How good are physicians at knowing what to bill? A 2019 study examined how accurate physicians were at billing in Canada1. The study asked 17 staff physicians and 16 residents to assess what they would bill for 10 different case scenarios. The researchers then compared what physicians would have billed with the correct billing codes. The result were stark. Physicians are missing a significant portion of their billings.
The study found residents achieved 82.3% of eligible billings. Perhaps this is not too surprising – after all, residents are new to billing. But staff physicians achieved only 93.1% of eligible billings. This means physicians were missing almost 7% of their eligible income. These losses represent a major financial loss to physicians. The average specialist in Alberta earns $415,000, meaning these losses add up to $28,635 per year for the average specialist. As the study notes, these potential billings losses represent “a revenue loss that would be catastrophic to any small business.”
What is getting missed? Most lost billings are due to missed codes or incorrect codes. Among missed codes, premium codes account for most of the losses. These include admission codes, after hours codes, procedure codes and travel codes. Many physicians are familiar with occasionally missing a modifier code. What this study highlights is how much these “occasionally” missed codes add up to.
It’s important to highlight that this study only examined billing scenarios related to the provincial insurance plan. In our experience at Statgo, physician’s billing errors and omissions with other insurance payers, including WCB, specialty billings and private claims, are substantially higher, indicating that the 7% missed billing rate understates the total loss physicians experience.
What can you do to ensure you are not missing billings? Get an expert. With Statgo, we use our expertise to ensure you don’t miss your eligible billings. You can also checking out of “Improving your billings” page or contact us today for a free assessment.
1Austin RE, von Schroeder HP. How accurate are we? A comparison of resident and staff physician billing knowledge and exposure to billing education during residency training. Can J Surg. 2019;62(5):340–346. doi:10.1503/cjs.008718