At this point in your career you have either joined a practice that you plan on growing with your partners or have been tirelessly working to get your own practice off the ground. Wherever you are in your career you have likely discussed how your billing is going to be done; in house, outsourced or maybe you are doing it yourself. First and foremost caring for your patients is your first priority however not too far behind that is your revenue cycle. If your revenue cycle is not successful then it doesn't matter how skilled of a provider you are, you'll be out of business.
Completing your own billing is risky business
I've crossed paths with a few providers over the years that felt completing their own coding and using an entry level professional or office manager to maintain payments, denials and other tasks was the way to save money and be successful. What I have found in these cases are out of control aging AR accounts, multiple level rejections and denials sitting unworked, enrollment and claims processing errors and high dollar patient accounts not being collected on. Years ago a small practice may have been able to get away with a single skilled office manager to oversee the revenue cycle however today it's simply too risky. With the implementation of ICD-10, constantly changing medical policies and increased auditing you can't afford to not have a certified professional to oversee your billing and coding cycle.
Is your office manager being transparent with you?
Having an office manager is essential and in many smaller practices the office manager wears many hats. If you have an office manager that submitting claims based on what codes you have selected and not what you have documented you run the risk of submitting claims that are not properly supported and could result in major recoups from your payers or under coding and leaving money on the table. Is he/she trending out your denials, reviewing your documentation, following up on aging accounts, providing you with education when codes or medical policies update annually? If not you're not getting your money's worth out of them. One failed audit can shut your practice down, why take that risk?
So what do you NEED ???
Let's start with the basics- separate your office manager from your revenue cycle unless he/she has proper training and education. A business and/or employee manager is NOT the same as a revenue cycle manager. This is the biggest mistake I see with small practices.
Certified Professional Billers and Coders- These are either two different professionals or one professional with both certifications. Coding is the processes of translating your documented services to CPT codes accurately based on coding regulations. Billing is the process of filing the claim in accordance to the payers procedures, understanding and working denials, processing payments and following up on unpaid claims. While these two work hand in hand not having a clear understanding of each can make both sides fail.
Specialties- I cannot emphasize enough how valuable a specialty certified coder is. You spent years perfecting your craft the specialty you work, cardiovascular, orthopedic, neurosurgery etc. Why wouldn't you invest in a coder that did the same thing? Someone that took the extra time to not only certify themselves as a professional coder but went one step further to certify themselves as a specialty coder.
Here are a few types of specialty coders you can look for:
Outpatient Coding
Inpatient Coding
Ambulatory Surgical Center Coding
Anesthesia and Pain Management Coding
Cardiology Coding
Cardiovascular & Thoracic Coding
General Surgery Coding
Urology Coding
Orthopedic Coding
IR and Cardiovascular Coding
Hematology & Oncology Coding
Investing in a certified professional coder that also holds a specialty certification is worth the money. This coder will have a better understanding of the anatomy and terminology used in your specialty, bundling rules to prevent over/under coding, medical necessity requirements to help with clean claim submissions and so much more. Look on LinkedIn or AAPC for experienced specialty specific coders, depending on your geographic location and specialty you can expect to pay an annual salary of $30-60K. The higher side being a more experienced coder in a complex specialty.
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Ask yourself if your practice was to be audited on your top 4 most billed codes by one major payer, would you pass or would you be looking at hundreds of thousands of dollars in recoupments and possibly shutting down your practice. Give yourself the peace of mind knowing that all of your ducks are in a row, T's crossed and I's dotted by having an expert revenue cycle management team on your side.
Want to discuss further or have some specific questions pertaining to your practice? Call me and lets chat. 913- 228-1918.
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