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Diversifying Your Income Streams as a Medical Billing and Coding Consultant

Updated: Mar 7, 2023


Note: transcription provided by Otter.AI, which is a technology company that develops speech-to text transcription and translation applications using artificial intelligence and machine learning.


Christopher H. Loo, MD-PhD: Welcome everybody to this week's episode of Financial Freedom for Physicians Podcast. And today we have a very special guest, Dr. Charlotte Akor. And, as on this podcast, we focus on four types of freedom. One is financial, second is time. Third is location. And fourth is emotional freedom. So we bring on guests that are doing things in these four different areas in different ways that are very innovative and on the cutting edge. So today we have Dr. Charlotte Akor. And I'm going to bring up her bio and introduce her to you.

So Dr. Charlotte Akor, aka Dr. Charlotte is a board certified Ophthalmologist, Certified Medical Chart Auditor and an internationally recognized speaker and consultant. And today you're going to hear all about medical coding and billing and consulting. So in addition, she is a sought after expert on billing and coding and understanding the financial language of medical practice, something that we as doctors and physicians need a lot today.

Dr. Charlotte meets with early career physicians and clinicians in a group setting to teach them the alphabet soup of billing and coding and how those rules apply in the practice of medicine. She also helps medical practices with chart audits so they can stay in compliance with the extensive rules and regulations regarding clinical presentation. She uses her extensive knowledge base to help clinicians and practices understand billing, coding and collections so they can continue to serve their patients.

As the Founder and Chief Medical Officer of Dr. Charlotte Billing, Coding and Auditing Services, she discusses real world strategies for physicians to understand the rules of billing and coding so clinicians can get reimbursed for the care they provide. She also shares her medical billing and coding expertise in her book, Medical Coding Decoded, a simple guide to understanding and applying codes in your practice. Her second book, Medical Compensation Decoded, is a more comprehensive manual on how young ophthalmologists can get paid for their work.

She is currently employed as a physician in Abilene, Texas, and her mission in life is simple: to be passionate, grow, learn and have fun. So you’ll hear about financial freedom as well as emotional freedom. She helps physicians understand the RVU system, how to docent appropriately for the level of service, how to use telemedicine codes and how to maximize reimbursement from procedures and tests and how to survive a medical audit. She received her undergraduate degree from Yale, earned her medical degree from West Virginia Medical School and she completed her Ophthalmology residency at SUNY Buffalo. She then completed an Ocular Pathology Fellowship at Emory and a Pediatric Ophthalmology Fellowship at Children's Healthcare in Atlanta. So we have a very distinguished and very experienced guest today. So let's welcome Dr. Charlotte to the show.

Dr. Charlotte Akor, MD: Thank you so much! The only part that was missing from that introduction in my early training years was really understanding billing and coding. As medical students and medical residents. We're just not taught that right? Our medical school or residency programs or extra fellowships, but that was one thing that was really lacking from my education.

Christopher H. Loo, MD-PhD: We'll have so much to talk about today. So tell us how you got started in your early days, as medical students and doctors who were just trained in differential diagnosis, what test order, what procedures, all of the studies and vocations, but tell us how you got started in this fascinating field. We really need to learn about proper coding and billing. Because the business of medicine, which is a large portion of the profession today.

Dr. Charlotte Akor, MD: Well, Chris, I did my fellowship with a private practice group. I thought that would really prepare me for the business side of medicine. But they actually said, Hey, we're here to teach you how to be a better pediatric eye surgeon. Not a better biller and coder. So when I went out to my first job, I joined a multi-specialty group. And at the end of my two years, they basically paid me $50 more than my contract, and said, hey we really like you, you're a nice person, but you don't make enough money to stay here, you don't make enough money to buy into our practice, that's our business and practice model. And to hear that, at the end, instead of preparing for it, or having that structure to do it throughout the two year contract, was very disappointing, right? You, you're like, I'm finally done training, and I'm just gonna go work and everything's gonna be perfect. And it wasn't.

So then I got another job, I thought I was doing better, I was doing better, I negotiated a higher salary. The next hospital system was happy to have me. This was a large hospital system. And when they assigned me a biller who had 10 years of Ophthalmology experience. And what had happened in that situation was, it was time to get a bonus, they started paying us to take call. And so I did a week of call. I was so excited to get that extra money in my paycheck. And I said, Hey, Where's, where's that extra money? And they said, Well, you haven't made your best base salary. Right? You signed a contract and have a number. But I didn't even understand how many patients I had to see, how much I had to collect to make that base salary because it was collections-based.

And then what I guess made me extra mad, right? Because it's my fault that I hadn't been educated in production. The hospital system brought an auditing team in and basically they said some of the surgeries were billed incorrectly. Not all my stuff was billed properly. And I said, Well, how am I going to win? Right? If the biller they've assigned me on my team isn't as experienced as he or she should be. The only person it affects me is me. Right? That's the only person it affects. And so that's when I really first just tried to learn more about billing and coding on my own. And so that was, like many, many doctors who don't stay in their first or second job,I was on to job number three.

