He is a highly experienced healthcare leader with an extensive background in Revenue Cycle Operations Physician Practice Management Accounts Receivable Management Health Information Management ID: 1043744
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1. Randy Sites is the Executive Director of UT Regional One Physicians (UTROP), a faculty practice group that is a partnership between Regional One Health and the University of Tennessee Health Science Center. He is a highly experienced healthcare leader with an extensive background in:Revenue Cycle OperationsPhysician Practice ManagementAccounts Receivable ManagementHealth Information ManagementFinancial Management and ReportingRevenue MaximizationBusiness Process Improvement and DesignPhysician Clinic OperationsPhysician AlignmentPhysician Compensation AgreementsPhysician RelationshipsStaff Recruitment, Retention, and Career ProgressionFor the past 25 years Randy has worked with several prominent health systems and medical practice groups throughout the South.Randy is an alumni of the University of Alabama, where he earned a Bachelor of Science in Commerce and Business Administration and a Masters of Business Administration with a concentration in Finance and Production Management.
2. The Importance of Medical Billing & Coding
3. How to save 15% on your home and auto.How to beat the house at black jack.How you get paid as a clinical physician.Things you hear about,but little emphasis is placed on “learning” about…
4. Revised:To earn a living as a physician, what must you do???Perform extensive research in the hopes of getting grant or industry funded.Generate clinical revenue by seeing patients.Become a travel nurse working in COVID-19 hotspots.
5. Let’s spend this next part of this discussion on clinical revenue.
6. Revised:So how do we generate clinical revenue?You are a physician in a booming clinical specialty.A patient needs your service.The patient is either referred to you from a different physician or the patient is a self-referral.Either way, an appointment is generated and the patient is scheduled to see you.Now let’s fast forward to the day of the visit.You are providing direct patient care. The visit is typically either a consultation or a new/established patient visit.You have provided exceptional care the patient goes home healed and happy.Post-patient visit. Now the real work begins and your ability to generate clinical revenue has started!
7. Revised:What must be done now?Clinical documentation in the EMR.Assignment of your diagnosis and CPT codes.
8. Revised:What is a diagnosis code?The ICD-10 CM (International Classification of Diseases, 10th Revision, Clinical Modification) is a system used by physicians and other healthcare providers to classify and code all diagnoses, symptoms, and procedures in conjunction with care provided to the patient.It’s basically what’s wrong with the patient.Currently, there are 72,616 ICD-10 codes!Anyone want to guess what is the first ICD-10 code???The fundamental objective of ICD-10 coding is to very clearly and specifically identify what is wrong with the patient.
9. Revised:What is CPT Coding?Current Procedural Terminology is a listing of descriptive terms and identifying codes for reporting medical services and procedures performed by physicians and other qualified healthcare professionals. The purpose is to provide uniform language that will accurately describe medical, surgical, and diagnostic services.Some call it the language between the providers and the payors.Currently, 10,471 CPT codes have been established.Codes are reviewed annually and updates do occur.
10. Revised:Unless you are Stephen Hawking, who is described as a “pure genius and astrophysicist”, it’s impossible to keep up with the conundrum of coding.With 72,616 ICD-10 codes and 10,471 CPT codes that change every year, the possible combinations are countless…
11. Revised:What do we do?Health Systems, Hospitals, Physician Groups, and the Healthcare Industry invest heavily in technology that helps ease the pain with this process.The creation of the EMR has greatly assisted to help automate coding based on your documentation.Still, manual intervention by the coder and physician is often needed.
12. Revised:What do YOU, as the physician, need to do?Understand the coding for your specialty.Get educated annually.Provide the greatest level of detail with your documentation.Be aware of your coding. Is someone coding for you? Never bury your head in the sand thinking it will go away.
13. I hear about RVUs…What are they?
14. Revised:RVU is an acronym for Relative Value Unit and is currently used by Medicare (and most other payors) to determine the amount of reimbursement that providers will receive.RVUs have three components:All CPT codes that are intended for a physician to perform have a RVU weight.
15. Revised:A wise man once told me, you can’t deposit RVUs at the bank.
16. Revised:How can I convert RVUs to Dollars???The current Medicare conversion factor is $37.89 per RVU. In other words, regardless of the type of service, Medicare will pay $37.89 for a code worth 1 RVU, $75.78 for a code worth 2 RVUs, $378.90 for a code work 10 RVUs, and so on.Physician’s compensation (both base and incentive) is typically based on RVUs. So, the more RVUs you generate, very often the more dollars you earn.Several leading firms aggregate and benchmark RVU and compensation data, which is shared across the industry. This data is often used to determine physician compensation based on either industry data and/or individual productivity data (measured in RVUs).
17. Revised:So… What is the moral of this story?The more patients you see provides the opportunity to generate more RVUs.Improved documentation in the EMR helps to improve the accuracy of your coding. By maximizing your coding to fairly reflect the work you actually perform, you can often increase your RVUs. Increasing your RVUs can help to generate more clinical revenue from the payors. Thus, increasing your individual earning potential from the hospital or medical group.
18. Sure, I get it. You’re not in it for the money. I hear that all the time, but let’s be honest with each other. Is your desire to go to medical school, residency perhaps followed by fellowship, earn board certification in yourspecialty, allocating between 7 to 10 years of your life and possibly racking up hundreds of thousand of dollars in student debt just to heal the sick?
19. Questions