You are browsing the archive for 2011 September.

Avatar of ronick

by ronick

Coder shortage goes straight to the Bottom Line

September 30, 2011 in Medical Billing/Coding


The prob­lems asso­ci­ated with nurse and phar­ma­cist short­ages are becom­ing an old and sad story. Now you can add a new chap­ter: The lack of med­ical coders has risen to crit­i­cal lev­els in some areas, and those who do noth­ing about it stand to lose mil­lions of dol­lars in unbilled charges.

Cod­ing is a key com­po­nent in the rev­enue cycle,” says Phil Incar­nati, president/CEO of McLaren Health Care Corp., Flint, Mich. “If you get bogged down in cod­ing, you stop the rev­enue. With the dif­fi­cul­ties health care sys­tems and indi­vid­ual hos­pi­tals are deal­ing with to make a mar­gin to sup­port their mis­sions, you cer­tainly don’t want to short­change your­self on the rev­enue side.”

McLaren board Chair­man Charles Weeks agrees: “Hos­pi­tals can’t afford to wait until the sit­u­a­tion becomes dire. They need to be dili­gent about keep­ing up with the sit­u­a­tion or they stand to lose a lot of cash flow.”

William Cronin, pres­i­dent of PHNS HIM Inc. (Provider Health­Net Ser­vices Health Infor­ma­tion Man­age­ment Inc.), Mon­u­ment, Colo., esti­mates the short­age to be as great as 30 per­cent nation­wide. A study by the Amer­i­can Health Infor­ma­tion Man­age­ment Asso­ci­a­tion, Chicago, finds that the short­age is most crit­i­cal in the north­east­ern and west­ern parts of the country.

The Bureau of Labor Sta­tis­tics esti­mates that U.S. hos­pi­tals will need 97,000 new med­ical record and med­ical health tech­ni­cians by the year 2010 to replace those who are leav­ing the field now.

The sit­u­a­tion is going to get worse before it gets bet­ter,” says Incar­nati, who has helped imple­ment a num­ber of mea­sures to min­i­mize the short­age among the health care system’s six hos­pi­tals. “Hos­pi­tal board mem­bers have a fidu­ciary respon­si­bil­ity to facil­i­tate the preser­va­tion of assets for a hos­pi­tal. Cod­ing is so crit­i­cal that it needs to be high on the radar screen for board mem­bers and hos­pi­tal admin­is­tra­tion. You don’t want to be in the posi­tion where you are mak­ing a lot of mis­takes in this area because the penal­ties are extreme.”

Fewer peo­ple are choos­ing cod­ing as a pro­fes­sion, in part because of the com­plex­ity and chang­ing nature of the job due to fre­quent revi­sions of gov­ern­ment reg­u­la­tions. Greater work­load result­ing from expanded prospec­tive pay­ment reg­u­la­tions are also to blame. These include out­pa­tient, skilled nurs­ing, reha­bil­i­ta­tion, home health and long-term acute care. Addi­tion­ally, because there are no degree pro­grams in cod­ing, hos­pi­tals have no direct source or pipeline from which they can recruit.

On top of that, learn­ing how to do clin­i­cal cod­ing is no easy task. The coder is respon­si­ble for review­ing all tests, diag­noses, results and med­ica­tions and giv­ing them a numeric value. This requires sub­stan­tial clin­i­cal under­stand­ing as well as med­ical record and com­puter tech­nol­ogy knowl­edge. Many coders come from the clin­i­cal field look­ing to begin a sec­ond career. Oth­ers pur­sue a degree in health infor­ma­tion man­age­ment to help pre­pare them for the job. To become cer­ti­fied, they must undergo an 18-month AHIMA pro­gram and pass an exam offered by that orga­ni­za­tion or take a cer­ti­fi­ca­tion pro­gram offered by the Amer­i­can Acad­emy of Pro­fes­sional Coders.

