Exceptional Coders | Innovative Technology

The Centers for Medicare & Medicaid Services (CMS) issued a final rule earlier this month that includes updates to payment policies and rates for services provided under the Medicare Physician Fee Schedule (PFS) effective on or after January 1, 2020, as well as updates to its E/M coding starting on January 1, 2021.

The annual U.S. national defense spending budget represents a massive hard-to-imagine number. Now consider the amount of waste in the country’s healthcare system. Likely a large amount, but it must be less than national defense—right? According to a recent article on CBSNews.com titled “Wasted health care spending in the U.S. tops annual defense budget, study finds,” the healthcare waste actually exceeds the FY2019 national defense budget, and is estimated at $760 to $935 billion per year. This is waste on a scale that’s difficult to imagine. It’s about a quarter of the sum total of healthcare spending. The study referenced in the article is from the Journal of the American Medical Association, and details the immense scale of the problem.

October is Breast Cancer Awareness Month.  As part of the overall push for mammogram screening and self-checks, there are also calls for practices to ensure they are coding properly for Medicare-provided mammograms. According to a recent AAPC blog post written by Barbara Aubry, RN, AAPC fellow, there are several important ICD-10-CM updates, recently deleted codes, and updates for 2020. These updates began on October 1^st for FY 2020.

The Centers for Medicare & Medicaid Services recently announced updates for ICD-10-CM coding. Managing and keeping abreast of these codes are a complex undertaking, as there will be 72,184 codes in FY 2020. Healthcare organizations should strongly consider utilizing outside coding assistance to effectively understand the changes and benefits of the changes to ICD-10-CM.

 

If you are considering having a serious career in medical coding, the first thing you need to do to gain credibility is to get certified. There are several different types of certifications for medical coders so make sure you know which one would be best for you. The certifications are split into two different levels: entry- level certifications and advanced certifications. Here are some of the most popular certifications:

 

Entry-level Certifications

 

Certified Coding Associate (CCA)

This is offered through AHIMA and is one of the most basic certifications that they offer. The program is designed to give medical coders a general understanding of coding principles. It will create coding competency in both hospitals and physician practices.

            Eligibility Requirements:

• High School Diploma

            Eligibility Recommendations:

• 6 months of medical coding experience
• Completion of an AHIMA approved coding program

 

Your practice will experience revenue leakage starting the moment a patient schedules an appointment with you. Some of these leaks typically start out small but overtime they will make large dents within your practice. Below are some tips to help improve your rev cycle management system and prevent those leaks.

1. Patient Information: Acquiring accurate patient information will help reduce claim rejections due to ineligibility, patient not found, or service not authorized. Implement a checklist at your practices registration office to help insure accuracy. The staff member registering a patient should verify the patient’s information, take a photocopy of the patient’s insurance card, and review the patient’s insurance (optimally, this would be done before the physician sees the patient in order to avoid performing services that are not covered).

 

E/M coding has become the most frequently billed physician service, and auditors are taking notice of its popularity. There is a fine line to walk when it comes to Medical coding.  Frequent E/M coding errors occur when medical practices are either upcoding or undercoding. Upcoding increases the risk of audits. Coding too conservatively doesn’t protect your practice from audits, and it severely decreases your level of reimbursement. Here are some tips to help you stay on the straight and narrow:

 

1. Sending out Claims Under the Wrong Provider: Popular medical coding errors occur when nurse practitioners and physician assistants report services improperly. Often times NP’s or PA’s will send out claims under the physician’s name and National Provider Identifier, but if the patient was treated solely by the NP or PA, the claim should be billed under the mid-level practitioner’s name and NPI.

 

Who Participates in Medical Coding?

Coding is a team effort, with the certified medical coder leading the way.

 

Front Desk/Receptionist

Medical coding starts with a patient making an appointment to see their physician. The receptionist makes the appointment – without the appointment the coding process would fail to start.

 

Physician or Healthcare Provider

Next, is the physician, or healthcare provider. They diagnose the patient based on their symptoms (complaints), and in some cases blood tests, x-rays, or any number of other test(s).

 

Certified Medical Coder

Then the medical record makes its way to the certified medical coder. The coder translates the written clinical documents into codes. This coding process allows the physician or healthcare provider to receive payment for the services they have provided to the patient.

 

The medical coding system originated in England during the 17th century. Statistical data was collected from a system called the London Bills of Mortality, and the data was organized into numerical codes. The codes were then used to estimate the most recurrent causes of death. 

 

Fast-forward a few centuries… The statistical examination of the Mortality Rate (causes of death) was then organized into the “International List of Causes of Death.” Over the years, the World Health Organization (WHO) used the list increasingly to help in tracking the mortality rates and the international health developments.

 

The list was later developed into the International Classification of Diseases, which is now in it’s 10th edition, also known as the ICD-10-CM/PCS.

 

In 1977, the global medical community accepted the ICD system, which compelled the National Centers for Health Statistics (NCHS) to expand their reach to contain clinical information. In other words, the ICD system was extended to include cause of death and clinical diagnoses, such as injuries and illnesses.

 For those familiar with the healthcare industry, right now you may be holding your breath as the much anticipated switch from ICD-9 to ICD-10 is only days away. Whether you work with physicians, in a third party billing company, insurance agency or see a future in the healthcare industry, this switch will inevitably effect the way your job is performed. This switch will even change the way one must prepare for a job in medical coding and the industry itself, from education and training, to benefits, work flexibility and market potential. Read on to find out why this is an exciting time to join the medical coding industry and how to land a job post ICD-10 implementation. 

Industry Changes & What This Means For You

The switch to ICD-10 means that, unless granted a crossover or extension, all states will be required to process all medical billing and documentation in the new code which increased the volume of codes by 520% or from 13,000 used in ICD-9 to 68,000 total for ICD-10. The bright side is, for those considering a career in medical coding, the switch has many healthcare providers and medical billing companies searching for well-trained and certified coders proficient in ICD-10. The US Bureau of Labor Statistics estimates a shortage of more than 50,000 qualified Health Information Management and Health Information Technology Workers by 2015. Meaning that while some degrees and programs leave you to fend for yourself in competitive, oversaturated job markets, while gaining certification in ICD-10 will leave you with many potential prospects in a secure and growing market. 

ICD-10 Training, Certification & Resources