Sensitive CPT Coding

Sensitivity Analysis teaches us to ask, “what if”…. This article shows how to answer the question – what if I invested in E&M Coding training? Calculating EM Bell curves is common practice to compare a practitioner’s coding pattern to others of the same practice specialty .The primary purpose of such an exercise is to identify potential areas to focus chart audits to verify supporting documentation which then allows a practice to target its plan for compliance education and training. And, in a world of declining reimbursement and increasing staff workloads, how in the world can we afford the time and money for education? Sometimes the answer is that training pays for itself, as was the case with one MedMan client who asked us to do a sensitivity analysis.

We used a simple method to estimate revenue summarized in the table below:

(Data is not actual – numbers are for illustration only)

We estimated the current reimbursement for Established Patient E&M codes (Column 9). We then measured the “sensitivity” to a change in volume – asking “ what if” the practice mirrored the CMS database distribution (Column 3 ) at the 2017 level of Medicare reimbursement (Column 8), resulting in a new estimate of Revenue (Column 10 ( actual reimbursement will vary based on payer mix ). The estimated revenue opportunity shown in Column 11 was just over $36,000.

The cost of training was estimated by contacting several companies specializing in training clinicians on chart documentation. Approaches and costs vary and can be customized by one of MedMan’s strategic partners. The approach used in this analysis was to conduct on – site training using chart documentation from actual practice encounters. The estimated cost was $9,500.

This is one of the many tools and approaches used by our staff at MedMan - contact us if you are interested in other ways we improve practices and the lives of physicians.