Background: There is minimal automated electronic feedback to hospitalists about their level of service in professional billing. Based on today’s payor requirements for inpatient admission, the medical decision-making involved in the care of inpatients almost always justifies a level of service above level 1. However, encounters may still receive level 1 due to under-documentation (e.g. [...]

Background: Accurate coding is paramount to hospital revenue generation and is often supported by a clinical documentation integrity (CDI) team made up of registered nurses and non-clinical coding personnel. Physician-led coding initiatives have demonstrated improvement in case-mix index and clinical documentation. We hypothesized that physician integration into CDI would result in a more robust improvement [...]

Background: The US has the most expensive healthcare system globally.1 Recent claims have raised concerns that hospitalists may be in part contributing to higher levels of high intensity billing over time through upcoding.2 However, there is little empirical evidence on this topic. As the number of hospitalists continues to grow and hospitalists disproportionately care for [...]

Background: The proportion of high-level bills submitted by our hospital medicine group was lower than national averages as reported by the Clinical Practice Solutions Center (CPSC). This did not seem to align with the complexity of patients at our level 1, safety net hospital in a busy urban location. The purpose of our project was [...]

Background: The importance of accurate patient documentation for effective medical communication and financial compensation is well-documented. However, appropriate medical billing based on medical documentation is not emphasized in graduate medical education. We performed a review and analysis of resident charting errors during inpatient rotations to improve documentation and billing skills. Methods: A retrospective study was [...]

Background: In the hospital care setting, clinician groups employ a range of staffing models utilizing physicians as well as advanced practice providers (APPs), to meet patient care needs. Models have evolved in recent years in part due to pandemic related staffing constraints; proposed policy changes to billing practices may also be contributing. The Centers for [...]

Background: On October 1, 2007, Medicare changed their payment structure from Diagnosis Related Group (DRG) to Medicare Severity-Diagnosis Related Group (MS-DRG) based reimbursement. This led institutions to prioritize clinical documentation improvement (CDI) programs in an attempt to align healthcare resources with patient complexity. Complete documentation has other benefits to a healthcare system as well. These [...]

Background: On January 1st, 2023, the AMA released updated CPT E&M codes and guidelines. While there were welcome aspects to these changes – including removing need for an extensive physical exam and making it easier to capture prolonged service time – healthcare systems were left grappling with a need to quickly respond to these complex [...]

Background: At academic institutions and other referral centers the process of accepting transfers from other hospitals has been a challenging and potentially laborious process to coordinate smoothly. It was also one that was not previously reimbursable. However, beginning in 2017 Medicare and other insurance companies began reimbursing Non-Face-to-Face Prolonged services procedural codes. These new codes [...]

Background: For academic hospital medicine groups to thrive and be partners with their hospital systems, physicians must document and bill appropriately as a means of demonstrating their clinical value. Yet, many major academic hospital medicine groups may be unaware or receive little training for this very important skill set. Based on data from the Society [...]