Are We Doing Enough To Address Billing And Coding In Residency Education?

Q: Does your residency program include any training in the areas of practice management, billing or coding? If so, please describe the formal or informal experiences your residents may gain in these areas.

Both David Bernstein, DPM and William Urbas, DPM cite inclusion of practice management principles in the curriculums of their residency programs. Dr. Bernstein explains that this is accomplished mostly in an office setting with residents gleaning practice management insights not only with doctors but with the billing department as well. He relates that this allows firsthand experience with office-based electronic health records (EHRs), practice management and IT concepts.

Dr. Urbas shares that all residents are exposed to lectures on billing and coding. He adds that third-year residents rotate through private practices to see practice management in action.

“We make a special effort to explain proper coding and billing in regard to treatments provided and different insurance carriers,” notes Dr. Urbas.

Conversely, J. Randolph Clements, DPM shares that his program does not have a formal practice management aspect to the curriculum. He does relate that residents receive guidance from Epic EHR, which illustrates ‘big picture’ items, even if they are not foot and ankle specific.

Q: What role do you feel practice management topics such as billing and coding play in residency training? Do you feel they are important or better reserved for a post-residency time frame?

Each panelist takes a somewhat different position on the best timing of these topics in one’s development as a provider. Dr. Clements feels practice management fits best in a post-residency time frame.

“We have a tremendous amount of clinical content to cover during residency training,” maintains Dr. Clements. “While billing and coding are an important part of success in practice, I don’t think it is the role of residency programs to teach people how to make money. It is our role to teach them to be safe and competent providers.”

Dr. Urbas relates that practice management topics fit well in the third year of training as many future employers expect incoming associates to be able to enter into a practice not only with clinical and surgical skills, but the ability to run an efficient office as well.

Dr. Bernstein shares that residents start learning these insights from day one in his residency program and he feels practice management is as important as medical and surgical care plans.

Q: What actions do you feel residents can take on their own to best prepare themselves for these aspects of their practice once they are finished with residency? Are there any resources you recommend for residents to learn about practice management, billing or coding?

Dr. Bernstein says his residents are encouraged to talk formally and informally with all attendings about what is next after graduation. He also cites close communication with former senior residents and fellows as productive.

“Residents need to spend time in the offices of podiatric physicians,” notes Dr. Urbas. “They need to go to seminars that deal with practice management and coding. The American Podiatric Medical Association (APMA) offers great courses in this respect. I stress to residents to read APMA News because it is filled with information … and presents resources where they can go for help.”

Dr. Clements agrees that APMA billing courses are good resources. He adds that the American College of Foot and Ankle Surgeons (ACFAS) also provides these courses that he feels are very helpful for those transitioning from residency into practice.

Dr. Bernstein is the Director of the Podiatric Residency Program at Bryn Mawr Hospital in Bryn Mawr, Pennsylvania.

Dr. Clements is the Director of the Podiatric Residency Program at the Carilion Clinic, based out of Carilion Roanoke Memorial Hospital in Roanoke, Virginia.

Dr. Urbas is the Director of the Podiatric Residency Program with the Crozer-Keystone Health System in Delaware County in Pennsylvania.