Primary care physicians play a major role in delivering definitive care to patients at the point of first contact and continue taking responsibility for the same. They provide care for a wider range of health conditions than most specialists do, thereby introducing a high level of complexity into their area of practice. For medical practitioners, accurate documentation of any health condition is essential from the view of patient care as well as that of maximum and timely reimbursement. When it comes to medical billing for the various treatment modalities PCPs provide, accurate diagnostic and procedural codes are vital to receive correct reimbursement. Inadequate codes used in medical bills can result in problems such as delayed payments, and reimbursement denials among other issues.
PCPs Use More Number of Diagnostic Codes
A new study published in the journal American Family Physician (December 2014 issue) found that primary care physicians (particularly family physicians) use more number of diagnostic codes than other specialists do. This may result in higher complexity in care and their payment criteria should be revised.
As part of the study, researchers analyzed data from the 2010 National Ambulatory Medical Care Survey to count how many diagnostic codes were used by primary care physicians compared to other specialists. It was found that family physicians used about 23 diagnostic codes in more than 50% of coding tasks whereas specialists such as cardiologists and psychiatrists used only 6 codes 3 codes respectively for medical coding.
Need to Adjust PCP Fee Schedule Appropriately
Reports suggest that the complexities of professional work may have a direct association with how many different tasks are being managed than with how difficult it is to complete a single task. Even the most complicated task such as managing a chronic health condition when repeated constantly will become simpler. The Centers for Medicare and Medicaid Services (CMS) should consider the complexity of care offered by primary care physicians and the time involved and adjust their fee schedule accordingly.
Experts in the healthcare domain feel that diagnosis codes should not be the standard measure of complexity. The fee structure doesn’t signify the complexity of treating each patient; neither does it account for how serious a patient’s condition is, or shows the difficulty PCPs face in diagnosing across a broad range of diagnoses.
Primary care physicians can efficiently handle their medical billing regardless of how complex it is with the support of reliable and reputable medical billing services.
Julie Clements, OSI’s Vice President of Operations, brings a diverse background in healthcare staffing and a robust six-year tenure as the Director of Sales and Marketing at a prestigious 4-star resort.