Family physicians receive outstanding education in a broad range of areas such as internal medicine, obstetrics, pediatrics, and other disciplines. However, changing insurance and governmental rules and regulations have increased the complexity of family practice medical billing and coding and physicians need to look for ways to maximize their reimbursements.
The aim of family medicine is to provide patients with a personal medical base through which they receive a full range of acute, chronic, and preventive care services including ancillary procedures and minor surgical procedures. But studies have found narrowing in the scope of family practices due to factors such as changing practice patterns including physicians’ age, employer restrictions, or generational choices. For instance, physicians’ approach to medical practice has changed and many are working relatively fewer hours, seeing relatively fewer patients, and are limiting access to their practices.
A study in JAMA indicates that this scenario may change. The researchers found that graduating family medicine residents intend to widen their scope of practice compared to current family physicians, including for prenatal care, inpatient care, nursing home care, home visits, and women’s health procedures. In other words, their findings suggest that graduating family medicine residents intend to provide a broad array of care commensurate with their training.
Researchers of the American Board of Family Medicine collected data from a practice demographic questionnaire completed by all individuals applying to take the American Board of Family Medicine (ABFM) Maintenance of Certification for Family Physicians examination. The aim was to identify components of care that are at the heart of the practice of family medicine by evaluating gaps between the intended scope of practice of residents and actual scope of practice of family physicians.
The final sample included 13,884 family physicians. Initial board certifiers reported intentions for scope of practice and recertifying family physicians reported actual provision of specific clinical activities. The Scope of Practice for Primary Care score (scope score), which ranged from 0 to 30, was calculated for each physician, with higher values indicative of broader scope of practice. The researchers found that:
- The average scope score was 18 for initial certifier intended practice which was significantly higher compared to 16 for recertifying physicians’ reported actual practices
- Compared with recertifiers, initial certifiers were more likely to report intending to provide all clinical services asked except pain management
- The recertifiers vs. initial certifiers average scope score for obstetric care was 24 percent vs 8 percent, for inpatient care – 55 percent vs 34 percent, and for prenatal care – 50 percent vs 10 percent
- Similar differences from initial certifiers were seen when comparisons were limited to recertifiers in practice for only 1 to 10 years.
The widening of scope of practice by family physicians could have many benefits such as lower overall health care costs and reduced hospitalizations, as well as increased availability of services in physician shortage areas. The researchers conclude that tracking the intentions of initial certifiers over time may make it possible to correlate them with health system reforms or alterations in family medicine residency training requirements. Following the new family physicians’ practice patterns could determine whether the intentions of initial certifiers have materialized and, if not, why.
Billing for family practices will become even more complex when they provide a broader array of services. ICD-10-CM has brought about definition changes, terminology differences, and increased specificity. Proper clinical documentation is crucial for communicating the purpose of an encounter, confirming medical necessity, and providing the details to support the selection of the ICD-10 codes. Moreover, knowledge about how to code ancillary procedures and minor surgical procedures is also crucial. The best option for family physicians would be to rely on a professional medical billing and coding company for insurance verification, timely claim submission, and collection of patient reimbursements.