SHM Converge Scientific Abstract ePoster Gallery-A Process Improvement Approach to Improve Billing

Pdf Summary

The project aimed to increase the proportion of higher-level inpatient billing codes in a hospital medicine group at a large urban safety-net hospital, where billing levels were below national benchmarks despite high patient complexity. Using the Institute for Healthcare Improvement’s Model for Improvement, the team conducted a needs assessment with hospitalists and billing/finance staff and implemented five PDSA cycles.<br /><br />Interventions included quarterly billing education sessions, individualized feedback packets comparing providers’ billing patterns with peers and national benchmarks, revised guidance on how copied-and-pasted text should be handled in progress notes, monthly “clearance cohorts” to assess and credential providers for independent billing, and incorporation of billing targets into the division incentive plan.<br /><br />Results showed statistically significant increases in the proportions of high-level bills for initial inpatient notes (99223), subsequent hospital services (99233), and discharge management (99239) from FY 2021 to FY 2023. The percentage of physicians cleared to bill independently also rose over time. Financial performance improved as well: RVUs per clinical FTE and per encounter increased, with the latter rising from 1.66 in FY21 to 2.01 in FY23.<br /><br />The greatest gains were seen after provider feedback packets and the change in copy-paste guidance, with additional improvement following the new CMS inpatient billing rules in January 2023. Overall, the process improvement approach successfully aligned billing practices more closely with national standards and produced meaningful financial gains.

Asset Subtitle

Ankur Segon

Meta Tag

Author List Amy Sowles, Ankur Segon, Misty Espinoza, Ting-Wei Lu, William Brian Reeves

Category Research

Concept Inpatient Billing

Concept Model for Improvement

Concept PDSA Cycle

Concept Billing Level

Concept Documentation

Distinguished Non-Finalist

Presenter Organization University of Texas Health Science Center, San Antonio

Presenting Author Ankur Segon

Track Other

Keywords

inpatient billing

hospital medicine

higher-level billing codes

PDSA cycles

Model for Improvement

provider feedback

billing education

CMS inpatient rules

RVUs

safety-net hospital

Inpatient Billing

Model for Improvement

PDSA Cycle

Billing Level

Documentation