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The Business of Medicine covers essential skills to your success as a physician in the United States after completing your medical education. Medical billing, medical coding, the medical practice revenue cycle, physician contracts, and other topics will be presented in a way you can apply to your practice today.
The challenges of Cost, Quality, and Value in healthcare are highlighted at relevant times during this course.
This course is the subject of a peer reviewed article published in PeerJ in August, 2016.
Physician revenue generation – Medical billing, medical coding, and the medical practice revenue cycle.
Physician Income - This section discusses how physicians are paid in today’s healthcare environment. Compensation models, RVUs (Relative Value Units), and other aspects of physician compensation are covered in detail.
Medical documentation – This section covers how medical encounters should be documented so that they comply with the strict guidelines outlined by Medicare and how improved documentation is related to increased compensation and quality.
to improve DRG coding in terms of CCs (comorbid or complicating conditions) and MCCs (major comorbid or complicating conditions) is discussed. Improving documentation of CCs and MCCs is a major effort underway in hospitals throughout the United States because of how this documentation can influence hospital payments from Medicare and other insurers.
Measuring physician quality – This section discusses a few of the ways physician quality is measured like HCAPHS and the VBP. The relationship to measured quality and physician compensation is discussed as well.
Physician contracts – This section covers the basics of physician contracting and a few areas for special attention – non-compete agreements, compensation, and signing bonuses.
Who is this course designed for?
This course is designed for medical students, residents, fellows, and attending physicians. This is a great course for attending physicians who are trying to maximize their productivity and value to the healthcare system.
What do I need to know to get the most out of this course?
A good knowledge of medical terminology and medical records will be helpful. Most 3rd or 4th year medical students will be well prepared for this course.
Conflict of interest and disclosures.
The instructor of this course denies any conflict of interest or disclosures with the content material in this course.
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|Section 1: Medicine as a Business|
This discussion provides an overview of the healthcare industry and some of the challenges facing the healthcare industry today.
Rapid change is underway in the healthcare industry due to forces like the Affordable Care Act ("Obamacare") and an aging population. Many of these industry-wide changes are impacting how physicians work and who physicians work for.
This course is the subject of a medical education preprint at PeerJ titled "Delivering a medical school elective with massive open online course (MOOC) technology".
The healthcare industry
This discussion covers how physicians generate revenue for their practice/employer.
Insurance billing, the medical practice revenue cycle, and medical coding are introduced.
Key topics include
This discussion focuses on how physicians are paid for the medical services they provide.
Charges, collections, practice expenses, physician productivity, and physician compensation models are discussed.
The topic of physician productivity is explored in more detail because of the central role it now plays in physician compensation.
Key topics discussed include -
|Section 2: Key Practice Skills - Medical Documentation|
E&M services are easily recognizable medical services such as a visit to urgent care, hospital admission, or daily rounds on people admitted to a hospital. These services have multiple levels which correspond to different levels of medical complexity, such as a ‘new outpatient visit – level 4’. Selecting the correct level of service is critical to being paid appropriately for the patient encounter. Medicare released guidelines on how to select the proper service level in 1995 and 1997. These E&M Documentation Guidelines serve as the rulebook for E&M coding for physicians in the USA.
Not all medical services are covered under the E&M Documentation Guidelines. Surgeries, lab tests, preventative medicine, counseling, and imaging studies have separate documentation rules.
What needs to be documented for E&M services?
The 1997 E&M Documentation Guidelines state that each patient encounter must include a medical history, examination, and medical decision making (MDM). Each documentation component requires certain types of information to be documented in the medical record.
Documentation Components from the 1997 Guidelines:
Medical Decision Making (MDM)
This section discusses the challenges and complexity of E&M coding, particularly as it relates to selecting the level of service. Several published studies on the accuracy and expert agreement in E&M coding are discussed.
Despite challenges, E&M coding trends are evolving. Changes in E&M coding frequency in the Medicare population between 2001 and 2009 are discussed.
References for this section
This discussion focuses on documenting medical procedures, which is much more straightforward than documenting E&M services.
This discussion focuses on how hospitals code for healthcare services with the DRG (Diagnosis Related Group) system and how your clinical documentation can impact this process. Effective documentation for the DRG coding process does not directly help physicians, but it can improve their risk adjusted quality metrics which can have long term benefits for individual physicians.
More effective DRG coding can have a major impact on the financial health of hospitals which results in significant benefits to the local community (jobs and access to healthcare to name a few).
|Section 3: Measuring Physician Quality|
This discussion covers how physician quality is assessed by a variety of programs including Medicare Value Based Purchasing and the PQRS system. These quality assessment systems are playing a growing and important role in how hospitals and outpatient practices are paid for medical services. This discussion will introduce you to the skills needed to excel in a quality and value driven healthcare enviroment.
|Section 4: Physician Employment Contracting|
This discussion focuses on physician employment contracting and covers key areas like noncompete clauses and signing bonuses.