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In this economy, it's more important than ever to ensure a practice's medical billing and coding staff are efficient and productive. And what better way to boost this department than with advice from a coder?

In the second part of MGMA's interview with Margie Vaught, CPC, we talk about best practices for billers and coders regardless of their specialty. (Catch the first part: "How to avoid 3 common medical billing and coding errors")

Vaught is a licensed instructor (PMCC) for the American Academy of Professional Coders and the coding content specialist for DecisionHealth. She's also a regular contributor to MGMA Connexion magazine's "Code of Conduct" column.

MGMA: What are your top three coding tips that can apply to any medical practice, regardless of specialty?

Vaught:

  1. It really needs to be a team effort.

    The provider needs to be able to have access to the coder/biller, and the coder/biller needs to have access to the provider. There needs to be some kind of communication, whether it's via e-mail or a form, there has to be that connection. And many offices with outsourcing their billing or their transcription, they lose that continuity because of the fact that there isn't that connection. I really feel for offices that don't have that open rapport.

    Whether coder/billers go to the administrator/practice executive and say, "Here are concerns, could you bring them up at the next board meeting?" or the coder/billers are invited to the next meeting to discuss it - teamwork is one of the biggest keys to getting everyone on the same page.
  2. Route the explanation of benefits (EOBs) to the people who are checking the coding and the billing, so they see what's going on.

    Usually what happens is, the coders and billers are in one section, they put in all their things and the bill goes off. And then the check comes with the explanation of benefits. The check goes to the controller, the EOB goes off to another department so they can key in the information on the patient's encounter. So if there are errors or problems, it doesn't ever get back to that coder or biller.

    As a coder, how am I to know if I forgot a modifier? Maybe I transposed codes? There has to be - whether you do it weekly, monthly, bimonthly - a sit down to go through those EOBs. The bigger the practice, the harder it is for the coders and billers to know if their coding is going through or if they're getting denied. As an executive administrator, you have to keep an eye out if you need more training for your staff, of if you need to replace staff because they're constantly making errors.
  3. Make sure you're keeping staff educated.

    Just like physicians are required to have so many continuing education units for their degree or for their state license, the same thing applies to your coding staff. In fact, the OIG Compliance Program clearly documents that there needs to be continued education. They leave the education up to the actual practice, but you need to show if (for any reason) you get pulled into an audit that you were trying your best and training your people.

    Even if you have a low budget, there are Webinars and subscriptions to different magazines that give official sources [of coding information]. It's up to the provider to make sure that information is getting to the coders.

MGMA: Why is it so important, especially during this economic recession, to get medical coding right?

Vaught: Usually in February and March, we are at the mercy of patients because the new deductible starts over. January we're usually pretty good because we're still recouping from December. We've got to make sure we get all the information in as timely as possible, so that we're able to let the patient know if we need to ask for their payment up front. Get the staff motivated. Send them to some courses where they learn how to collect that money. Some office staff can't ask for money. They are totally embarrassed and they can't say, "Margie, we're glad you're here today, can I have your $15 copay?"

I went at least 15 years where I was never approached when I went into my family practice office. I would stand there and say, "Is there anything else you need before I leave?" and nobody would ever ask me for my copay. I always had it, but I didn't give it until I was asked because I wanted to see if the staff had been trained.

You may think that a $10, $15 or $5 copay is not a lot, but multiply that by the patients, and if we're sending out bills to try to collect that every time, we're losing money because of the costs of the statements and manpower. Make sure your front office and your coding/billing department is up to par so that we can make sure we get it right the first time around.

 

Listen to the podcast To hear these tips and more, listen to our podcast with Margie Vaught, or get more expert coding ideas from MGMA


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