To really become com­pe­tent at the pro­fes­sion, on-the-job expe­ri­ence is a neces­sity, says Nelly Leon-Chisen, direc­tor of cod­ing and clas­si­fi­ca­tion with the Amer­i­can Hos­pi­tal Asso­ci­a­tion. While they are often hard to find, there are cer­tifi­cate pro­grams that spe­cial­ize in cod­ing, Leon-Chisen notes. Some asso­ciate degree pro­grams in health infor­ma­tion tech­nol­ogy teach cod­ing and there are sev­eral bachelor’s pro­grams in health infor­ma­tion man­age­ment that cover cod­ing as well. “The prob­lem is that there aren’t a lot of edu­ca­tional pro­grams that offer these degrees, and when they do, they are in larger cities,” she says.

Typ­i­cally, those enter­ing the pro­fes­sion have a med­ical records back­ground and are forced into on-the-job train­ing, accord­ing to Incarnati.

That leads to another part of the puz­zle. Because hos­pi­tals are so short-staffed with cod­ing per­son­nel, many lack the man­power to pro­vide essen­tial train­ing for new coders. Even those peo­ple with an edu­ca­tion in med­ical infor­ma­tion man­age­ment need direct over­sight and train­ing for six months to a year to get up to speed on the com­plex­i­ties of the job, Leon-Chisen says.

In the rush to fill med­ical cod­ing vacan­cies, hos­pi­tals need to be scrupu­lous about hir­ing qual­i­fied peo­ple. After all, a hospital’s rep­u­ta­tion is on the line, says Bill Robert­son, pres­i­dent and trustee of Adven­tist Health­Care Inc., Rockville, Md. “Hos­pi­tals have a lot to lose if they don’t use qual­i­fied peo­ple,” he says. “Cod­ing essen­tially cre­ates the win­dow [through] which oth­ers judge the com­plex­ity of care you’re pro­vid­ing. Out­comes are adjusted by sever­ity. If your cod­ing is not com­plete and up-to-date, it will affect how out­side com­pa­nies judge your level of care.”

Rita Sci­chilone, AHIMA’s direc­tor of cod­ing prod­ucts and ser­vices, agrees: “Coders are an inte­gral part of a health care sys­tem. Not only are they key in reim­burse­ment and pro­cess­ing claims but they are crit­i­cal in deci­sion sup­port, index­ing of dis­ease and over­all clin­i­cal man­age­ment. They are respon­si­ble for mak­ing sure the hos­pi­tal fol­lows the appro­pri­ate gov­ern­ment rules and reg­u­la­tions. Inac­cu­rate and inap­pro­pri­ate codes are what get a hos­pi­tal into com­pli­ance prob­lems with fraud and abuse.”

Con­tract cod­ing com­pa­nies pick up the slack for many hos­pi­tals, and have become a $5 bil­lion busi­ness, says Cronin.

It is not uncom­mon to see more than $1 mil­lion to $2 mil­lion worth of charts that have been untouched for weeks or months, accord­ing to Cronin. He’s even seen the num­ber rise above $20 mil­lion because of missed dead­lines. The result is a sig­nif­i­cant loss of revenues.

A tell­tale sign that your hos­pi­tal may be short of coders is an increase in accounts receiv­able or out­stand­ing days to col­lect pay­ment, Incar­nati says. Adven­tist strives for a three– to four-day turnover, Robert­son says.

For McLaren Health Care Corp., which has annual rev­enues of approx­i­mately $2 bil­lion, a day lost in accounts receiv­able trans­lates into approx­i­mately $5.5 mil­lion in lost reim­burse­ment, Incar­nati says.


Many hos­pi­tals, such as Adven­tist, are begin­ning to imple­ment inter­nal mea­sures to ease the short­age: upgraded pay scales, sign­ing bonuses, flex-time and over­time oppor­tu­ni­ties, schol­ar­ship pro­grams for cod­ing edu­ca­tion, online train­ing pro­grams, in-house train­ing for inter­nal employ­ees and increased use of free­lance coders.

Hos­pi­tals also should con­cen­trate on employee reten­tion. “Coders need to know that they are respected and rec­og­nized for the impor­tant con­tri­bu­tions they make,” Sci­chilone says. “Cur­rent coders need to be sup­ported by oppor­tu­ni­ties for con­tin­u­ing edu­ca­tion and pro­fes­sional development.”

