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Why it’s Difficult to Hire a “Generalist” Medical Coder

Medical Billing

4 Essentials for Surgical Centers | AdvancedMD

Understanding medical coding is not an easy task, and one of the areas where physicians and office managers can get into trouble is assuming that a single coder will be able to handle all the coding for a clinic, especially one with multiple providers or one where you have multiple specialties that practice together in the same clinic. Just like a doctor would not expect to be able to learn every single symptom in every area of medical specialty, coders also should not be expected to know it all.

The Challenges of Medical Coding Today

Today there are more than 70,000 ICD-10 codes and over 10,000 CPT codes. Each area of medicine has its own segment of that total, but it’s unrealistic to expect that a coder will be able to learn all of it all the time. Even someone who has been on the job for a while will still need to learn new codes each year—there were 279 new codes, 143 revisions, and 51 deactivated codes in 2019, and 2020 has been even crazier with all the COVID-19 code changes. Besides just knowing the codes themselves, medical coding requires an in-depth knowledge of procedures, anatomy, and physiology to prevent undercoding or overcoding (which could get you and them in legal trouble), and avoid errors that could cost your clinic in lost reimbursements.

Why it Matters

Medical coding is essential to your ability to get reimbursed for the care that you provide. When someone makes a mistake in coding, it could lead to denied or rejected claims. That requires more time for someone to research the problem, correct it, and resubmit it, which is a frustrating waste of resources when the claim could have already been paid. Appeals also have a strict time limit for when they can be submitted, so an overworked and overwhelmed medical billing staff person could easily miss it, leaving you with the option to bill the patient for the full amount or write it off as bad debt. Neither of those are great options.

What Small Clinics Should Do

If you find that your medical billing staff cannot keep up with the growing volume of codes, but you’re not ready to hire a new staff member, one option is to outsource to medical billing companies. Outsourcing provides several benefits:

  • You get access to a large volume of medical coders, including those with expertise in each medical specialty
  • Coders are regularly trained and stay up to date on the latest changes, new codes, deactivated codes, and code revisions
  • You won’t need to hire additional staff and take on the costs of more medical coders to ensure that all your medical billing is done
  • Claims are generally paid faster than with an in-house medical billing staff
  • Outsourced medical billing firms have dedicated staff to follow up on and correct claim denials and rejections
  • Most clinics, especially smaller or independent clinics, see a boost in total collections as a percent of billed charges when they switch to medical billing services
  • You get access to revenue cycle management tools to further improve efficiencies and collection rates

AdvancedMD offers medical billing services and can help you determine whether that is the best option for your clinic moving forward. To learn more, contact us today.



Topic: Medical Billing


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