Learning the business side of medicine

Learn how to document and bill effectively for medical services and improve physician quality metrics
4.5 (72 ratings)
Instead of using a simple lifetime average, Udemy calculates a
course's star rating by considering a number of different factors
such as the number of ratings, the age of ratings, and the
likelihood of fraudulent ratings.
3,378 students enrolled
Free
Start Learning Now
  • Lectures 9
  • Length 1.5 hours
  • Skill Level Expert Level
  • Languages English
  • Includes Lifetime access
    30 day money back guarantee!
    Available on iOS and Android
    Certificate of Completion
Wishlisted Wishlist

How taking a course works

Discover

Find online courses made by experts from around the world.

Learn

Take your courses with you and learn anywhere, anytime.

Master

Learn and practice real-world skills and achieve your goals.

About This Course

Published 8/2014 English

Course Description

The Business of Medicine

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.


Key post-residency skills covered in the Business of Medicine:

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.

Hospital documentation

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.

What are the requirements?

  • Familiarity with the healthcare system of the United States
  • Understanding of medical terminology
  • Understanding medical records
  • Understanding of how health care insurance billing works

What am I going to get from this course?

  • Understand how physicians generate revenue
  • Undertand how physicians are paid for their services
  • Understand how medical documentation can influence revenue and compensation
  • Understand how medical documentation can influence healthcare quality
  • Understand basic physican contracting

What is the target audience?

  • Medical Students
  • Residents and Fellows
  • Physicians
  • This course is probably not for you if you are not a health care practitioner working in the United States of America. All the course material is focused on how the health care system works in the USA.

What you get with this course?

Not for you? No problem.
30 day money back guarantee.

Forever yours.
Lifetime access.

Learn on the go.
Desktop, iOS and Android.

Get rewarded.
Certificate of completion.

Curriculum

Section 1: Medicine as a Business
03:07

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.


The healthcare industry
3 questions
10:47

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

  • Medical Billing
  • Revenue Cycle
  • ICD-10 Coding
  • CPT Coding
Revenue generation
4 questions
08:30

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 -

  • MACRA, MIPS, APM
  • RVUs
  • Quality Bonuses
  • Where to find physician productivity benchmarking data
Physician pay
3 questions
Section 2: Key Practice Skills - Medical Documentation
16:10

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 History

  • Chief Complaint (CC)
  • History of Present Illness (HPI)
  • Past Family and Social History (PFSH)
  • Review of Systems (ROS)

Physical Exam

Medical Decision Making (MDM)

  • The number of diagnosis or management options
  • Amount and complexity of medical data reviewed
  • Risk of significant complications, morbidity, or mortality
08:33

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

Medical Decision Making: guide to improved CPT Coding

Expert Agreement in CPT coding for E&M Services

Evaluation and management services. A comparison of medical record documentation with actual billing in community family practice.

Accuracy of CPT evaluation and management coding by family physicians.

E&M Documentation
9 questions
02:48

This discussion focuses on documenting medical procedures, which is much more straightforward than documenting E&M services.

09:33

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
08:07

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.

Physician quality
3 questions
Section 4: Physician Employment Contracting
10:06

This discussion focuses on physician employment contracting and covers key areas like noncompete clauses and signing bonuses.

Students Who Viewed This Course Also Viewed

  • Loading
  • Loading
  • Loading

Instructor Biography

R Robinson, MD, Academic Physician

I am an associate professor and hospitalist at Southern Illinois University School of Medicine in Springfield, Illinois and the recipient of the general internal medicine teacher of the year award for my first year on the faculty.

In 2012, I created the first Business in Medicine course at SIU as a 4th year medical school elective.  Over time, this course evolved from a face to face flipped classroom course to a MOOC hosted on Udemy with over 2,500 participants.

Ready to start learning?
Start Learning Now