[ttcbj]

My wife is a doctor at a major university. They are under pressure right now and are looking to increase revenue. Changing the way they document cases can substantially alter the billing outcome. Note that these are not errors, they are omissions of work done in the note that prevents the downstream billing experts from using higher paying codes.

They have been aware for a few years that many clinicians aren’t documenting their work in the best way for billing. The current solution is to have an annual talk given by the one billing expert in their department pointing out where people often lose revenue due to poor documentation.

Not all the doctors attend this talk. There is no internal process for measuring subsequent improvements quantitatively. There are 85 doctors in her group.

Anyway, this is just to say that something automated to help doctors document their work in a billing friendly way seems powerful. But for my wife’s group, the issue doesn’t seem to be denied claims or “errors” per se. More omissions/sub optimal documentation due to lack of knowledge. Or lack of follow through on knowledge which is only occasionally communicated.

[digitaltzar]

Thank you for the insights, I believe the challenge they have is related to CPT coding - not mistakes or errors, but the completeness' of clinical picture fro m the billing/insurance standpoint. A lot of this coding knowledge is tribal and resides in the head of clinicians. We can help, would greatly appreciate an introduction to your wife's colleagues at [e-mail] (Dmitry Karpov), thank you!

[ttcbj]

Thanks, I will ask my wife to ask the guy who gives the talks (their internal expert in billing matters) if he is interested and send him your email. Personally, I really think your solution has potential to help them, in the sense that they don’t have a sustainable/automated process for training clinicians to write notes in the correct way, or to detect issues when the clinicians don’t know or remember to do so. I know that meeting wasn’t perfectly attended, but even if it had been, they add like 8 new people at the beginning of July, and those people won’t attend the billing meeting until the next one happens in a year. The push for more revenue has been within the last month or so (I think maybe due to Trump related cuts to grant funding and concerns about Medicaid), so it’s an issue that is currently on the mind of leadership.

[jmcgough]

I'm a software engineer who's spent the last two years in the emergency department scribing before med school. I've only worked at a few hospital systems, but honestly baffles me how piecemeal EHR is, with everyone rolling their own customized implementation of Epic. Monitoring and error checking could have been solved a decade ago. And I agree that most doctors do an inadequate job of charting the work they do - I am sure I routinely miss things like critical care time, documenting heart scores, etc. There is sooo much to do and not enough time to not make billing mistakes on a daily basis. Additionally, many providers have limited insight into reimbursement rates (as they vary by insurance).

Our current approach seems to be quarterly newsletters that nudge people into adding something to their charts.

[cco]

I am not trying to be antagonistic, just earnestly trying to clarify.

The goal here of your wife's hospital is to try to increase revenue and the outcome, either AI assisted or not, is more accurate visit notes which leads to more accurate billing, which would lead to higher costs to the patient for the same medical care.

If that's right, I suppose a truer reflection of the medical care provided is a good unto itself, but I have to say I don't love the outcome as someone who's a patient and not a shareholder (401k notwithstanding).

[digitaltzar]

Thank you for these thoughts. I think billing inefficiencies caused by documentation make both hospitals and insures lose - one will get paid later, one will pay anyway, but the process is costly for patients who finance both, in the end of the day :(