How To Increase Revenue In Your Medical Practice With Medical Billing Stacking

What is billing stacking?

Billing stacking is the practice of stacking, or “combining”, multiple CPT codes in order to maximize revenue.

This is done when you provide multiple services in one patient encounter, however, it is known that many practices fail due to the lack of use of this method. Money is left on the table by not billing for the work or service you already provide as a standard of care.

Example:

You see a patient for high blood pressure. Blood pressure is uncontrolled and you note that the patient’s lower extremities are swollen.

During the visit, you decide that the edema is significant and want to give Furosemide IM, you also counsel the patient on lowering sodium intake, foods to avoid, and fluid restriction implementation.

You also, as a standard of care, provided a PHQ-9 to be done and interpreted the results.

You billed for a 45 min office visit and medication administration – 99214 and 96372. 

But you just lost money.

You missed the counseling you provided the patient as well as the PHQ-9 the patient did and you interpreted.

Rather than 2 CPT codes, you could have used 5. 

• Office visit
• Counseling
• Furosemide 10 mg IM
• Med administration
• Patient Questionnaire

What about niche practices?

You benefit from this too even more so!

Not only can you bill for the services above but let’s say you give a B Complex injection for energy, you can bill the patient cash for that since there is technically “no medical necessity”.

Example:

You see a patient for bioidentical hormone replacement therapy. Patient is on intravaginal estradiol for vaginal atrophy but still having hot flashes, decreased libido, and insomnia. You prescribe a compounded estradiol/progesterone/testosterone mixture to the compounding pharmacy for optimal symptom management. Patient also complaining of weight gain and would like to start GLP-1a injections, however, deductible with insurance is too high and patient also is sensitive to medication, requiring micro-dosing of Glucagon-like Peptide-1 Receptor Agonist (GLP-1a), however, since this is not available in commercial version, you prescribe compounded GLP-1a injection. You advised the patient on exercise implementation and dietary changes. Follow up scheduled in 4 weeks.

Cash pay model:

You charged the patient $40 for the cost of the compounded hormonal cream which you sold at cost. You charged the patient cash for her visit which was a new patient so consultation fee was $150. You also charged the patient her GLP-1a vial, which was $300.

Revenue = $490 (- cost of vial ~$100) = $390

Insurance model:

You charged the insurance 99204 for office visit of a new patient. You sent the compounded hormone cream to local compounding pharmacy, and you charged the patient the at cost price of GLP-1a vial.

Revenue ~ $124 for office visit and MAYBE you billed a counseling for about $24 = $148 

In both models you lose money.

If you were to use a hybrid model AND you optimize your billing, your revenue would be:

• Office visit ~$124
• Obesity counseling ~$24
• Injection administration because you gave the first injection in office - $8
• BED-7 administration and interpretation ~$4.50
• Compounded BHRT cream sold for $85 (cost of medication $40) ~ $40
• GLP-1a vial ~ $300 (-$100 for cost of medication) = $200

Total revenue ~ $400.50

See how you just increased your revenue and just realized you’ve been losing money all this time? 

This is why it’s VERY IMPORTANT to educate yourself and have a VERY good billing to help maximize all your patient encounters.

Don’t keep giving away your time and efforts for free. It is well deserved if you are already doing the work.