Adds Incar­nati: “Our indus­try receives a lot of crit­i­cism that we are not proac­tive enough [with] rev­enue. There are some good lessons to learn from the pain of oth­ers. This is one issue that hos­pi­tals can’t afford to sit on.”

Writ­ten By: Susan Meyers

Avatar of ronick

by ronick

10 Things You Should Do Before You Start Your Medical Billing Business

September 30, 2011 in Medical Billing/Coding

One time, I saw a news­pa­per ad say­ing they are hir­ing work-at-home med­ical billers. I called the num­ber (just to find out what it is!), I found out that for you to be able to work as a Med­ical Biller, you have to pur­chase their soft­ware at a range of $800–1,500 (I thought, it is actu­ally a packaged-medical billing busi­ness). They will then train you how to use their soft­ware, after (I think) 10 days of train­ing, you will have an access to their so-called doc­tors’ data­base. They promised you can get your 1st client through their database.

Due to my curios­ity, I started read­ing and research­ing pack­aged home­based med­ical billing busi­ness. But take note: the train­ing you will get is NOT actu­ally a med­ical billing train­ing. The bot­tom line here? – you sim­ply pur­chase the busi­ness, pay for their soft­ware and start your busi­ness! But how real­is­tic is this? I know some peo­ple who ended up with no clients at all after pur­chas­ing the soft­ware! And then later on, I’ve read that the Fed­eral Trade Com­mis­sion warned us about these com­pa­nies offer­ing home­based med­ical billing busi­ness with their false claims on how you make a lot of money on this business.

Med­ical Billing is a legit­i­mate busi­ness (either home-based or office-based) and you can make good money as long as you know how to do it, the right way. But before that, con­sider the 10 Things You Need To Do:

1. Try to gain actual work expe­ri­ence. Work as a Med­ical Biller in a doctor’s office (or even as a vol­un­teer at your near­est hos­pi­tal). Do this for at least a year.

2. You should be highly knowl­edge­able on HIPAA (Health Insur­ance Porta­bil­ity and Account­abil­ity) and how does your cur­rent work/practice place complies/follows its rules and reg­u­la­tions. I always empha­size this because it is very impor­tant in any health provider businesses

3. Learn the actual “know-how” on claims sub­mis­sion (paper billing & elec­tronic billing)

4. Learn how you can deal with insur­ances, can you han­dle col­lec­tions? denied/rejected claims? Learn how to file appeals for denied claims

5. Learn how to ana­lyze and opti­mize proper cod­ing (pro­ce­dure and diag­no­sis codes) to avoid rejec­tion & denials

6. Learn how to review and ana­lyze the rea­sons for unbilled and or aged med­ical claims

7. Beside learn­ing the med­ical ter­mi­nolo­gies, you should also know many “med­ical billing” terms and its mean­ing: (PCP, copay, co-insurance, deductibles, allowed amounts, pre­de­ter­mi­na­tion, med­ical neces­sity, progress notes, prog­no­sis, treat­ment plan, preau­tho­riza­tion, appeals, refer­rals, scripts, ben­e­fits and eli­gi­bil­ity, cap­i­ta­tions, HMOs, PPOs, POS, EPOHIPAA)

8. Learn how to prop­erly post: – pay­ments, deductibles, co-insurance, adjust­ments and write-offs (it is dif­fer­ent when you are actu­ally at work doing the post­ings than what you learned dur­ing your training)

9. Feel the med­ical billing sce­nario (how is the cash flow? what about the turn-around time of payments?)

10. And the last but not the least, feel the work— do you like what you do? Do you have the abil­ity and the man­age­r­ial skill to run your business?

