tag:blogger.com,1999:blog-1640145326942707855.post1535909938029844160..comments2023-11-02T08:54:33.024-07:00Comments on Throckmorton's other signs: Medical Coding and Billing and String TheoryThrockmortonhttp://www.blogger.com/profile/12362147065452723155noreply@blogger.comBlogger4125tag:blogger.com,1999:blog-1640145326942707855.post-61970033576121922532017-11-06T20:53:47.614-08:002017-11-06T20:53:47.614-08:00awesome post presented by you..your writing style ...awesome post presented by you..your writing style is fabulous and keep update with your blogs.<br /><br /><a href="http://institutesformedicalcodingandbilling.com/" rel="nofollow">Institutes for medical coding and billing</a><br />poojahttps://www.blogger.com/profile/18171043892615499297noreply@blogger.comtag:blogger.com,1999:blog-1640145326942707855.post-49273032758457826692008-12-15T02:58:00.000-08:002008-12-15T02:58:00.000-08:00Amen, Throckmorton! I say let's all go back to fee...Amen, Throckmorton! I say let's all go back to fee for service and have everyone just carry catastrophic care insurance. It gets even worse! Insurance companies will take a physician's billing statements and put it in a spreadsheet to see how many 99212s,99213s and 99214s etc have been billed, and if the "spread" falls out of the norm, (like too many 99214s) they may be audited. This happened to a colleague of mine, and they actually made her pay back money the insurance company said she owed them because her chart notes didn't justify her charges. Sometimes it was just because she didn't put "face to face time" counseling/coordinating care for the patient - because if you are not coordinating the care IN FRONT OF THE PATIENT, you can't bill for it!!! (Imagine if lawyers had to be present in front of their client in order to bill them! Why the double standard?). But she got off easier than if the government was involved. I believe they can fine a doc $10,000 if their chart is audited and does not pass the mustard! So what I do, and a lot of docs do this, is we "undercode" just in case we are audited for fear that our documentation is missing one key element and we are accused of overcharging the Medicare!!!mercydochttps://www.blogger.com/profile/08941215640600286255noreply@blogger.comtag:blogger.com,1999:blog-1640145326942707855.post-77247649595520938832008-11-24T22:30:00.000-08:002008-11-24T22:30:00.000-08:00Throckmorton... I didn't think I could possibly re...Throckmorton... I didn't think I could possibly respect doctors or empathize/sympathize any more than I already do... but after reading those tables... I do.<BR/><BR/>Does it all get memorized, although I am assuming tables change accordingly. As far as I am concerned y'all should be getting paid for the 99214 anyway because even the 99213 is involved.<BR/><BR/>And when MDCR sees docs consistently going for the higher severity...they'll find a way to knock it down. Unless this stuff is a carved in stone standard.<BR/><BR/>I have to tell you... I had no idea...this was so involved. But my experience with coding is after the diagnoses have been made and was more generalized for the ED and I imagine that even that has gotten more specified now that trained coders took it over. Although...we still did the OP codes.<BR/><BR/>And when do physicians learn all this? On the job?<BR/><BR/>Btw... the pt with bilateral knee pain on increased NSAIDS has to come in every two months for a cbc and renal screening? and NSAIDS can cause HTN? All a moot point because I "try" to take I-buprofen sparingly. But it is one of the best drugs ever created in my opinion. <BR/><BR/>What exactly does i-buprofen do to the kidneys? I know it's not good and my urologist prefers that I not take it and so he knows I take it minimally. I have to remember to ask him WHAT it does that could compromise the kidneys.<BR/><BR/>Anyway... 500 word essay notes? for routine visits? just don't forget...go for the 99214! :)<BR/><BR/>Lawyers definitely seem to have it made! I think it is wrong that physicians are becoming more and more micromanaged. I know there has to be checks and balances... but how did doctors treat patients and get paid prior to all this detail?<BR/><BR/>I think it is sad that you seemingly get paid for documentation vs patient care. It really is a Business. I prefer to think of it as skilled and caring doctors looking out for their patients and it bothers me to think how much you all have to look out for your own interests 24/7 because their is potential for loss on all fronts.<BR/><BR/>You work in such an honorable profession... it just doesn't seem right that you have to deal with all this extraneous minutia vs hands on with the patients. <BR/><BR/>I mean you go into medicine... presumably to help patients and yet that patient care time is challenged and so is your paycheck because so much time has to be spent with all the regulation, rules and cya against lawsuits.<BR/><BR/>You need a reliable middle person to handle all that so you are freed up to practice more medicine... but I guess it all still comes back to the physician.<BR/><BR/>The average person doesn't have a clue about these things. I didn't until I began wandering through the med blogasphere and have learned a lot... although... I feel frustrated for all of you and as a patient... feel concerned for the future of medicine, i.e., will students continue to seek out medical careers? Will even my favorite docs get burnt out? Will the quality of medicine be compromised?<BR/><BR/>I am a hands on person. I would hate not having full knowledge of something printed out in notes that was representative of what I diagnosed, nor would I be happy with not having easy access in a timely readable version. There's always a trade off. <BR/><BR/>Andrew said"Maybe you can write down the keywords and a bit of explanation about the exam and keep it in a folder somewhere, for each patient." I think that is a good idea, but if course...additional work. <BR/><BR/>* I see that the Independent Urologist has a short post up on how to convert an EMR from a cost to a profit center.SeaSprayhttps://www.blogger.com/profile/07906503090688697222noreply@blogger.comtag:blogger.com,1999:blog-1640145326942707855.post-54400796575823081402008-11-19T18:28:00.000-08:002008-11-19T18:28:00.000-08:00The solution to this is like the one for the tax c...The solution to this is like the one for the tax code: programs to take the simple data and fill out the complicated forms.<BR/><BR/>You will reduce your practice to a set of your own keywords. The software will translate and integrate the keywords, looking for the best presentation to maximize payment to you.<BR/><BR/>Any notes will be generated in a way similar to home inspection software. Again, a few keywords will generate a 500, 1000, or 4000 word note, as you wish.<BR/><BR/>This standardization has some regrettable defects. You wont be able to read either your billing descriptions or your clinical notes, being that they are so long.<BR/><BR/>Maybe you can write down the keywords and a bit of explanation about the exam and keep it in a folder somewhere, for each patient.Andrew_M_Garlandhttps://www.blogger.com/profile/02855052302054611917noreply@blogger.com