I don't think there is anything available to all moral physicians that can be as profitable as spending the extra little time making sure you have recorded enough history to justify a 99214 charge, if the rest of the visit can support it. If an EHR can change a physician from always charging 99213 to prevent audits over to doing 99214s half the time, the difference is a lot of profit. AC can help us make some money with meaningful use, and maybe an integrated PM could minimize staff time, but nothing compares to billing exactly what you did.
As we all know and have been trained by CMS for 18 years, a 99214 charge requires 2 out of 3 of a detailed history (required CC, extended HPI as per Mario, extended ROS, pertinent Past, Family, Social History), a detailed exam (at least 6 organ systems/body areas or 12 elements of one organ system/body part), and moderate complexity of decision making (2 out of 3 for multiple diagnoses, moderate data to be reviewed, and moderate risk of significant complications).
Moderate complexity of decision making is subjective, so you can probably get this for an acute illness or more than one chronic disease, starting a new treatment, etc.. This is where we have to think that not every visit is either a 99213 or a 99214. It is the ratio that will leave money on the table or trigger an audit.
A detailed exam is probably the element that doesn't get recorded fully, even if it was done.
So the detailed history is the tie breaker. EHRs make it a lot easier to record a detailed history. Some offices even use a nurse for most of this.
I hope AC will make this area very robust in future versions.
I never want to trust a program to do more than help me know if I have recorded enough bullet points, elements, etc in the history and exam. If we get too confident in letting the program decide our visit charge, eventually the insurance companies will be choosing it for us.
