With the financial incentives and health care reform that the Obama administration has promised to provide the health care industry, more and more providers are beginning to consider the implementation of an EMR system in their practice.

The idea behind an EMR system is to improve work flow and overall efficiency within the practice and allow providers to provide enhanced quality care and patient safety.

Most physicians also make it a priority of achieving compliant evaluation and management (E/M) coding within their practice. Physicians are often sold on “the promise” that these sophisticated and costly EMR systems will ensure that compliant documentation is achieved and applicable coding is correct, thereby making any E/M decision making problems disappear.

Unfortunately the increase in the number of government audits such as the Medicare RAC have revealed that some EMR systems have allowed, or even worse facilitated, the creation of incorrect coding and non-compliant documentation that has led to potentially fraudulent claims for E/M services. Such cases can lead to severe financial penalties and even close the doors on some practices.

During the last several years, numerous articles have high lighted compliance problems intrinsic to the majority of the current EHR systems that are on the market. The number one complaint of such systems relates to coding engines that fail to consider medical necessity, which CMS describes as “the fundamental reason for payment”.

Some EMR vendors promote their systems by informing providers that they will now be able to increase their reimbursement and bill for higher level office visits as their EMR system will create the documentation to support that level of visit.

One that is considering purchasing an EMR system due to the financial incentives that are out there must be weary of a vendor that is selling their system based on this view point.

One such practice located on the West Coast purchased an EMR system with the intent to get rid of their current three coders and to use the system for all their coding purposes. Historically this practice did not code for services higher than a level 3 office visit but their EMR system was consistently calling for level 4’s and 5’s.

It didn’t take long for the nightmare to follow when the Centers for Medicare and Medicaid showed up for an audit and recouped more than $1 million in refunds, fines and penalties owed to CMS. That practice immediately stopped relying on their EMR system for coding and hired five coders to ensure that their coding was done properly moving forward.

When practices investigate the possibility of purchasing an EMR system, they should include experts with a background in compliance and quality documentation on their EMR evaluation team. As a condition for purchase, one should require that the EMR system contain only compliant documentation and coding features.

As folks move forward to take advantage of the incentives that are out there to purchase EMR systems, it’s critical to remember that the main purpose of these systems are to improve your practice’s overall efficiency and quality care that you provide your patients.

Medical billing and coding professionals are gaining steady popularity for years now. The demand for these professionals has increased along with the increase in demand for health care services. This is primarily due to the fact that more and more people are depending on the health insurance system for their health care issues and the medical billing and coding professionals are the ones in the back office of hospitals or clinics taking care of filing health insurance claims and monitoring settlements by the health insurance companies.

The medical billing and coding profession is one interesting career to get into if you want to start working in the health care sector. The professionals in this sector are the people making sure that the health care professionals are properly compensated for the service they rendered to the health insurance policy holders. The medical billers and coders in effect are the ones making the health insurance system work.

So, if you are interested to start a career in this sector, good. It’s a fast way to become a part of the medical industry and an exciting career as well, knowing that you are helping people improve their health and prolong their lives is one rewarding and fulfilling knowledge.

Here are some advice on where to get the appropriate training for those who are thinking of starting a medical billing and coding career.

1. Online training – home based, self-paced online training are available if you want a quick training. Online training usually take anywhere from 8 months to one year and a half depending on how motivated you are and how fast you study on your own. Online training is excellent for those who are presently working because you can take it anytime you want. There’s a lot of benefits when studying billing and coding online along with a lot of savings since you won’t spend money on travel and extra food when studying at home.

2. On-campus instruction – you can also accomplish training via the traditional on-campus instruction. If you are the type of person who learns faster with face-to-face interaction with instructors and classmates, then the on-campus training is perfect for you.

Whatever the training option you choose, make sure it offers the following subjects: Human anatomy and physiology, medical terminologies, the health insurance system and claim forms, the CTS and ICD-9-CM databases.

The above subjects are required. It forms the core knowledge required from a professional medical biller and coder. Good luck!

Medical billing specialists translate patients’ records to medical industry-established alphanumeric codes. They will then assign these codes for different types of illnesses, injuries, allocated medications, medical treatments, surgeries, follow up treatments and other related types of information into the computer system.

One of the major advantages of Medical billing and coding specialist is that its employment outlook is extremely good. Increase in demand for this profession is expected because of escalated demand from the insurance companies end for high integrity recording of patients’ medical data and records. This is also contributed to the increase growth in the medical treatments, antidote and medical tests.

