Background: Medical training often lacks formal education on accurate documentation for billing and coding. Studies show residents are aware of their lack of knowledge and have a desire for more training[1-4]. Consequently, attending physicians lack confidence in billing and coding and also desire further education [5]. However, there is a paucity of studies on effective attending education. We present results of a novel peer education pilot program utilizing provider specific billing data implemented with internal medicine hospitalists at one institution.

Methods: The pilot project aimed to increase appropriately coded hospital encounters billed by the pilot hospitalists to greater than 70% as measured by documentation. Standard deviation (SD) of usage was assessed as a measure of variance for the specific billing codes as a secondary outcome. Clinical denials were used as a balancing measure. An audit of the department billing was completed and providers were compared on de-identified graphs. The authors (JW, CM) were trained in billing and coding accuracy and implemented a 90 minute presentation that reviewed billing and coding documentation requirements. Provider revenue cycle data and actual notes for examples were included. Each participating provider was assessed for prior billing education, billing confidence, and perceived knowledge with a pre and post survey. At one and two month follow up, targeted feedback was given focusing on documentation support for billing codes.

Results: Nine hospitalists were included in the pilot program with 2 to 7 years work experience. Fifty percent reported prior billing education. One month after education, 100% of the reviewed documentation (20 notes) accurately reflected the associated billing code. Standard deviation for level 3 billing codes overall decreased but was not statistically significant (Figure 1, Table 1). Specifically for the initial level 3 code, (99223), SD decreased from 0.163 to 0.125 and the subsequent level 3 code (99233) SD decreased from 0.232 to 0.187. Pilot group billing showed an increase in level 3 codes (table 1). This change reflected an approximate $60,000 increase in monthly revenue for the department. There was an overall decrease in clinical denials from 1.43% to 1.28%. Post- survey found 100% of the hospitalists found the education helpful and 100% felt their knowledge increased. Education series was expanded to entire hospitalist group with results pending. The model was adapted for pediatric hospitalists with series ongoing and data expected March of 2022.

Conclusions: Our peer-to-peer education model demonstrates the successful use of provider specific examples and provider specific billing information with targeted feedback. Specifically, we found improved accuracy with decreased variance in billing across all participating providers. Additionally, the model allowed us to engage with divisions and departments intra-institutionally to improve financial representation of work performed by providers through billing and coding. This model may similarly be of use to other institutions.

IMAGE 1: Comparison of CPT Code Usage Percentages and Average Standard Deviation Pre and Post Education

IMAGE 2: CPT code percentages by Attending in Pilot Group