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gcohen

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Looking for suggestions of how to discuss levels of coding to patients in simple terms. They do not want to hear about complexity, MDM, etc...
 
gcohen said:
Looking for suggestions of how to discuss levels of coding to patients in simple terms. They do not want to hear about complexity, MDM, etc...
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It's hard not to use the word complexity or decision-making at all, but something like this could be a less technical/more patient-friendly explanation:

"When you visit the doctor, the time they spend with you and the complexity of your condition help determine the level of your visit. Some visits are quick and simple, like a check-up for a minor issue, while others involve more complex decision-making or take more time, like managing multiple conditions or ordering tests or prescriptions. Doctors use specific guidelines to assign a level to your visit."

(That's just really to get you started - please modify and adapt to suit your needs!)
 
We usually state it is a decision made by the physician and there are many areas that go into their office visit level decision making besides the issue they came in for, health history, social history, prescriptions, plan for problem(s) etc.. Some state they looked up visit levels by time, we do not bill on time so that is irrelevant. We are Otolaryngology and it is rare that a patient has just 1 issue, the physicians address everything the patient has going on, they do not make the patient make an appointment for each individual issue as some offices do. I also suggest to patients that they focus on the reimbursement vs the charge.
 
It's been awhile since I had patient interaction like this, but my method was to give a general sentence or 2 like @sls314 provided above emphasizing that time (and not just time spent with patient) OR complexity could be used. And if a patient was asking repeated questions and very insistent, something like "I have reviewed the records and the coding and everything is accurate. I will gladly spend time with you explaining various guidelines of why the services meet the nuances of coding requirements if you are interested in learning." I had to maybe say that 10 times in 10 years, and no one was ever interested in learning. 😆
 
Agree, a general, basic sentence is good. Using basic and lay terms helps. Many (most) patients have no understanding of their insurance, co-pays, coinsurance, deductibles, coding or anything revenue cycle/money related other than they don't want to pay much. Some even think that having insurance covers all the charges and they should not have to pay anything at all, "because I have insurance". It can be very frustrating. On the other hand, you may have a patient that completely understands and is ready with their copay every time.
Good points above too to focus on the reimbursement and not the charge.
Stay calm and have empathy in all interactions. And, if there was a mistake made, acknowledge it and work to correct it.
I have had to sit for hours with a few patients and go line by line before they would "get it" and that was after they went through multiple customer service, accounts receivable, and other representatives before making it to me.

Links from basic search:
This was for patient doctor interaction, but the same ideas work for talking about money/billing with patients https://www.physicianspractice.com/view/handling-angry-patients

If you google this: "how to explain office visit billing to patient", the AI has a good response below:

When explaining office visit billing to a patient, clearly state that the bill reflects the services provided during the visit, including the doctor's time spent reviewing medical history, conducting a physical exam, making medical decisions, and documenting the encounter, and that the cost can vary based on the complexity of the visit and the level of service required, which is determined by factors like the patient's medical history, the reason for the visit, and the time spent with the doctor; also, be transparent about the patient's responsibility regarding co-pays, deductibles, and any remaining balance after insurance coverage. [1, 2, 3, 4, 5]
Key points to include when explaining office visit billing: [6, 7, 8]
  • Coding system: Explain that medical codes (CPT codes) are used to categorize different types of office visits based on their complexity, which determines the cost of the visit. [6, 7, 8]
  • Factors affecting cost: Mention that factors like the new patient status (new vs. established), the reason for the visit (routine check-up vs. acute illness), the number of issues discussed, and the amount of time spent with the doctor can influence the billing code. [1, 3, 9]
  • Insurance breakdown: If the patient has insurance, explain how their insurance plan will process the bill, including the copay they will need to pay at the time of service and the portion that the insurance company will cover. [2, 10, 11]
  • "Total time" concept: Clarify that the "total time" listed on the bill includes not just face-to-face time with the doctor but also time spent reviewing medical records, documenting the visit, and coordinating care. [1, 3, 5]
  • Billing questions: Encourage patients to ask questions about their bill and explain any charges that seem unclear. [2, 10, 11]
Example explanation: [1, 2, 10]
"Your office visit bill reflects the services provided during your appointment today, including the doctor's evaluation of your medical history, physical examination, and discussion about treatment options. The cost of the visit is based on the complexity of your case and the amount of time the doctor spent with you. Your insurance will typically cover a portion of the cost, and you will be responsible for your copay and any remaining balance." [1, 2, 10]

Generative AI is experimental.
[1] https://www.aafp.org/pubs/fpm/blogs/gettingpaid/entry/emcoding-series-part-two.html
[2] https://www.cms.gov/medical-bill-rights/help/guides/how-to-read-bill
[3] https://www.aafp.org/pubs/fpm/issues/2021/0100/p27.html
[4] https://www.ama-assn.org/practice-management/sustainability/documenting-time-each-task-during-outpatient-visits
[5] https://www.aafp.org/pubs/fpm/blogs/gettingpaid/entry/level5_visits.html
[6] https://www.aafp.org/pubs/fpm/blogs/inpractice/entry/coding_office_visits_the_easy_way.html
[7] https://www.ama-assn.org/practice-m...stablished-patient-office-visit-10-19-minutes
[8] https://www.medicalbillgurus.com/office-visit-cpt-code/
[9] https://www.aafp.org/pubs/fpm/issues/2003/0900/p33.html
[10] https://www.cms.gov/medical-bill-rights/help/guides/explanation-of-benefits
[11] https://www.medicalbillingandcoding.org/billing-process/
 
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