What Happens When Physicians Stop Coding: Lessons from Vanova Health

 This is an all-too-common story. A patient shows up for a 15-minute appointment with a list of issues that takes 45 minutes to work through. The physician talks through each concern, counsels, prescribes medications, makes referrals, and schedules follow-up labs. Later, when the physician codes the patient's chart and sends it to billing, they enter a code for a 15-minute visit because they are afraid of denials or compliance issues.

The problem isn’t that they documented the wrong thing. It’s that they don’t have confidence that they can defend a higher-level code if a payer pushes back. So they take 80 cents on the dollar rather than risk losing the whole dollar to a denial.

This problem is not particular to one practice. Physician undercoding is a persistent and costly issue in independent practices and is driven by a lack of defensibility. Physicians spend hours every week navigating administrative and billing decisions they were never trained for, and without a clear, explainable record of why a higher code was assigned, they and their billing teams have nothing to point to when a payer pushes back. So they simply avoid the risk.

Daimion Haughton has watched this exact thing play out across Vanova Health’s network of independent physician practices in Northern New Jersey more times than he can count. As Director of Revenue Cycle, it was his job to fix it. Part of what made that possible was finding an autonomous coding solution that could back every decision with a full, explainable audit trail. This choice has allowed physicians to get paid accurately for the care they delivered and the audit trail to defend it if a payer pushes back.

 

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