Physicians Prefer Hiring Certified Billers and Coders to Avoid Various Coding Errors and Increase Revenue at Their Clinic!

Providers and patients both are acutely aware that medical coding errors are the core of many billing issues. Medical coding and billing is becoming increasingly complex, and at times larger hospitals require more than 200 people involved to generate a single medical bill.

As certified coders provide proof of coding knowledge and competence; healthcare facilities to increase their revenue, prefer to hire a certified coder to avoid unnecessary coding errors.

Industry Standards State

A survey result depicted certified billers and coders earn approximately 20% more than their non certified counterparts

Medical Coding Facts

  • There are errors in almost 40% of claim statements sent between providers and payers
  • From the processed claims which are returned by insurance payer approximately 20% have errors
  • Nearly 15% of all the claims processed have fraud, negligence and abuse

These errors drastically impact revenue hence physicians are increasingly seeking certified professionals with a complete understanding of industry-standard codes and practices.

Frequent Medical Coding Errors to be avoided?

Modifiers used incorrectly –this may occur due to wrong information, misinterpretation, common error, or maybe even to just simply to get paid. However eventually it is detrimental to the revenue of a clinic to error in this significant area of medical coding. Modifiers include CPT and HCPCS modifiers and their usage requires an understanding of the global surgical package and National Correct Coding Initiative (NCCI) edits.
Errors while picking the procedure code – reason for this can be inaccurate information on encounter form, incomplete information, confusion, electronic format breakdown. As there are greater than 75000 CPT codes and various rules, errors could be caused due to incomplete knowledge while gathering information, comments and notes from CPT books. Hence the medical coder must constantly focus and update their knowledge.
Wrong use of CPT codescommon example of this is when practices believe that they can charge a nurse visit (CPT code 99211) with an injection or for a venipuncture. However services like allergy shot, venipuncture, etc should not be billed as nurse visits. Hence it is a requisite for your coders to be well informed to get usage of codes right.
Service and reason for service related wrongly – while CPT or HCPCS code confirms the service, the reason for the service is confirmed through the diagnosis code, but coders at times error when multiple unrelated services are rendered resulting in claim rejection. Hence to avoid this error it is extremely important to be able to properly link the right diagnostic code for services by medical coders.
Irregular updating of new coding rules – this is a costly mistake medical practices’ and hospitals make in order to remain within their budget as it can result in loss of revenue and significant compliance risk for practices.

Medical coders need to update their coding knowledge regularly through certifications and varied books to avoid majority of the above and other coding errors. Consequently coders with credentials like Certified Professional Coder (CPC®) improve their job opportunities with medical practices.

Physicians hence often favor credentialed billers and coders with verifiable skills while hiring because a certification signifies the candidate is capable of -

  • Accurately reviewing patient records and assigning correct medical codes
  • Displays awareness of healthcare services such as surgery, radiology, anesthesia, etc
  • Has right knowledge of medical coding rules, procedures, compliance and payment
  • Can handle issues like denials, medically necessary procedures and bundling
  • Sound knowledge of important medical terminology, along with anatomy and physiology

Medical Coder’s future and certification

Certification can lead to expanded career opportunities, and more medical billers and coders are getting certified in their relevant field. Currently only half of the medical billers and coders are certified however considering the increasing competition and coding regulations, certification are expected to become a necessity by 2020 with employers expecting applicants with certifications before hiring.

To be ready to appropriately handle the future competition in medical billing and coding jobs, it is a necessity to be updated with the ongoing changes, one way is to secure a certification in your field. Nationally-recognized certification test and securing certification in CCS or CPC can be a good start for medical billers and coders who want to improve their future job prospects. largest consortium of expert billers and coders offers wide opportunity to medical billers and coders across all US States. Our job portal and regular billing & coding updates and newsletters provide a vast pool of opportunities and knowledge to billers and coders about industry updates and certifications; also continuously updating about the ICD-10 updates.

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