medical billing - fine lineMedical coding seems like a profession where everything is black and white. There’s the right code for a diagnosis or procedure, and there’s the wrong code—no shades of grey. The reality is somewhat different.
Medical billers are not automatons who spit out the right code time and time again. They are skilled individuals who understand the nuances of coding and medical documentation. They also constantly walk that fine line between coding to the highest level and (illegal) upcoding.
Let’s explore some pitfalls practice managers need to watch for when it comes to medical billers.

  1. Complacency. Highly experienced billers are a boon to a practice because of their knowledge. However, it’s not unheard of for billers to become complacent. They’ve been in their position for so long that they’ve gotten into the practice of skimming the record and coding accordingly. That can lead to  incomplete or incorrect codes from coding the first condition they see, rather than reading the entire encounter. It can also lead to missing codes altogether.
  2. Haste. When coders feel pressured to meet a quota or are simply rushing through claims to finish on time each day, they may employ shortcuts that cause claim rejections or under-coding.
  3. Distractions. It’s difficult to do a thorough job when you’re distracted, whether its due to work email, non-work email, social media, office chatter, or domestic disturbances (for remote workers). It’s impossible to eliminate distractions completely, of course, but you can help workers understand how much productivity is lost to it and encourage habits such as checking email hourly rather than each time a new message comes in.
  4. Failure to reach out. Whether coders are in an in-office setting or a home-office one, they should feel comfortable reaching out to their peers to ask questions when they’re unsure about a code. Make sure to encourage and reward this behavior.

Finally, make sure anyone responsible for coding your practice’s services knows they are never expected to code anything that is not in the medical record. As the practice manager, it’s important for you to state this explicitly and then set an example by consistently behaving with integrity.
Physician Billing Services Case Study

Last Updated on November 26, 2014