Cognitive Changes in Physician Documentation Habits and Revenue Cycle by Organized Training

1Emcare Hospitalist Division, Dallas, TX

Meeting: Hospital Medicine 2007, May 23-25, Dallas, Texas

Abstract number: 62


Physician documentation is the principal determinant of reimbursement for services provided. In 2001 the Office of Inspector General cited $20 billion of Medicare overpayment, 29% of which resulted from improper coding.1 Conversely, the Health Care Financing Agency suggests physicians often undercode.2 There is scarce data regarding physician coding accuracy, physician training in coding accuracy, or the impact of such training on the revenue cycle.3,4 Despite the importance of this activity, physicians receive little formal training in this area. This study examined the impact of an individualized training program on physician documentation and services coded.


One‐on‐one training for medical documentation was provided to a group of hospitalists delivering care at multiple sites. The medical records before and after the training were coded by professional certified coders blinded to the training status of the physicians. Relative value units (RVUs) per patient were then calculated for each physician for each month prior to the training session and for each month after the training session. Patient encounters during the month of the training session were not included. Before and after RVUs/patient ratios were compared using the Student t test and bivariate and regression analyses.


Thirty‐five hospitalists at 17 sites met inclusion criteria for the study. A total of 451 patient encounters (247 before and 204 after) were coded and included in the analysis. Mean RVUs per patient were 4.72 before training and 5.07 after training (P < .02) Bivariate analysis produced the following formula to determine the impact of documentation training: expected RVUs/patient after training = 1.36 + 0.76RVUs/patient before training.


Formal training intervention improves physician documentation, resulting in an increased number of RVUs per patient encounter. By attaching a dollar value to the expected increase in RVUs/patient after training, the increase in revenue could be forecasted.


1. Martin S. OIG $20 billion in “improper” Medicare payments. Am Med News. 1998;41(18):11‐13.

2. Mastering Medicare's new documentation guidelines. Fam Pract Manage. 1995;Jan:60‐67

3. Zuber TJ, Rhody CE, Muday TA, et al. Variability in code selection using the 1995 and 1998 HCFA documentation guidelines for office services. J Fam Prac. 2000;49:642‐645.

4. Kikano GE, Goodwin MA, Stange KC. Evaluation and management services. A comparison of medical record documentation with actual billing in a community family practice. Arch Fam Med. 2000;9:68‐71

Author Disclosure:

S. A. Syed, Emcare, employment (full‐ or part‐time); M. Wagner, Emcare, stock options or bond holdings, employment (full‐ or part‐time); D. Ramirez, Emcare, employment.

To cite this abstract:

Syed S, Wagner M, Ramirez D. Cognitive Changes in Physician Documentation Habits and Revenue Cycle by Organized Training. Abstract published at Hospital Medicine 2007, May 23-25, Dallas, Texas Abstract 62. Journal of Hospital Medicine. 2007; 2 (suppl 2). Accessed March 28, 2020.

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