Examples

Here’s an example of how the risk-based coding method works:  
                                                             
Let’s look at the actual dollar amounts (not even RVU’s) of what Medicare is paying a client physician office of mine for a 99212, ($28.70); a 99213, ($39.46); and a 99214, ($61.99). So if you move a level 2 outpatient code up to a level 3, you just made your practice an additional $10.76 for doing NO MORE WORK other than using my system. Move a level 3 up to a level 4, you make and extra $22.53. (And this is just what Medicare is paying, not the co-pay…but since this is just an example, let’s call it the absolute profit increase.) And if you move the level 2 code up to a level 4 code (this will happen more than you’ll believe), you’ll increase profit $33.29. Fair enough?

     If you’d rather use your own office’s Medicare payments, go ahead and plug in your Medicare reimbursements for the three codes. Calculate a conservative estimate of your increase in daily physician profit using this formula:

(X)(.2)($10.76) + (X)(.1)($33.29) + (y)(.2)($22.53) = $ increase/day

  where x = (# of level 2 patients seen in one day)
            y = (# of level 3 patients seen in one day)

What we’ve set up is a hypothetical situation where ONLY 20% of your level 2 patients will increase to a level 3, ONLY 10% of your level 2 patients will increase to a level 4, and ONLY 20% of your level 3 patients will increase to a level 4. THIS IS VERY CONSERVATIVE. After you listen to the audio program, see the DVD, and actually understand how the documentation system is driven, you’ll see just how conservative this example is.

So put in your numbers. How many level 2 patients do you see a day? 5? 10? 15? To be conservative, let’s say only 7. How many level 3 patients do you see a day? Again, conservatively let’s say 10. I know in reality you see more than this…but we’re being as conservative as possible. Again, this formula uses estimates of 10% and 20% (.1 and .2) factors of successful use of my system … again, very CONSERVATIVE. If I’ve been too audacious and too presumptuous with my example, plug in your own EVEN MORE CONSERVATIVE NUMBERS.

Using the example above, with the parameters specified by X and Y, you’ll make $91.52 by my arithmetic. That’s ONE doctor, using VERY CONSERVATIVE estimates.

With that daily revenue increase, you’ve paid for the ENTIRE SYSTEM in less than 10 days. Just imagine if you put in your real numbers, not conservative examples. How many days would this system take to pay for itself? Now take that tiny little $93.52 and multiply it by the number of days you work a FULL DAY ONLY. Don’t even think what it would do with higher paid codes in hospitals, or consultations, ONLY SIMPLE OFFICE VISITS!!!!!  Just imagine. Well, if you calculate you work only 40 weeks a year, four days a week, in a year’s time you’ll make (160)($93.52) = $14,963.20.

     Double check my math. Could it be true? Could you really be leaving all this money on the table? In actuality, you’ll find it’s not true. You’re leaving even more money on the table…we just went as conservatively as possible to do these calculations.