Secondly, medical billing specialists can work in many different settings, such as in a hospital, clinics, dental office, insurance company, government agencies and a lot more. The career opportunity and employment outlook for medical billing and coding specialist is great and will continue to be in high demand for the subsequent years.

In addition to the above different settings where medical billing and coding specialists can be found working in, more and more companies are offering the medical coders and billers chose to work from home because with just a computer and internet access as well as with the relevant medical coding and billing program software, one can find himself adequately equipped to run and accomplish the tasks of medical coding and billing as long as one has the skills and expertise of medical coding and billing.

Another well identified trend is the swift of medical billing and coding tasks for out-sourcing. Hospitals, nursing homes, insurance companies as well as many other types of medical providers are seeking for specialized third party where they can outsource the medical coding and billing related functional work to, so that they can rely on these private companies to run and manage all the necessary medical coding and billing work for them separately and professionally. Looks like this trend can be “taken” as a benefit for those who are venturing or have the intention to venture into the medical coding and billing professionalism as this had yield a new job opportunity and a new market for medical coders and billers.

Next, a medical billing and coding tend to work in clean, air-conditioned and comfortable offices, some settings required these medical specialists to be on normal shift while others may have the need for both morning and afternoon shifts, depending on the work place activities.

Another great benefit for medical coding and billing graduates is the short duration of their training programs which tend to be completed in less than one year. With this, graduates will be able to venture into the open market seeking for their suitable jobs as soon as they can, and start their career ahead of the rest of their peers of the same age.

A medical insurance specialist is an expert on both medical billing and medical coding. It’s not necessary to get your education and or training in both of these fields. In fact most people don’t. They specialize in billing or coding but usually not both. In terms of salary or how much money you’ll make in either field you may make just as much if you focus on just one of these fields.

In fact it will cost a lot more money to get the education or training you need if you do try to enter both fields. If you’re lucky enough to work into or be hired for a job in either medical coding or medical billing without having to get any advance training or education, you’ll likely only be working in one field or the other. Most insurance claims, when they come to the billing department, have already been coded in the coding department which may or may not even be in the same company.

Whether you end up working as a medical insurance specialist or a medical biller or medical billing specialist or as a medical coder, there are a number of different titles that can indicate working in those departments. When you scan classified ads you’ll see a broad range. Most will indicate the type of work involved. Many or most, do not require any certification.

How much money you make or in other words how much of a salary or hourly rate you can expect will depend a lot on a few factors – how much experience you may already have for example. If not directly in medical billing or coding you may have experience in related departments that will count somewhat. In other words also — how long you were working in those previous positions.

Another factor will be how much directly related training or education you have had in billing, coding or both.

Medical insurance specialists, medical billers and coders work in many different types of companies, including hospitals, large health clinics, insurance companies, large dental clinics etc. Your salary or wage will depend on what type of company you’re working for also.

Another important factor is where you live. If you live in a large city you likely will be able to get a higher salary than in a smaller city.

Again all these factors will have a big bearing on how much you’ll get as an hourly rate or starting salary. Of course you don’t always want to work at a company just because it pays the most. There are other factors to consider such as how long of a commute you will have to make etc.

Make sure to do a lot of research before you sign up for any college or online courses in medical billing training or medical coding training. Know what your local colleges have to offer either on campus or online or both. Compare call costs. Scan the ads so you know what is offered already and make a few calls and ask questions about the job and salary. Check out the free federal money offered for online courses too. The more research you do the more you’ll learn if this field is right for you.

Venturing into the medical billing and coding career is one of the best decisions you can ever make especially since it is one of the well paying professions today. Apart from giving you a chance to make enough bucks, this career will also allow you to grow both spiritually and socially. It is a great chance for you to meet new people who are in need of your assistance. But before you become a professional medical billing and coding expert you have to go through enough training. The good thing is that there are enough medical billing and coding schools that you can enroll with.

However, the more training institutions there are the harder it becomes for you to find a school that will give you enough training. New institutions that offer this kind of programs continue to emerge all over the world. This makes it difficult for people looking for this training to choose the suitable institution to enroll with. But with enough research you will be able to find the right college for your billing and coding course. There are several important factors that you need to consider whenever you are looking for billing colleges.

