When we think about medical billing and coding training, specifically medical practices and patients visits, we tend to simplify our perception of office protocol:

• A patient checks in at the front desk.
• A co-payment might be required at the time of service.
• A referral might be needed for a specialist.
• A healthcare provider visits with the patient face to face.
• Information concerning the patient’s chief complaint and treatment is documented in the electronic medical record.
• The medical coder and/or biller receive the information, input the data into the practice management software and transmit the claim.
• Payment arrives approximately two weeks later.

This process is very straightforward. Right? Not quite!

Regardless of how productive a physician is; if the front desk does not do their job verifying patient demographics and insurance eligibility at the time of service, no revenue will be generated. By the time the billing department receives the encounter form, the patient has already left the building. Today, transmitting a clean claim involves much more than just accurate coding.

Not long ago, a patient could be registered as “Tom Smith” in the medical record and a claim would get paid. This is no longer the case. For example, if the insurance card states the patient’s name as “Thomas M. Smith”, the claim should read exactly the same way or the claim will deny for lack of recognition.

Claims often deny for terminated coverage and patient invoices are often returned for invalid mailing address.

If a level of service qualifies for a $37.25 reimbursement and the co-payment of $35.00 was not collected at the time of service; the physician will only earn $2.25 for his services if the patient ignores his monthly bills or the invoice gets returned.

A physician I know recently treated a former patient who had transferred to Hong Kong for business and was in the states for a brief visit. He provided the front desk with his Hong Kong address (which does not fit into EMR or PM software) and his Blue Cross of Hong Kong card, which contained information in Chinese. The claim did not transmit electronically and the mailing address was not in English. I found a website and discovered the patient should have paid at the time of service and forwarded his receipt and doctor’s notes to Blue Cross of Hong Kong for reimbursement. Guess who is not getting paid $340.00 for services?

Medical coding is another issue. Medical coders search for clues within diagnosis codes, when indications such as UTI, or B12 Deficiency are listed but no correlating procedure codes are presented. Most likely the procedures took place but time is wasted querying doctors for documentation.

In Summary:

It is my hope that healthcare providers will understand the growing need for accurate documentation and coding. Hiring coders is the responsible action to take as we move towards ICD-10-CM. It can be very frustrating for a coder to read an encounter where a complex repair of the trunk code was recorded, when in fact; a simple repair of the hand was performed.

It is these types of coding errors that make the demand for medical coders continue to grow.

Regardless of the job position, however, accurateness is required in every facet of practice management.

More Medical Billing and Coding Training

Medical Coding Training
What is Medical Billing? AAPC.com

By JoAnne Sheehan

Since 1981 JoAnne Sheehan, CPC, CPC-I, owner of Lomar Associates, Inc. has provided medical practice management expertise as a medical biller and coder, chart auditor, A/R manager , author, and consultant. She has worked on high profile fraud and abuse cases in the Boston area and is also an AAPC Licensed PMCC Coding Instructor.
She has recently joined Laureen Jandroep, CPC, CPC-I, owner of www.codingcertification.org, as an affiliate and independent support representative for CCO’s online physician medical coding program. JoAnne believes CCO offers the most comprehensive approach to becoming a proficient medical coder and is excited to be part of Laureen’s team. She looks forward to working with Laureen and her CCO team and offering students the best education and resources available for the coding profession.

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