Learn With Me: All Things Billing

Course Description: This activity will address the importance of accurate clinical coding and billing.  Education will focus on best practices related to optimal use of codes and explanation of how to properly utilize for appropriate reimbursement.

Statement of Need:  Physicians receive limited formal training in the coding, documentation, and billing requirements used to translate patient care into reimbursement. This creates an important knowledge and practice gap because physician documentation is foundational to accurate code assignment, medical-necessity determinations, reimbursement, and regulatory compliance.

In FY2025, CMS reported a Medicare Fee-for-Service improper payment rate of 6.55%, representing $28.83 billion, with documentation and coding among the identified causes of improper payments.

Current E/M rules also allow physicians to select many outpatient visit levels based on medical decision-making or time, creating opportunities to reduce unnecessary documentation when physicians understand and correctly apply the requirements.

Physician-focused education is needed to strengthen competency in documentation, E/M coding, diagnosis and procedure coding principles, medical necessity, modifiers, and common billing errors. Improving physicians’ coding and billing literacy can support more accurate claims, decrease avoidable denials and compliance risk, improve communication with coding and billing teams, reduce unnecessary documentation burden, and help ensure that physician practices are appropriately reimbursed for medically necessary care.

Expected Results:

UTILIZATION OF Microsoft Copilot aided in the provision of descriptions related to identification expected results:

• Apply current E/M coding and documentation requirements, including medical decision-making and time-based coding.
• Improve documentation so that it accurately supports the diagnoses, complexity, and services provided.
• Recognize common causes of coding errors, claim denials, payment delays, and payer requests for additional documentation.
• Differentiate appropriate coding from undercoding, overcoding, and unsupported coding.
• Capture appropriate reimbursement for medically necessary services while maintaining compliance with payer and regulatory requirements.
• Reduce unnecessary documentation by understanding what information is actually required to support appropriate code selection.

Improving physicians’ coding and billing literacy can support more accurate claims, decrease avoidable denials and compliance risk, improve communication with coding and billing teams, reduce unnecessary documentation burden, and help ensure that physician practices are appropriately reimbursed for medically necessary care.