What we mean when we say clinicians get their lives back

When we say clinicians get their lives back, we mean the hours between the last patient and the last signed chart. In independent primary care, a doctor sees the last patient at 5:30 and closes the last chart at 10 or 11, some nights later.

Doctors call it "pajama time," and nobody says it fondly. It's the complaint we hear most from physicians who run their own practices or work in small groups.

Where do the evenings go?

Most of that time goes to the record. The clinical questions usually get settled in the room, with the patient. The question that keeps a doctor at the keyboard is whether the note will hold up when a biller reads it next week or an insurance company reads it in three months.

The chart has to satisfy the biller, the insurance company, the quality program and the auditor, and it still has to say what happened with the patient. In a small practice there's no coding department behind the doctor. The doctor sorts it out alone, after hours, every night.

What goes wrong in the chart?

The misses are small, ordinary and constant.

A patient with type 2 diabetes and nerve damage in the feet gets two codes: G62.9, polyneuropathy with no cause given, and E11.42, type 2 diabetes with polyneuropathy. E11.42 already says both things, so G62.9 shouldn't be there. The biller spots it two weeks later and sends the chart back. The doctor, two weeks and 200 patients removed, reopens it and writes an addendum.

Two codes on one claim contradict each other. I12.9 says high blood pressure damaged the kidneys. I15.0 says kidney disease caused the high blood pressure. The coding rules say pick one, and the insurance company can deny or kick back the claim when both show up. (More on code pairs like this.)

The note says right knee, and the code is M25.569, knee pain with no side given. The right-knee code is M25.561.

Chronic conditions need a line about what happened today. "Hypertension, continue lisinopril" says less than "Hypertension, BP 136/84, taking it daily, continue lisinopril, goal under 130/80." Coders want to see that each condition was monitored, evaluated, assessed or treated at this visit. (What the note needs for each chronic condition.)

On top of that sit quality measures, prior authorizations and each insurance company's own rules. A busy doctor is supposed to hold all of it in mind while seeing 24 patients.

Each of these fixes takes a minute while the visit is fresh. Two weeks later it takes a message from the biller, a reopened chart and an addendum, and it happens across a full panel.

What does Cortex Lens do about it?

Cortex Lens checks the chart in Practice Fusion before the doctor signs. It flags codes that can't be billed together, a code missing a left or right, two codes that should be one combination code, and a visit level the note doesn't support, up or down.

The doctor sees each flag the way a writer sees a spell-check underline and fixes it while the patient is still fresh in mind. Lens never changes the chart. A person makes every change, and Lens checks again.

The note goes to billing right the first time, and nobody has to chase the doctor for an addendum two weeks later. That's the work we're taking off the evening.

Why does this matter beyond one doctor?

Physicians leave primary care every year, and plenty of them are good at it. They leave because the paperwork around the medicine, the documentation, the coding and the back-and-forth with insurance companies, makes the job unsustainable.

Independent primary care runs on thin margins. A practice that loses a doctor doesn't always survive it, and the ones that do often sell. Every evening we give back makes it a little easier for a doctor to stay, and for a practice to stay independent.

If you run an independent primary care practice on Practice Fusion, book a demo and watch Lens check a chart before it's signed.