MGMA Insights: Unlocking the potential of time-based billing with Dr. Tej Singh

Serving as Medical Director of Vascular Surgery at Intermountain Health, Peaks Region in Colorado. Dr. Tej Singh understands the transformative potential of time-based billing for surgical practices. As a recognized leader in healthcare innovations, Dr. Singh shares how implementing time-based billing allows physicians to accurately bill for the full range of work they perform, which can enhance billing accuracy while capturing lost revenue. Leveraging this technology, as Dr. Singh explains, not only helps enhance billing accuracy but also helps reduce administrative burdens while improving compliance.

Understanding Time-Based Billing

Dr. Singh describes time-based billing as a billing model that “captures all the things you are doing outside of the hospital, outside of the clinic, inside the clinic, after the clinic, before the clinic, and you can get credit for that.” He highlights how traditional billing models often fail to account for non-clinical tasks, such as imaging reviews, patient follow-ups and operating room preparation. “I think the problem has been that surgeons are just not educated that this time-based billing is to our advantage,” he says, explaining that time-based billing can help surgeons capture the time spent outside of direct patient consultations, which frequently goes uncompensated under traditional billing models.

Addressing Burnout and Reducing Administrative Burden

The integration of time-based billing helps alleviate two critical issues facing healthcare providers: burnout and excessive documentation (colloquially known as “note bloat”). Dr. Singh describes how the shift from traditional MDM (Medical Decision Making) billing to time-based billing aligns better with physicians’ workflows. “With EMRs, people were writing long notes, throwing things together … and whether it was relevant or not, we learned a lot,” he says. time-based billing’s time-focused approach reduces the need for detailed documentation of every clinical decision, allowing providers to focus more on patient care rather than exhaustive record-keeping​.

Leveraging AI in Time-Based Billing

To enhance the accuracy of time-based billing, Dr. Singh has been working on an AI-based app that helps surgeons track time for non-clinical tasks more effectively. “As you’re talking to your app, [the AI] is recording what you’re doing and will give you a report at the end of the day,” Dr. Singh explains. This app is designed to eliminate guesswork that can often result in billing inaccuracies and increased audit risks. By allowing surgeons to document time spent on chart reviews, family consultations and imaging assessments verbally, the app provides a streamlined way to create standardized logs that meet compliance standards​.

Financial Benefits of Time-Based Billing

Time-based billing’s significant revenue potential can benefit surgeons with complex cases. “If you’re a surgeon who is planning before clinic, during clinic and after clinic, you can capture that work,” he says, underscoring that this model enables practices to bill at higher levels without increasing patient volume. For surgeons who often start their days reviewing imaging or preparing for surgeries, time-based billing can offer a valuable way to account for these activities, leading to higher-level billing and enhanced revenue cycles​.

Ensuring Compliance and Audit Readiness

Education and compliance are essential to successfully implementing time-based billing. “You’ve got to do the education. That is the number one thing following appropriate coding and billing,” Dr. Singh emphasizes. He explains that compliance teams must educate providers on time-based billing protocols to prevent audit issues, such as “the impossible day,” where inflated time estimates can raise red flags. Dr. Singh stresses that “compliance and education [go] hand in hand,” highlighting that well-informed providers are more likely to adopt accurate billing practices that ultimately benefit both their revenue cycles and compliance.

The Future of Time-Based Billing

Looking forward, Dr. Singh sees time-based billing as an opportunity for broader adoption across surgical practices, predicting that as more providers learn about the model, adoption rates will increase significantly. As he notes, “Time-based billing for the surgeon is an awareness and educational opportunity.” According to Dr. Singh, “Only about 20% of surgeons use time-based billing,” but he anticipates that education on such technology as AI-driven tracking tools will increase this number, reducing burnout and improving clinic efficiency​.

Resources:

• 2022 JAMA Time-based Billing Study: "Association of Time-Based Billing with Evaluation and Management Revenue for Outpatient Visits" - Read Here
• NAMAS article: "Not All Time-Based Billing and Coding Rules are Created Equal" - Read Here
• Annals of Family Medicine Study: "Tethered to the EHR: Primary Care Physician Workload Assessment Using EHR Event Log Data and Time-Motion Observations" - Read Here
• RACmonitor Article: "Take the Time to get Time-Based Billing Right" - Read Here
• Intermountain Health - Visit Here
• About Tej M. Singh MD - Visit Here

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