2013 Poster Session Summaries - AAMC

Problem:
Most medical school curriculums only provide basic science and clinical education, without formal exposure
to practical business elements relevant to medicine (e.g., billing, reimbursement payment models, or practice
management and expenses). 1 Not understanding medical business allows inappropriate financial planning
and decreased efficiency, which ultimately increases patient care costs. 2
Objective:
The University of Mississippi Medical Center’s (UMMC) Department of Family Medicine’s business in
medicine workshop provides every UMMC medical student exposure to the interplay between insurance,
coding, and patient care costs as well as the basics of practice management.
Program Description:
Starting in 2002, UMMC’s Department of Family Medicine implemented a business in medicine workshop as
part of the clerkship orientation. The workshop involves lectures, problem-based learning, and scenariobased
learning.
The business in medicine workshop starts with an introduction to International Classifications of Diseases-
9th Revision (ICD-9) and Current Procedural Terminology coding systems and their use in patient
documentation and reimbursement. Students then learn the basic billing process by discussing allowable
charges, non-allowable amount, and contractual adjustments. A hypothetical patient bill with different
insurance companies (i.e. Medicaid, Medicare, BCBS, United HC, Cigna, Uninsured) is used to enrich
discussion and demonstrate how insurance impacts business and patients. Students learn why CPT code
reimbursement varies between companies. An overview of insurance negotiations helps students understand
how to tailor these negotiations to their future practices, when to charge more or less for procedures, and
how cash discounts can legally help the uninsured. These discussions are reinforced through Excel
examples calculating sample payouts from different companies. Discussion on payment models including fee
for service, diagnosis related groups, value based payment modifier, and the Accountable Care Act help
students learn incentives, costs, advantages and disadvantages for different models. They receive an
overview of payer classes and how percentages of charge payer mix predict expected income, serve as a
model for budgeting expenses, as well as how to recognize problems if not receiving expected amounts.
Excel examples are applied to convey the importance of payer mix analysis. Students receive an overview of
expected expenses of running a practice and what percent of income should be spent on human resources,
facilities, insurance and marketing. Students learn how efficiency and work flow in a clinic can reduce overall
costs, the importance of quality staff members, which staff members qualify for hourly wage vs. exempt
employees, how to manage overtime pay, and how nurse practitioners are utilized in practice.
After learning the elements of the business-side of medicine students are introduced to the basics of medical
billing. A certified medical coder discusses the purpose of medical coding, the importance of documentation,
and how the coding process functions. Students receive a sample doctor’s note and instructions on how to
extract information from the note to determine the appropriate level of service for the visit. Afterwards,
students create their own note based on a hypothetical patient visit. Students code the note individually, then
as a group to see how leaving out details could change the level of service. The coding exercises culminate
when students are given another note and asked to quickly assess the level of service based on their current
knowledge.
Once coding is complete, students apply their knowledge to a hypothetical patient. Small groups are formed,
and each is provided with an imaginary $3500, list of procedure and laboratory costs, patient age, and chief
complaint. Groups develop a differential diagnosis, a plan, and decide which tests to order ranging from
history, physical exam, x-rays, CT scans, various blood work and laboratory tests. Students are encouraged
to think about which tests are most appropriate given the patient information and your differential diagnoses.
Conclusion:
Through various learning methods and activities, students are exposed to basic business elements they
need in the medical field. Students have a broader understanding of aspects of medical billing,
reimbursement, payment models and healthcare policy, payer mix analysis, expenses and budgeting,
organizing a practice, the importance of documentation, and overall costs of patient care.
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