The 4 REASONS Why Doctors NEED to Understand CORRECT Billing & Coding!

The basic reason for doctors to understand billing practices is simple - this is how they get paid!

Yet, this system is constantly changing both from the doctor's and patient's perspective. When doctors don't keep up, they miss out on compensation on their side and clarity from the patient's side.  

Here are the top 4 reasons all healthcare professionals need to learn how to bill CORRECTLY for their services:

1: It’s complicated - and changing fast!

Today, fee-for-service (FFS) reimbursements are still the primary way doctors get paid. In other words, for every patient you see and for every procedure you do there is a diagnosis and a CPT code that must be used correctly to code for that service. 

This system can be tough enough to master, however, captiation and other 'performance-based' reimbursement models are gaining traction in medical reimbursement. With such initiatives as MACRA in Medicare, we are seeing a new phenomenon where reimbursement for medical service is becoming tied to the quality of service and severity of illness. 

So, unlike the FFS model, reimbursement will be tied not only to doing a particular service, but also how well that service was performed. As you might imagine, documenting how well a treatment was performed could get really complicated, really fast!

One instance of this new standard is the Hierarchical Condition Category (HCC) heading in Medicare, which enables it to pay more for certain disease groups which are categorized under this new heading. What it means is that it is of utmost importance to recognize these condition and code them correctly during visits. 

Not being aware of these new changing quality and severity standards, in addition to the existing FFS reimbursement structure, means that a lot of doctors miss out on a lot of reimbursement.

2: Doctors who don't understand billing VOLUNTARILY miss out on reimbursement.

One of the biggest problems facing doctors, especially newer ones, is UNDERCODING!

That's right, many newer doctors are afraid to do something wrong and figure it’s better to code for a lesser level of service, just to avoid mistakes!

But the truth is that most doctors, especially those using Electronic Health Records, tend to actually over-document thereby easily meeting requirements for higher level of service.

While it’s important to differentiate between cutting and pasting information from previous notes from actually documenting what happened during the encounter, there is NO REASON to under code just to “play it safe”.

Instead, with a proper understanding of billing and coding, doctors should confidently bill for the CORRECT level of service so they don't miss out on compensation!

3: Doctors constantly miss billing for additional services.

Many physicians forget to bill for procedures they do in the offices such as urine analysis, vaccine administration fee, ear lavages, and even EKGs. While these charges may seem small, over the course of a year they certainly add up - and there is definitely no reason to miss out on compensation for something you are already doing!

For instance, it’s common for physicians with elderly patients who had chest X-ray done for have an incidental finding of "tortuous aorta”. This finding should result in an extra code and itemized service for which to be reimbursed, but many doctors miss this. 

4: When the doctor understands billing, so can patients!

As much as understanding correct billing & coding practices is about maximizing reimbursement and compensation for the doctor, in the long run it will help patients too!

Here's why: As we have said in the past, we believe that it's the doctor's responsibility to help their patient's understand the financial side of their medical care, too. If patients understand what they are paying for and why they will ultimately be happier when it comes time to pay for their medical treatment, especially in our current high-deductible PPO world! 

And a doctor simply cannot adequately explain the financial side of a patient's medical care when the doctor does not understand the ins and outs of the billing process! When a doctor doesn't know exactly how his or her services and services ordered, like lab tests, will translate to the patient's bill, he or she cannot truly help those patients navigate the financial aspect of their care. 

Those are the 4 key reasons WHY all physicians and healthcare professionals should understand billing & coding.

As far as learning the WHATS and HOWS of medical billing & coding, we present The Financial Blueprint Seminar for Medical Professionals, where we teach EVERYTHING doctors need to know to be able to bill & code CORRECTLY for their services.

For more details about events near you, please go to!


The Financial Blueprint Seminar for Medical Professionals

Coming to the NYC AREA - June 16-17th, 2018

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