MGMA Insights: Dr. Tej Singh on Maximizing Efficiency and Revenue with Time-Based Billing

Welcome back to the MGMA Insights Podcast. This week, Senior Editor and host Daniel Williams sits down with Dr. Tej Singh, Medical Director of Vascular Surgery at Intermountain Health, Peaks Region in Colorado. Dr. Singh, a recognized leader in healthcare billing innovation, shares his expertise on the transformative impact of time-based billing for surgeons. In this episode, Dr. Singh discusses how time-based billing helps reduce physician burnout, improve revenue cycles, and integrate AI to streamline healthcare billing and compliance. Tune in to understand why time-based billing is becoming essential for medical practices aiming to enhance billing accuracy, increase efficiency, and capture revenue for non-clinical work.

Key Takeaways:

• Understanding Time-Based Billing: Dr. Singh explains how time-based billing captures a surgeon’s non-clinical work—such as reviewing imaging, coordinating with other physicians, and pre- and post-clinic tasks. This approach, introduced by the AMA in 2021, allows surgeons to accurately bill for these essential tasks that were traditionally uncompensated. “Time-based billing captures all the things you are doing outside of the hospital, outside of the clinic, inside the clinic, after the clinic, before the clinic, and you can get credit for that.”
• Reducing Physician Burnout: By enabling billing for the full scope of work, time-based billing reduces administrative burdens, or “note bloat,” allowing physicians to allocate time efficiently and avoid unnecessary documentation fatigue. As Dr. Singh emphasizes, “With EMRs, people were writing long notes, throwing things together… and whether it was relevant or not.”
• Increased Revenue with AI and Time-based Billing Tools: Dr. Singh and his team at Harvard are developing an AI-driven app for real-time tracking of time-based activities. The app records each non-clinical task to ensure accurate billing and mitigates “guesstimation,” which often leads to audit risks. Dr. Singh shares, “As you’re talking to your app, the AI is recording the minutes.”
• Enhanced Compliance and Audit Readiness: Compliance education is key in ensuring the successful adoption of time-based billing. As Dr. Singh notes, “You’ve got to do the education. That is the number one thing for following appropriate coding and billing.” He explains that well-informed providers can prevent audit risks by understanding potential pitfalls like “the impossible day,” where excessive time estimates can trigger audit flags.
• Future Outlook: Dr. Singh envisions widespread adoption of time-based billing, aiming to shift the current 20% of surgeons using the model toward a majority within the next few years. He highlights that time-based billing, combined with efficient tracking tools, could streamline workflows, reduce burnout, and significantly improve revenue cycles across surgical practices. He notes, “Time-based billing for the surgeon is an awareness, educational opportunity.”

Resources Mentioned:

Time-Based Billing App (currently in development by Dr. Singh and Harvard colleagues)

• Article Reference: Miksanek TJ, et al. "Association of Time-Based Billing With Evaluation and Management Revenue for Outpatient Visits," JAMA Netw Open, 2022. DOI: 10.1001/jamanetworkopen.2022.29504

Additional Resources:

• E&M Coding 
• Get Time-based Billing Right 
• NCBI Article 

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