ED Coding & Reimbursement Alert - 2003 Issue 8
CODING: If You're Downcoding on Purpose, You're Burning Cash
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Article Overview
This piece looks at why some physicians underbill out of fear of audits and fraud investigations, and how that practice can affect revenue and compliance. It is aimed at physicians, coders, compliance staff, and practice managers who want a general discussion of documentation, office-visit evaluation concepts, and the risks of billing below the supported level.
Why This Topic Matters
It helps readers understand the business and compliance implications of conservative billing and why documentation support matters when selecting a level of service.
Article Sections
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Survey findings on conservative billing behavior
Summarizes survey results about how often physicians bill below what they believe is supported and why they may do so.
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Financial impact of downcoding
Discusses the revenue effect of consistently billing at lower levels than documentation may support.
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Compliance concerns and documentation support
Reviews the article's broader compliance theme, including the need for documentation to support the chosen level of service and the risks associated with inaccurate billing.
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Office visit documentation elements
Covers the general components used to support office visit coding and how multiple clinical issues may affect service level selection.
What You Will Learn
- Why some physicians deliberately bill more conservatively than they believe is warranted
- How conservative billing can affect practice revenue
- What general documentation elements are discussed for office visits
- Why documentation support is tied to compliance risk in evaluation and management billing
Who Should Read This
- Physicians
- Medical coders
- Compliance staff
- Practice managers
- Billing staff
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