Developing a Billing and Coding Curriculum for Family Medicine Residents Maggie Riley, M.D. Joel J. Heidelbaugh, M.D. University of Michigan Department of Family Medicine

Practice Management 100 hours required by Fam Med RRC 100 hours required by Fam Med RRC –Includes unspecified amount of time on billing Residents from most fields typically have little formal billing and coding education Residents from most fields typically have little formal billing and coding education –2/3 of Family Medicine graduates feel unprepared for managing a practice, including accurate billing Residency Review Committee in Family Medicine. Available at: Breitwieser D, et al. J Fam Pract 1981;13:1063-4

Billing and Coding 1/3 of office visits undercoded 1/3 of office visits undercoded Downcode 1 office visit per day Downcode 1 office visit per day – –$63.73 for a visit – –$96.01 for a visit –Yearly revenue loss of $ King MS, et al. J Am Board Fam Pract 2001;14(3): Medicare Utilization for Part B. Centers for Medicare & Medicaid Services. Available at:

Primary Care Exception “Teaching physicians providing E/M services with a GME program granted a primary care exception may bill Medicare for lower and mid-level E/M services provided by residents.” CMS definition available at:

Primary Care Exception Attending physicians do not need to see the patient if the resident bills a level 3 or below. Attending physicians do not need to see the patient if the resident bills a level 3 or below.

“10 Billing and Coding Tips” 6 lecture series 6 lecture series Chart reviews Chart reviews Heidelbaugh JJ, Riley M, Habetler J. 10 Billing and Coding Tips to Boost Your Reimbursement. J Fam Pract Nov;57(11):

99213 vs Initial one hour lecture Initial one hour lecture Ongoing theme at every lecture Ongoing theme at every lecture Highlighted through chart reviews Highlighted through chart reviews Spirit of accurate billing emphasized Spirit of accurate billing emphasized

Lecture Series –Level 3 vs level 4 established patient –Modifier -25 to bill HME or procedure + E/M office visit –“Welcome to Medicare” physical and Medicare preventive services –Coding for common skin procedures –Level 4 new patient, level 5 visits –Billing based on time

Goals of curriculum Increased resident comfort with common billing and coding topics Increased resident comfort with common billing and coding topics Improved accuracy of resident billing Improved accuracy of resident billing

Measures of success More accurate billing as evident in chart review More accurate billing as evident in chart review Change in percentage of pre- and post- intervention Change in percentage of pre- and post- intervention –Compared to faculty and MGMA benchmark data Improved resident satisfaction Improved resident satisfaction –Post-graduate survey

Future Directions Increased focus on chart reviews Increased focus on chart reviews Intensive billing and coding intervention with faculty preceptors Intensive billing and coding intervention with faculty preceptors

References 1) Residency Review Committee in Family Medicine. Available at Accessed Sept 4th, ) Residency Review Committee in Family Medicine. Available at Accessed Sept 4th, ) Breitwieser D, Wallace A, Arvidson M. Resident evaluation of current practice management training. J Fam Pract 1981;13: ) Breitwieser D, Wallace A, Arvidson M. Resident evaluation of current practice management training. J Fam Pract 1981;13: ) Howell J, Chisholm C, Clark A, Spillane L. Emergency medicine resident documentation: results of the 1999 American Board of Emergency Medicine in-training examination survey. Acad Emerg Med 2000;7: ) Howell J, Chisholm C, Clark A, Spillane L. Emergency medicine resident documentation: results of the 1999 American Board of Emergency Medicine in-training examination survey. Acad Emerg Med 2000;7: ) Williford LE, Ling FW, Summitt RL Jr, Stovall TG. Practice Management in obstetrics and gynecology residency curriculum. Obstet Gyenecol 1999;94: ) Williford LE, Ling FW, Summitt RL Jr, Stovall TG. Practice Management in obstetrics and gynecology residency curriculum. Obstet Gyenecol 1999;94: ) Fakhry SM, Robinson L, Hendershot K, Reines HD. Surgical residents’ knowledge of documentation and coding for professional services: an opportunity for a focused educational offering. Am J Surg 2007;194: ) Fakhry SM, Robinson L, Hendershot K, Reines HD. Surgical residents’ knowledge of documentation and coding for professional services: an opportunity for a focused educational offering. Am J Surg 2007;194: ) King MS, Sharp L, Lipsky M. Accuracy of CPT evaluation and management coding by family physicians. J Am Board Fam Pract 2001;14(3): ) King MS, Sharp L, Lipsky M. Accuracy of CPT evaluation and management coding by family physicians. J Am Board Fam Pract 2001;14(3): ) Medicare Utilization for Part B. Centers for Medicare & Medicaid Services. Available at: Accessed June 25, ) Medicare Utilization for Part B. Centers for Medicare & Medicaid Services. Available at: Accessed June 25, ) CMS Primary Care Exception: 8) CMS Primary Care Exception: 9) Heidelbaugh JJ, Riley M, Habetler J. 10 Billing and Coding Tips to Boost Your Reimbursement. J Fam Pract Nov;57(11): ) Heidelbaugh JJ, Riley M, Habetler J. 10 Billing and Coding Tips to Boost Your Reimbursement. J Fam Pract Nov;57(11): ) Mulvehill S, Schneider G, Cullen CM, Roaten S, Foster B, Porter A. Template-guided versus undirected written medical documentation: a prospective, randomized trial in a family medicine residency clinic. J Am Board Fam Pract. 2005;18(6): ) Mulvehill S, Schneider G, Cullen CM, Roaten S, Foster B, Porter A. Template-guided versus undirected written medical documentation: a prospective, randomized trial in a family medicine residency clinic. J Am Board Fam Pract. 2005;18(6): ) Sprtel SJ, Zlabek JA. Does the use of standardized history and physical forms improve billable income and resident physician awareness of billing codes? South Med J. 2005;98(5): ) Sprtel SJ, Zlabek JA. Does the use of standardized history and physical forms improve billable income and resident physician awareness of billing codes? South Med J. 2005;98(5):524-7.