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Billing, Coding Errors Costing Providers Big Time

Analysis  |  By Amanda Norris  
   June 28, 2022

New research estimates that a single primary care physician could add $124,435 in preventative services to their practice's annual revenue if coding and billing practices were rectified.

Physicians left a large amount of money on the table for services that were provided but not coded and billed, according to a recent study published in the Annals of Internal Medicine.

Researchers from Brigham and Women's Hospital and Harvard Medical School used national survey data to conclude that a single primary care physician (PCP) could add $124,435 in prevention services and $86,082 in coordination services to their annual revenue if coding and billing practices were resolved. They also estimated that each PCP provided preventive services worth up to $40,187 in additional revenue.

The authors analyzed 34 distinct prevention and coordination codes, representing 13 distinct categories of services for Medicare patients. They found that although services were provided to up to 60.6 percent of eligible patients, billing codes were only used at a median 2.3 percent.

According to the authors, the results suggest that having to navigate the eligibility, documentation, time, and component requirements of numerous separate codes may be too high of a hurdle to warrant the effort from PCPs to use prevention and coordination codes.

The physician fee schedule plays a dominant role in how primary care and other physicians are paid. However, core features of primary care—first-contact care that is continuous, comprehensive, and coordinated—are poorly matched with visit-based payments.

CMS has made efforts to address this issue by adding billing codes for these aspects of primary care including preventive services and for coordination services, but many of these codes have been characterized by low rates of adoption, suggesting that the codes are not being adequately used, the authors said.

Amanda Norris is the Revenue Cycle Editor for HealthLeaders.


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