Factors to Consider When Choosing the Best Medical Billing and Coding School

Dozens of colleges continue to advertise their billing and coding programs on the internet and other mediums. You might be confused in choosing the right one for your training. But with the following guidelines, it will become easier and faster for you to find a good billing college.

• Accreditation: The most important thing that you should always look for in the training institution that you choose to enroll with is its accreditation. This should help you in determining the quality of education that is being offered in such a college. The benefit of receiving a certificate from an accredited institution is that it enables you to win the confidence of your employers. Every employer wishes to have highly qualified employees who have gone through enough training in recognized institutions.

• Tutors: A good school is one that has well trained and highly qualified teachers. Remember, teachers are the most important part of any training institution because they are the once that impact knowledge on the students. Thus, they have to be well versed with knowledge on the course.

• Course Duration: There is no need for you to register for a course that will take you more than one year to finish. Always go for short-term courses because they are cheap and time efficient.

The right staffing, training and education can go a long way in meeting the demands of keeping medical insurance and billing coders at the top of their game. While there are numerous challenges, such as employee retention, industry infrastructure and occasion personal error on occasion, the majority of industry challenges come from a work environment where fewer people are required to do more work.

Medical insurance billing and coding (MIBC) requirements periodically change, and facilities are forced to adapt and train existing professionals to keep pace with demand. An increased workload on coding departments can place a strain on other parts of the department. The more time spent on coding, the less time there is to prepare and adapt to new changes. The more time that is spent on preparing for changes, the less time there is to code.

While many coding organizations consider the benefits of outsourcing, other venues struggling to stay within budgeted guidelines are less inclined to pay an outside source even if understaffed in house. Medical coding departments lose staff due to the obvious reasons, which can include downsizing, firing, voluntary termination and professionals retiring from the industry. These combined activities can leave medical billing and coding departments short of the required help.

Hiring skilled billing and coding professionals can also be a concern in rural areas. The reason being, billing and coding practices may vary from the industry standard; combining inpatient and outpatient services in ways that are challenging for most medical billing coders.

Billing System Slowdowns

As reporting requirements increase and facilities make the migration to electronic records, productivity will naturally take a hit as billing coder’s work with hybrid systems consisting of electronic and paper records. In some instances, medical billing coders must double enter coding into the clinical and billing systems. Information can be spotty, whereas some electronic record systems lack a “quick view” summary that provides billing coders with all the information needed. Information must be pulled from multiple sources, leaving an opportunity for information to be missed and errors made.

For many medical billing coders, the challenge of maintaining productivity while producing quality work is ever present. Facilities with unique processes are usually the ones with the greatest challenges, and finding certified medical billing and coding applicants to fill the gap is critical if the revenue cycle is to be properly maintained.

Solutions

Updating billing systems, staying abreast of billing and coding education and training of ongoing guidelines, for existing employees will be a key factor in minimizing workload and managing a reduced workforce.

The challenges experienced in this particular segment of the health care industry are many and ongoing. But when the decision is made to hire new medical insurance billing and coding professionals to fill the gaps left by people terminated, retiring or migrating to other companies or departments, finding and hiring well-trained and experienced individuals is an initial key to success for any business.

Lean thinking is about mindset or the way of thinking of organizations to achieve a totally waste free operation that focuses on customer value. It involves cross functional orientation within organizations to improve efficiencies and achieve waste free operations. However, it is easier told than practiced!

It needs a house of lean tools laid on stronger organizational commitment to improve their level of service to the customers. It is more so challenging on the services industry when compared with the manufacturing since the process maturity levels on the services industry are still evolving. However setting aside the challenges, one would still find surprising similarities between services and manufacturing, that both involves complex interlinked processes managed by personnel to accomplish their tasks to yield end value to customers. Hence it necessitates a need to cognitively approach the success stories on the manufacturing side and apply those best practices with more rigor.

In the context of Medical Billing & Coding Service

To maximize value and reduce waste in the context of medical billing and coding services, the first step is to create a unit with lean thinking. It needs lots of communication from the strategic management team to the line personnel on the objectives of lean. This shall create a sense of belonging and brings down uncertainty around job losses. It needs to carry a strong and meaningful message that services differentiators can be accomplished only with personnel.

