examines your note and recommends a billing code. It includes it's justification which is nice. So far I have agreed with it 80% of the time and felt like it upcoded a couple more times than it should have and down coded a couple of times. Like all things, it's a tool and if you don't know how to use it, you can certainly do some damage.

The good news as a noob is that it will take you so long to get anything done that you can just bill on time for the first 6-12 months.

 

[HemeOncHopeful19]

Get very familiar with the MDM charts

This is a pet peeve of mine when people don’t know billing after being top of their cohort academically their entire lives and suddenly learning this chart is just too much for them.

For example what qualifies as “intensive monitoring” - you need to do a LAB test, every quarter. So Lupron every 6 months would not count, Aromatase inhibitor would not count, but basically any pt on treatment who you see quarterly or more often and check labs for their treatment (Abi Pred for example) would qualify.

Get used to documenting when you discuss a case with an outside specialty will often bump up the coding in my experience (I may not have a liver cancer patient on treatment but it I call and discuss with IR for example that will often get you to a level 5)

I also try to make sure if I am actually addressing two issues that I document that even if one issue is the primary reason for their visit if you actually address something else then that can bump a level 3 to level 4. Example: I am seeing for thrombocytopenia and patient also happens to have fatty liver, if I am reviewing a CMP that day I document that I reviewed it and no evidence of progression (you are already doing the work you just don’t really think about it)