This independent emergency physician group from the LA area had been at their hospital for years when, as a result of the 1982 Tax Equity and Fiscal Responsibility Act (TEFRA), they could no longer bill professional component services to Medicare as part of their facility claim. Like all groups in that era, they were forced to separate out their billing and start doing it on their own. Back then, most emergency medicine practitioners were either compensated or employed by hospitals, so the idea of doing their own billing was a radical new concept.
By the late 80s, the billing arrangement between the group and their hospital-designated biller had deteriorated badly, with neither party particularly happy with the other. To make matters worse, another billing operation, run by the hospital in a separate arrangement, was also foundering and on the verge of failure. Against this backdrop of struggle and disappointment, practice leaders contacted our founders, Del and Jane Brault.
The couple, who had retired not long before, agreed to come back and take over the client’s billing operations. A joint venture between the Braults, the practice, and their hospital ensued, and all parties enjoyed mutual success. Around 2007, the group sold its interest to the Braults and became just another of Brault’s billing clients, with no special privileges or interests. Free, in fact, to contract with any billing company they chose. Yet, they saw no reason to change.
Fast Forward to 2017
The physicians who originally retained Brault for billing are almost all retired now, replaced by a new generation of ambitious young doctors with no knowledge of the group’s history or previous ties to Brault. In time, they did what any prudent, cost-conscious practice should do: take a good hard look at the billing operation to determine whether they could do better elsewhere.
After a comprehensive assessment of our processes, best practices and financial results, management acknowledged the value we’d been bringing all those years. They not only continued retaining us for coding and billing (after more than 25 years), but also dramatically increased our role in advising and managing their practice.
Among the first problems we noticed in our expanded advisory capacity were rampant documentation deficiencies, stemming from inconsistent recording practices and difficulties navigating the electronic medical records (EMR). We observed that several doctors, though attempting to be thorough, were recording billable information in the wrong place. And, even on occasion, forgetting to document critical procedures, differential diagnosis, or create a robust HPI. All of these miscues had financial implications, but fortunately, all were correctible with proper guidance and training.
Intelligent Practice Solution: Physician Education
To increase their personal awareness and help physicians self-correct, we implemented a documentation improvement plan that taught them what to look for, how they could improve, and methods for monitoring and measuring their own progress. Elements of the plan include:
Performance Reporting. To help physicians monitor and improve their individual performance, we developed a monthly report that shows documentation errors, including type and frequency, along with amount of charge lost that month due to mistakes in data recording. Group leaders also receive a similar report for the whole practice.
One-on-One Training. Because we also track each physician’s documentation habits, we are able to notify them individually when problems occur, and offer to set up a one-on-one review of their actual EMR charts. Doctors simply go to the internet, check trainer availability, and schedule a session that fits their busy schedule. The process and the feedback are very specific and very granular.
Monthly Business Meeting. As the group’s practice management advisor, we have instituted a regular time each month to go over key performance indicators–theirs and ours–to identify victories and successes, and areas where improvements are needed. This helps keep everyone accountable for the group’s success, and shows practice leaders the high level of value and support Brault contributes every month.
Outcome and Results
Practice leaders report overall improvements in the quality and consistency of physician documentation, resulting in a more stable and predictable monthly revenue flow. Most doctors have embraced and appreciate the reminders they receive, and have responded favorably to their one-one-one documentation reviews.
“I don’t know many relationships in emergency medicine that have lasted longer than our ties to Brault. It’s amazing. Thirty years and they’re still helping us get better.”
— Practice leader