At a next level on the process side, the starting point need to be defining the critical to quality parameters for their customers that includes but not limited to,

* Expected financial accuracies and processing accuracies

* Turnaround time requirements

* Rework percentages

It is important that organizations assess themselves on their standings with respects to these parameters so that they will be able to define road maps. This includes doing a value stream mapping of their processes that will list the steps involved in accomplishing the end value desired by the customer. Being a federally regulated process, it becomes mandatory that organization assess their process efficiencies to identify and isolate value added processes from non value added processes. Imbalances here shall definitely create friction within the system. It needs classification of processes into,

* Core repeatable processes

* Core non repeatable processes

* Support and repeatable processes

* Support and non repeatable processes

Define Implementation approach to a successful lean program

It begins with defining a program charter to roll out and institutionalize a lean program. It involves programs to 1. Improve Quality, Eliminate wastes through Training Integrated Quality Assurance Framework.

It involves rolling out a training integrated quality framework. This includes combination of statistical tools and methods that results in identifying and isolating defects / wastes from the process. Statistical tools are extensively adopted to perform

1. Pareto analysis – to identify the vital few

2. Define Corrective and Preventive Actions (CAPA)

3. 5 Why Analysis and

4. Time Trend Analysis

This QA framework helps in accomplishing the process within its control limits. However organizations need to appreciate those statistical tools assists only in identifying and isolating the outliers. But to improve quality, there needs to be very active participation from the training function since variations within billing and coding processes are very high.

2. Improve Quality, Eliminate wastes through Technology

Define claims scrubbing mechanisms on top of claims data so that common and more frequent errors can be automatically detected. This shall increase the velocity of the process and also reduce rework. For instance a claim for male insured with a diagnosis code related to gynecology is obviously incorrect and this can be caught upfront in the system instead of allowing it to traversing through different processes within the overall system and finally getting rejected for payment. This saves lot of payment rejection upfront. Hence a good lean program shall leverage the expertise from IT and operations team to define solution. Hence it becomes imperative that the medical billing and coding team to understand the way adjudication systems on the insurance companies work so they can build upfront claim scrubbers and pre edits.

3. Optimize Process Overheads

It involves operations unit to do a comprehensive time trend analysis on operations data. This shall include incoming volume data, capacity utilization levels, throughput, TAT compliance etc. With proper incentive and remuneration program, organizations need to do plan for running the process with optimal utilization levels that shall remove over allocation of personnel to the processes. This approach reduces process overheads. Organizations need to understand overproduction is equally bad as under production.

Conclusion

Lean thinking is not new. However the dynamics of Health Care Industry keeps continuously changing and it places a need on the organizations to keep striving for innovations so they perform exceedingly well on customer satisfaction index. Innovations cease to exist if organizations fail to ask one fundamental question on an ongoing basis – Why am I doing it this way and am I doing it right?

Lean thinking facilitates organization to ask these fundamental questions, as it did before!

Software codes are not physical products. We cannot see the codes, but the user can use the results of a running a coded program in the form of a software application. The software applications so developed have redefined our everyday experiences and made life so easy, be it controlling a flight or buying groceries from a supermarket. Learning computer programming is thus an excellent avenue to gain employment and improve a person’s career profile.

The first generation of codes are called machine language. The second generation of codes are called assembly language and the third generation of codes is called high level language or HLL. All software programming languages need to be translated into machine codes for a computer to understand the instructions. While most of it happens internally, it is important that software engineers correctly ‘write’ programs that deliver the desired output.

Coding practice can be improved either by attempting to write a number of new programs suited to specific applications or even by modifying the existing codes. But what exactly is the purpose for which a program needs to be written? How do we define the software life cycle? What are the best languages to use to derive a certain output? How can people without any basic programming know-how get into coding and the software industry? This is where the role of software institutes occur.

Several software training institutes have mushroomed all over the world to address these issues. Often, they help in making people employment ready, give career guidance and training in a broad spectrum of software and programming languages including JAVA, SAP, CAD,.Net etc. Some also recommend software testing courses based on the candidate’s profile. With experienced faculty and tie ups with key companies, they deliver real value to a student and help in placements after course completion.

These institutes conduct long and short-term courses. They also prepare students for various international certifications. Further, they conduct workshops, events and other activities to encourage student-industry interaction, prepare novices for their job interviews and make them ready to face opportunities. Job fairs, campus interviews, etc. are also conducted regularly for students to get job placements on successful course completion. Many governments have also come forward to set up training institutes to train homeless people, women, unemployed and under employed persons. In order to encourage children to pick up coding skills, many software training institutes have also made available a number of courses for school students and kids in summer vacations.

