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by Jarrod Shapiro, DPM
Joined practice July 2006 of
John K. Throckmorton, DPM
Lansing, Michigan |
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I’ve been writing the New Docs on the Block editorial for almost two years. During this time I’ve maintained an essentially positive view of practicing podiatric medicine. In fact, I still feel very positive about practicing podiatry. It’s a very satisfying field that provides enough variety and challenges to keep me interested. However, nothing is perfect, and I would be remiss if I never discussed any of my problems or mistakes. As such, I want to discuss what I consider to be my biggest mistake as a new doc and as an associate to another physician. This editorial is most applicable to those of you new to practice, but is a cautionary note to anyone practicing medicine as someone else’s employee.
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My biggest mistake is this: don’t trust that your practice income and billing is being handled correctly.
Let me say at the outset that my relationship with my current employer is excellent and has remained so the entire time we’ve known each other. My boss is a very fair person who has treated me respectfully at all times. However, my boss is the classic physician, which is a poor businessman. When it came to billing
he kept this in-house rather than using a billing company. Relying on one of the staff to function as our biller he was able to save a little money by not outsourcing the billing.
However, our biller was never formally trained and has missed years of errors, even prior to my arrival to the practice.
Toward the end of my first year of practice I started pulling reports to see exactly how much money I’d been bringing into the practice. I had pulled reports periodically but never analyzed them in any detail. During my analysis I found that I was bringing in a lower percentage in comparison to my employer. For example, when I compared the dollar amount I was being paid by insurances in comparison to my boss it was significantly less. When I investigated deeper I found out three important things:
- When I billed for an E&M code and a palliative care code together (especially for hospital consults), I would be paid for the palliative code and not the E&M. The billing error here was the staff was not using modifiers for these claims. As a result I would be paid for the palliative care code and not the E&M code. My boss never billed for palliative care codes, only billing the E&M, so was paid more for these patients than I was. In essence, we were both undercoding what we’d been doing. Technically, he was also overcoding the follow-up patients whom had only palliative care performed.
- My boss was grossly overcharging for wound care debridements. He would charge $350 for the 11042 code, which actually pays significantly less. Now, you can bill whatever you want, but you’ll only get paid what the insurance companies contract to. What this does is overinflate your gross receipts. So, for example, if you billed out a theoretical $350,000 in a year (for 1000 debridements) – the gross charges—you may only get paid $65,000 (1000 debridements at $65 actual reimbursement)- the net income. In this case your gross looks a lot better than your net.
- Our biller never pursued claims that were rejected. She was essentially entering the information and sending the primary claim but not pursuing secondary claims at all. It’s common for claims to be rejected for a variety of reasons, and it’s important to resubmit these claims and try to get paid. It takes a team to run a practice, and in our case, it took a team to make these mistakes. Of course the bottom line blame is mine because I did not keep more careful track of our billing from the start of my associateship. Now, almost 2 years from my start in practice we’re still figuring out the kinks. At my urging, we now have a professional billing company assisting us with the billing which has helped greatly. However, I can only guess the actual dollar amount I’ve lost to billing errors, and I cringe at the thought of the money my boss has lost over his practice life of almost 30 years.
My recommendations to all of you who are about to graduate your residencies, in fact all residents, is to first learn correct billing methods. If your program does not teach this then take one of the seminars. ACFAS offers a billing/coding seminar. Then when you’re in practice keep a careful eye on your billing. It’s a lot of work, but you should create an Excel spreadsheet or database that covers your billing. The bottom line is it’s your income, so you’re responsible for it. Learn from my mistake and carefully monitor your billing and income generation practices. Best wishes.
Jarrod Shapiro, DPM
PRESENT New Docs Editor
[email protected]
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