Writ­ten By: Pinky Mcbanon

Avatar of ronick

by ronick

The Coder Codes

September 30, 2011 in Medical Billing/Coding


CPT man­ual

I was sit­ting com­fort­ably on the couch, watch­ing the foot­ball game in the liv­ing room on a cold, win­ter Sun­day after­noon. the New York Giants were play­ing the New York Jets in a game for big apple brag­ging rights. the game was close and time was run­ning out. I gave it my undi­vided attention.Suddenly, my wife runs down the stairs and heads towards me car­ry­ing my two year old son. Fran­ti­cally, she states, “I think he’s sick. Look at him, plus he hasn’t eaten all day.” This was unusual for my son. He usu­ally eats any and every­thing avail­able. I see sweat drip­ping from his fore­head. I check for a fever by putting my hand on his fore­head and i’m sur­prised by how cold it is. “He is freez­ing,” I state.“Do some­thing,” she screams at me. I look at my son who is lay­ing in her arms, limp as can be with his eyes barely open. This is a far cry from the two year old who is nor­mally keep­ing busy by ter­ror­iz­ing every­thing and every one in the house. “You’ve got to do some­thing,” she con­tin­ues. “Isn’t this what you do for a liv­ing?” She had turned to sar­casm so I knew that she was really upset and unrav­el­ing. Our son had never been sick in the two plus years that he’d been alive.I began to take him from her. At that moment, when we were both hold­ing him, mak­ing the exchange, he began to cough. He unleashed a cough that’s only heard from vet­eran drinkers who chase the smell of alco­hol from their breath by smok­ing half a pack of cig­a­rettes a day. He con­tin­ued to cough, an uncon­trol­lable cough that led to him vom­it­ing. the pro­jec­tion was mostly in my direc­tion, but my wife caught some of the after effects. She grabbed a nearby towel and began to wipe his face. I stood him up and aimed his head away from us in case he had more to offer.

My wife looked at me once again. “What are you going to do for him? Don’t you do this for a liv­ing?” She was vis­i­bly upset and the sar­casm was at its fullest. “Don’t you take care of patients? This is a patient.” I knew that see­ing some­one ill or hurt or help­less, espe­cially if that some­one was your child, was a hard pill to swal­low, but geez…I hurt too. Finally I yelled, “I AM NOT A DOCTOR. I AM JUST A coder.” I had never referred to this posi­tion as ‘just’ a coder. I know that coders play a very impor­tant role in med­i­cine, but let’s face it, I’m no doc­tor. She looked at me and seemed to calm down. She jumped on the phone and began speak­ing with his pediatrician’s office. While she did that, I did what comes naturally…I began to code.

I put my hands on my son’s neck then on his fore­head. This time he was burn­ing up. He had a fever. I sat down and cra­dled him in my arms. He was shak­ing. Although he was hot, he was expe­ri­enc­ing chills.

I leafed through the alpha­betic pages of my men­tal ICD-9-CM man­ual and found the codes for chills with fever, cough and vom­it­ing. I was sure to con­firm them in the numeric index. My wife hung up the phone and explained that we were going to take him to the pediatrician’s office. they had told her to bring him in right away.

We quickly changed clothes, grabbed our coats and headed for the front door. I attempted to use my periph­eral vision to steal a glance at the tele­vi­sion in hopes of catch­ing an update on the score of the game, but my wife pressed the power but­ton on the remote before I could.

We arrived at the office and were called in imme­di­ately. My son’s doc­tor asked, “what’s wrong with him?” My wife’s voice echoed loudly in my head, ‘DO SOMETHING.’ So I did. I handed my son to the doc­tor and con­fi­dently stated, “he is expe­ri­enc­ing a 780.6, has a 786.2 and 787.03 all over my wife and I. He is all your now.” the doc­tor laughed, my wife smiled and I was back on her good side. 



After an estab­lished, office visit E&M code, my son turned out to have 382.9, Oti­tis media. Doc gave him antibi­otics and a cough sup­pres­sant and sent us on our way.

R. Rus­sell, CPC


Avatar of ronick

by ronick

It’s ok to know you’re Stupid

September 30, 2011 in QUOTES


There are two types of peo­ple in the world: 1) those that are stu­pid and 2) those that know they are stu­pid.  Those of us that are stu­pid think that we know it all and there­fore learn­ing has stopped.  Those of us who know that we are stu­pid know that there is so much more we can learn.  R. Russell

Avatar of ronick

by ronick

You are what you do.

September 30, 2011 in QUOTES



We are what we repeat­edly do. Excel­lence, then, is not an act, but a habit” Aristotle

© 2011-2019 C l a i m D x All Rights Reserved -- Copyright notice by Blog Copyright