While the remarkable results are here to see, the software training industry is rather unregulated. Many institutes seem to promise the moon and charge hefty sums, while the real certification is either invalid or based really on the reputation of a known parent brand. Going forward, it will be interesting to see how various governments tackle the issue and ensure that the benefits of software training reach all sections of society.

Medical billing & coding is a booming career. For that reason, there are many schools that offer programs to help you become a medical biller & coder. Unfortunately, some of these schools are scams by offering you diploma mills. Hence, it is a must for you to investigate the school you are planning on attending.

Training is a must in this field. With training, you can better read and understand the content of a patient’s char. A chart contains codes about medical procedures applied and their reasons. An employer will usually hire a person who underwent training and education for this profession. If you want to take up a medical billing & coding program, the training program must have the following subject’s:

-Medical terminology

-Basic math

-Medical documentation evaluation

-Medical billing software

-Keyboard and computer tutorials

-Laws

The program should be able to help you perform your administrative duties as medical biller and coder. In addition to that, it has to teach you how to properly interview patients, doctors and other health care professional. It must show you the proper way of documenting medical records. Essentially, the program should help you hone your interviewing and documenting skills.

Working environment of this profession

Medical billers and coders work in an office that has various pieces of equipment, including printers, computers, telephones, and the like. The number of hours may vary but it is usually a 40-hour workweek. Part-time schedule is also available.

You may also interact with patients when you work in this field. When dealing with patients, you have to understand that it is challenging. Some patients that you will be interacting with are sick and may be suffering from contagious disease. Plus, they are short on patience. Therefore, you should know how to deal with them in a way that they will have a positive experience while communicating with you.

Can you work from home?

It is possible to work as a medical biller & coder from home. However, it can be very difficult especially if you are just starting out. Home-based medical billing & coding requires for you to have a solid client base. You can have it with years of experience working in this area. Therefore, you should not let your hopes up on working from home because it is very rare. In fact, the US Department of Labor Statistics reported that only 3% of medical billers & coders are working at home.

However, you can obtain a training program for this profession through online schools. It offers more flexible schedules. This is especially important if you are working full-time while completing a program for this profession. But you will still need to undergo hands-on training even if you opt to complete a training course online.

The medical billing and coding sector is experiencing growth today. This growth is due to the increase of demand for health care services, and since it’s now a common practice for people, especially those who are a part of the labor force to get a medical or health card as a part of their compensation package, medical billing and coding tasks increases.

This is where a medical billing and coding professional comes in. To prevent chaos and make sure the health care service provider, doctor, or physician focused on saving the lives of people while still making sure that medical reimbursements and insurance payments for rendered services of these professionals are properly claimed and given to them, a medical billing and coding professional is needed.

Medical billing and coding professionals are persons well trained in medical procedures and services. Aside from their in-depth knowledge of medical procedures and services, they are also adept in human physiology and anatomy. However, that’s not all, they are also very familiar with the entire health insurance system. They are very knowledgeable in processing health insurance claim forms and are very familiar with the insurance claims process all the way to claims approval and settlement.

Medical coders and billers are also a dedicated group of professionals, most of the time they handle multiple claims from different patients and handling the status of claims for multiple health care service providers.

The health insurance claims submission all the way to settlement takes several interactions between the person who submitted the claim and the representatives of the health insurance companies, mostly their medical examiners. The medical biller stays on top of the status of the claim as well as other claims as well and makes sure that when the insurance company sends an approval of the claim, the proper doctor is paid. They also make sure that when a claims rejection happens, they will be able to point that claims rejection to the appropriate claim and make adjustments to the claim if necessary, re-submit the claim and again, wait for feedback from the insurance companies.

This is easy for single health insurance claim transactions, but when there are hundreds of claims being submitted and monitored like in the case of large hospitals and clinics, this becomes a heavy task. If doctors are left to this task all by themselves, they won’t be able to focus on saving and improving their patient’s lives because they’ll be tied-up to the paperwork. So they employ a medical biller and coder to do the billing tasks for them. It’s more efficient that way.

So, that’s the overview of what medical billers and coders do and that’s how important they are in the medical industry. I hope you got a better understanding and enthusiasm towards this allied health care service.