Background: Hospital Medicine continues to be a rapidly evolving field. Within our own institution, 15-20% of our graduates in the Internal Medicine Residency Program in recent years have pursued careers in hospital medicine. Although hospitalists and residency program leaders recognize the importance of clinical documentation and accurate coding, curricula to teach the basics are lacking at many academic centers. Studies have stressed insufficient training for residents regarding billing and coding. Garcia et al (2017) suggested that 82% of residents do not receive adequate training for billing and coding. Medicare and private insurers do not discriminate between overcoding and underdocumentation, and with it come steep financial penalties during an audit. Failing to properly bill and code, even if unintentional, is considered “healthcare abuse” since it is failing to adhere to accepted billing/coding practices.

Purpose: According to the Society of Hospital Medicine, billing and coding, are foundational concepts necessary for any hospital medicine practice. Our purpose is to share our new billing and coding curriculum created for our residents pursuing careers in hospital medicine.

Description: The billing/coding curriculum was launched in 2019 and embedded into our 1-year Hospital Medicine Pathway during the PGY-3 year for up to four selected residents. During the PGY-3 year, residents rotate as a cohort working one-on-one with faculty hospitalists on a 4-week “Junior Hospitalist” block. During the block, there are twice-weekly hospital-medicine focused didactics on various topics, including billing/coding. The billing/coding and documentation curriculum reinforces retention of the subject matter through weekly mock History and Physical Examinations (H&P) and progress notes that are completed with their assigned attending. Faculty and residents have access to our “Billing/Coding for Beginners” guide that they can refer to at any time. A detailed answer sheet for each mock case is subsequently sent out to the residents and faculty a week later. To further solidify the educational content, each week each resident does a practice bill and code on 5 of their progress notes to be reviewed by faculty. Our curriculum was created with the assistance of our Director of Billing Education, and consulting the American Academy of Professional Coders guide, “Advanced E/M Auditing”.Topics covered by the weekly mock H&P/progress notes include:Billing a level 1 (99221) vs level 2 (99222) vs level 3 (99223) for H&PsBilling a level 1 (99231) vs level 2 (99232) vs level 3 (99233) for subsequent careUnderstanding time-based billingProlonged Billing (face to face time)Non face-to-face timeAdvance Care PlanningCritical Care TimeBilling for a Discharge Summary

Conclusions: It is important for residents pursuing hospital medicine to receive training about billing/coding and documentation during residency because they ultimately affect reimbursements to the health care system and health care costs to patients. Our post-billing/coding curriculum survey (n=8) demonstrated that prior to this curriculum, 100% strongly agreed that they received little to no formal billing/coding training, and after this curriculum 100% felt more comfortable with the inpatient billing/coding process. Since our curriculum was recently launched, we recognize that there are limitations to our data due to a very small sample size. Despite our limitations, the curriculum is promising in filling this needed educational gap in residency.

IMAGE 1: Link to see sample cases