So job number three. That was in academics and academics is very interesting. But what had happened, there was I really did sit down with the billers to find out, hey, if I saw this patient, and I did this surgery, where is it on the other side of the AR sheet, right? So they were very willing, and helpful to tell me hey, this is why you don't see it here, doctor, this is what needs to be done this way. This is a reason why you saw this patient and there's a zero there, somebody didn't get the pre authorization. So there's so many steps in getting your money. And sometimes you assume that it is going correctly. And even if you are blessed to be in a situation where it goes correctly, you need to know all the steps.

Christopher H. Loo, MD-PhD: So, that's interesting. So you went from going through these different situations and scenarios, and then you realized the importance of learning to read the contract, understanding the lingo, and then going to actually understand the mechanics of how hospitals and physicians actually get paid and reimbursed by these different codes. So what resources and what extra steps did you take? I know you got some certification and you got further training in this area and specialty.

Dr. Charlotte Akor, MD: So my national organization, The American Academy of Ophthalmology, they have some very good resources. They bring a yearly coding meeting to our area. Several years ago, they started teaching some fundamentals of billing and coding. And so that's where I started.

And I said, Hey, I really like this. And my current job, which I've been in for eight and a half years in a hospital sponsored practice, in Abilene, Texas, is that I get paid on the RVU system.

So I get a billing code for all my work. And it's really just a number system, right? When they came and sat with me with my numbers, they said, Well, you need to do this much to get this much money, right? It finally clicked, right. It finally clicked in so one, educating myself, what codes do I use the most? What's the best way to build surgical codes?

It finally clicked for me. It was like, hey, this should be a test, this should be a class in last month of residency 101, right? You're just excited to do surgeries and take care of patients. But then come June 30, you're going to be on that other side. And so it is something that physicians need to take time to learn, just like they're honing their craft. And I started in practice before the internet age where you had to go to the library and run off an article. It is just amazing on this internet, decades of being able to talk to different people and to get that information compressed. So that's what I do. I teach other doctors, I give them the Kaplan of billing and coding, I help them speak that language, I help them really get paid for their work. Because they don't they don't teach us that.

Christopher H. Loo, MD-PhD: I know you mentioned that, it's great that you went from understanding it, and now you're taking that knowledge and resource in teaching. That's like the next level and the next progression. So, we'll talk about that. And for the listeners, you mentioned a couple things. RVU, just give us a basic gist so they can understand our views, and clinical production and output getting paid and all that sort of thing.

Dr. Charlotte Akor, MD: Well, most doctors are getting paid on some sort of productivity model, obviously, there are doctors on salary, we'll give you this X amount of money. And we expect you to show up this many hours. So you can get paid to predict monetary productivity. So whatever money that practice collects for you or your department collects from you, they'll actually give you the monetary value for your evaluation and management code. But the way some hospital systems have started doing it is a relative value unit. And what a relative value unit is a number set up by Medicare that gives the value of each procedure, evaluation and management code, ER visit code; it gives it a specific number. And that number, that work unit that you do, it's multiplied by a conversion factor. And that's how the doctor figures out what's in their paycheck.

What's important to know about the RVU is that it is something set in stone, right? It's something set in stone. And still, it has its caveats too. So my hospital system, they pay their physician based on these relative value units set up by Medicare, and some practices. Oh, and the important reason why some people think or some organizations like to pay doctors based on RVU is that it doesn't matter what insurance plan the patient has, right? If somebody has Medicare, and it pays $100 for an office visit, and this doc in the group sees a Medicaid patient, and it pays $25 for the same visit, the doctor isn't only trying to see the hiring higher paying patients so that's how some hospital systems especially where they may have a certain amount of indigent patients, that's how they try to make it even or equitable for the group.

Christopher H. Loo, MD-PhD: That was a wonderful explanation. But as an aside, these sort of things are one of the reasons why healthcare is so convoluted and especially the business side. And why we're the profession is just in such a real dysfunction and mess. We were talking about RVUs and billing codes and fighting with insurance and. As doctors we shouldn't need to be doing this, but we have to, because that's the way the system is set up. And if we don't understand it, and we know we don’t be proactive and start learning about these things, then we will be on the short end of the stick while the business side will actually flourish.

So you took and now you have, you have a course right? And now you're a consultant, and you teach individuals how to do that. So tell us more about that.

Dr. Charlotte Akor, MD: So, let me tell you about some of my favorite doctors I've had the opportunity to teach. I had one physician who had just come out of residency, she said, Hey, I'm doing the same thing as my colleagues. Why are my numbers looking different? Why are my numbers looking different?

