Coder in Residence

The benefit of having your own in-house billers is that they are well-versed in billing procedures for your practice and specialty. They will come to learn your physicians’ coding patterns and preferences.

However, if your practice is small, the downside means requiring your billing department to be the proverbial “jack of all trades.” Sometimes this arrangement is less than practical. Understandably, their first priorities are getting your daily services recorded and generating claims as quickly as possible. In between they will be busy trying to get your claims paid, collecting patient deductibles and copays, and handling whatever else comes their way.

So, how is this complex function orchestrated in your practice? Do you just cross your fingers and hope for the best? Or, do you have a reliable coding/billing manager who has her finger on the pulse of your practice? Whatever the size of your practice, you need to designate a key person to direct the flow of your billing department, if you have one.

I like to call this person a “coder in residence.” A coder in residence is of chief importance to the success of your practice, so you need to select the right person for the job. Obviously that person should have up-to-date coding knowledge, but also should be willing to take responsibility - which means being accountable for results.

Here are the primary responsibilities for a coder in residence:

1. Ensures that coding accurately represents the services performed and that services are coded appropriately so that claims will be paid correctly the first time.

2. Monitors/audits the coding and billing performance of your practice at routine intervals.

3. Makes sure that coders are using the most up-to-date CPT and HCPCS coding manuals and stays current with the most recent changes in ICD-9/10 diagnostic coding.

4. Obtains coding continuing education courses each year with close attention to changes specific to the practice.

5. Presents an annual coding update for the entire practice that focuses on coding procedural changes.

6. Provides formal coding training for all new hires, both providers and billing staff, within 30 days of hire.

Your coder in residence should also monitor the coding performance and variances for all providers each month by graphically comparing each provider and presenting the results and analysis to the management team. In other words, is there a reasonable explanation why one physician is producing more low-level E&M services while another physician in the same practice is coding mostly level 4s and 5s? It may be reasonable if the first physician sees more patients with routine problems, while the other manages patients with multiple chronic problems.

Should your coder be certified? I think it’s a good idea. After all, your coder is at the center of a process that drives the revenue flow for your practice. The American Academy of Professional Coders offers certification for coders. Once certified, coders are required to obtain continuing education credits to maintain their certification.

Your practice can only get paid when your coders correctly code and submit claims to payers. With a typical physician generating a minimum of $400,000 in billable claims annually, it would be foolish to skimp on your coding/billing staff. A well-trained and managed coding staff can help the entire practice bring in every dollar it earns. Give them the support they deserve. It’s a prudent investment in your practice’s future.

Judy Capko is a healthcare consultant and author of the popular books “Secrets of the Best Run Practices” and “Take Back Time.” Based in Thousand Oaks, Calif., she is a national speaker on healthcare topics. She can be reached at judy@capko.com or 805 499 9203.

This article originally appeared in the July/August 2010 issue of Physicians Practice.