Volume and billing

[Iamnew2]

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Hey all,
How many patients do you guys typically see in a day?
Do your billers go with whatever you code or do they change billing codes ?

 

[lejeunesage]

20-24 inpatient visits 4 days per week.
Billers don't change the codes.

 

[PMR2008]

25-30/day. Either you have billers review your note and bill or you do it. Should not have a mix of both. If you are employed you might not have an option.

 

[Iamnew2]

25-30/day. Either you have billers review your note and bill or you do it. Should not have a mix of both. If you are employed you might not have an option.

That's what I'm very annoyed with - I'm on a guarantee now plus production eventually only production but they are ridiculous when they come to billing - I am having to address it because they change codes as they see fit - which I feel is inappropriate. I bill like the rest of my peers even within the same group and my codes get decreased but other people's dont. I'm like what the heck!?
Certainly wouldn't work to be on production but only with the codes they feel are appropriate. So absurd.

 

[Iamnew2]

20-24 inpatient visits 4 days per week.
Billers don't change the codes.

Sigh that's the way it should be. Can't believe this.

 

[RangerBob]

80-ish patients/week (roughly 18-24/day) currently

I tell my billing company the codes.

 

[lejeunesage]

Sigh that's the way it should be. Can't believe this.

Do the billers work for you or for the hospital?
I'm assuming for the hospital.

On one hand, I could see their changes be annoying. On the other, you're absolutely protected in case of an audit.

 

[runfastnow]

Mixed ortho/PMR practice.
70-80 patient visits per week, 15-20 spine procedures per week
In house billing department - they only touch the bill/codes if I really mess something up.

 

[DMBandFan86]

I have no way of coding any of my inpatient care, it is all done by coders. Of course, they bill/code off what I document.

Can you provide an example of this, hippa compliant? To review

If you are using coders, how are you also able to code your notes?

If you time-based billed then there shouldn’t be a way for them to down-code, unless you billed for more time in the day or something. If you bill on complexity then there is somewhat of a grey area. You should ask them why it was coded down and see what you have to do to keep it higher.

 

[Bostonspine]

That's what I'm very annoyed with - I'm on a guarantee now plus production eventually only production but they are ridiculous when they come to billing - I am having to address it because they change codes as they see fit - which I feel is inappropriate. I bill like the rest of my peers even within the same group and my codes get decreased but other people's dont. I'm like what the heck!?
Certainly wouldn't work to be on production but only with the codes they feel are appropriate. So absurd.

Have they given a reason for down coding? Some institutions downgrade everything to avoid audit(they only care about the facility fees). The other thing have had an internal audit of your actual notes I'm sure you do the work, but does the note reflect the level of complexity you are coding?

 

[Iamnew2]

Have they given a reason for down coding? Some institutions downgrade everything to avoid audit(they only care about the facility fees). The other thing have had an internal audit of your actual notes I'm sure you do the work, but does the note reflect the level of complexity you are coding?

I did tell them for example in this or that I’m billing based on time and your downside does not denote my over hour long visit, education etc. the coder tells me well I don’t see any notion of time based coding. I did notice some of my partners add a blurb saying I spent x amount of time so maybe I need to do that too. So lame though

 

[lejeunesage]

Yeah, I add a blurb at the end and state the time: 35 vs 50 vs 75 minutes, etc.

 

[Iamnew2]

Yeah, I add a blurb at the end and state the time: 35 vs 50 vs 75 minutes, etc.

Maybe I need to do that sigh

 

[DMBandFan86]

Yes you have to write how much time was spent.

Example H&P

“I spent 75 minutes in today’s encounter to include same day prep, face-to-face evaluation with patient, counseling, reviewing of admission notes, labs and discharge summary, ordering admission labs, orders and medications, discussion with hospitalist and writing of this note. Due to the above conditions, the decision was to continue inpatient hospitalization at the acute care rehabilitation level.”

 

[DMBandFan86]

Or progress note:

“ I spent 10 minutes on team conference today. I spent 35 minutes on a family conference today. Total time spent on today’s encounter was 65 minutes to include same day prep, evaluation of patient, coordinating care, discussion with case management and therapy, patient education, reviewing todays labs, adjusting medications, team conference and family conference.”

Or whatever variation you did that day.