Physician Business Ideas - “Coding is the Business of Medicine”

Coding, EMRs, and the State of Denial Management

I recently spoke to James Weintrub, MD, a plastic surgeon in Providence, Rhode Island, With his partner, Greg Brownell, an Internet expert, James has spent nine years developing a coding system, DPNX (Digital Physicians Network, dpnx.com). DPNX helps doctors code for themselves – without going to coding school, attending coding seminars, hiring coding clerks, or installing expensive EMR systems.

James’ rationale for devoting nine years to helping his fellow physicians is stunningly simple: “Coding,” James says,” is the business of medicine. No codes, no revenue.” As the nun CEO of a Catholic health system once told me, “No Profit, no Mission.” In other words, if you’re to carry out your healing mission as a doctor, you’d better be economically self-sufficient.

James maintains that coding, backed by appropriate documentation, is more practical and important to most doctors than EMRs. With EMRs, doctors may need a practice manager, may have to bear heavy expenses in training and implementation, and may experience losses as their practices grind to a halt during the installation process.

The operative word, you will note, is may. Some doctors, especially those in larger groups, swear by EMRs. Others swear at EMRs. I know of one physician consultant who devotes full time dismantling, rather than installing EMRs. For many doctors, especially those in small practices, see no return on investment, or ROI, for EMRs, to use the parlance of EMR vendors.

With the system of Weintrub and Brownell, on the other hand, James says all you need is Internet access. With information on their website, doctors can manually go through their charts, run chart information through their system, and see instantly if the practice’s documentation supports coding levels. By upgrading their documentation, doctors can quickly reduce the number of denied claims and raise their level of reimbursement.

In practice management circles, what James and Greg are advocating is known as “denial management.” Experts agree it’s better to code correctly, than overcode and risk a denial backlash, even litigation and fines, from insurers (Pamela Lewis Dolan, “Denial-Claims Systems Bring Cleaner Claims, Better Coding.” American Medical News, April 23-30, 2007). For a discussion of the James Weintrub and Greg Brownell approach, see pages 57 and 58 of Innovation-Driven Health Care: 34 Key Concepts for Transformation, Jones and Bartlett, 376 pages, indexed, $59.95, Amazon.com)