She was so insulted that the CEO of the hospital told her, well, we could probably just use a nurse practitioner in your place, or we're gonna transfer you to another place like why are we paying you a doctor salary, you're just not producing. And so she went through my program, and she actually tripled her RVUs. Because what billing and coding is, it's just a language, right? It's a language for physicians, the convoluted language, they tell us we have to have, to explain to the insurance company how we get paid.

And so another doctor I just finished working with, she said, Well, I didn't know I could bill and code for that, right? If nobody taught you that word, you can't use it. So just like, we spend that time mastering our surgeries, you have to spend that time mastering billing and coding, and ultimately, collections, which shows up in your paycheck and allows you to have that financial freedom that you've worked so hard for.

Christopher H. Loo, MD-PhD: I like that. Yeah, it's almost like, in financial literacy, you have assets, liabilities, income and expenses. So that's like your balance sheet. And if you understand, if you can explain it and be able to read it, then you can be proactive and start achieving your financial goals. And the same thing, sounds like with billing, if you understand the codes and how the system works, then you can be strategic and your focus and your efforts so that you can maximize your gains.

So, tell us more about, in terms of if people are interested, because I know, there's a Billing and Coding Certification. Is it necessary, if somebody is interested in pursuing that? So, feel free to tell people about how to get certified and learn more about all this.

Dr. Charlotte Akor, MD: Well, I would encourage people to work with me, of course, but the reason why I would encourage somebody to work with me is because.. we, as physicians, we're busy people, we only have so many hours in the day. So of course my complete coding bootcamp is tried and true, right? I pushed several doctors through my system, and I've gotten a lot of positive feedback. And so as physicians we’re smart, we can learn and we're busy. And I don't know if you're like me, Chris, I'm somebody who likes to do things Live, right? You can sit there and teach something to me and talk to me. Yes, as a physician, I love to read, but if you're held accountable to show up and do it, it's gonna get done.

I think that physicians using their academy resources are essential. And I've helped clients to use their academy resources. For example, I coached a pulmonologist. But one benefit she got from me was I could help her interpret or translate her Academy's resources. Because it is complicated. There's LCDs, NCDs, bundles, frequency edits, it's just crazy. It is crazy, right? All these crazy rules to help us to make sure we don't get our money.

And also part of my program is, how do you communicate with your biller? Right, if he was a doctor, you need to be the expert at taking care of your pain. But you can't let that financial piece completely be out of your purview. So what questions should you be asking your biller weekly, monthly, right?

When do the codes change, right? When has something changed, right? Part of it is knowing what is going on. But knowing how to use the people on your team to help you get access to the changes. So again, you can do the work, but you can get paid appropriately for your work.

Christopher H. Loo, MD-PhD: That's awesome. And I see you also wrote two books, tell us more about the two books that you wrote.

Dr. Charlotte Akor, MD: So Medical Coding Decoded, is high yield. Hey, are you doing this? Are you billing for a smoking cessation, right? Are you billing for transition of care? Have you forgotten that you can still build consult codes. Every $50 adds up, right? And one thing that you may not know about can pay dividends. So Medical Coding Decoded is just a high yield quick read of your CPT codes that you should be using, if you're not using them yet.

And then, as an ophthalmologist, that book is for ophthalmologists, but it's actually for any doctor because I had some of my colleagues help write it. I have a good friend, a neurologist. I have a good friend that is a direct primary care physician. And even though I play in the insurance company space, I'm an employed physician, I take all insurances, even Medicaid.

I think doctors need to start thinking about, hey, especially if I'm in private practice, how do I make sure that I'm getting paid the most for my work? What things can I offer differently? So some of those things that I'm doing can be cash pay, right. So that's why I had the direct primary care physician talk. That's why I had the neurologist talk, right? It's different when you're in private practice, if you don't collect the money, you don't get paid. Compared to, I read about my hospital system, they're not broke yet, so I'll be at work on Monday.

So that book, it just gives you a bigger, complete view of, hey, and these are things that need to happen for you to even get paid for that CPT code.

Christopher H. Loo, MD-PhD: Awesome. So we'll put all the mentions in the show notes. And you gave a really great overview of the whole billing and coding space, and I'm sure a lot of people will be reaching out to you. What's the best way to contact you by reaching out to your social media websites? We'll put all those links there.

Dr. Charlotte Akor, MD: Okay, thank you so much. It is a pleasure talking to you, Dr. Loo

Christopher H. Loo, MD-PhD: Well, any last words in any parting advice for the listeners?

Dr. Charlotte Akor, MD: Stay positive, right as, as physicians, people really look up to us, they still respect us, despite what the media wants to show. And if it's your passion to practice medicine, it just has to be your passion to understand how you get paid, so you can keep the lights on.

Christopher H. Loo, MD-PhD: I love that. All right. So thanks so much for tuning in. And we look forward to having you on future episodes. Thank you.


Editor's note: This transcript has been edited for brevity and clarity.


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