MAY 15, 2017 -- As many as 80 percent of all medical claims submitted to insurance carriers contain mistakes estimated at $68 billion (1). Approximately 55 percent of evaluation and management (E/M) claims are incorrectly coded resulting in $6.7 billion in improper Medicare payments.(2) Providers looking to avoid lost revenue and serious consequences are raising the training standards of its administrative staff seeking out those who have completed specialized training and certification offered by Practice Management Institute (PMI).
Watchdog agencies, enforcement, and penalties are on the rise, creating a high-risk environment for physicians. Tighter screening measures adopted by the Affordable Healthcare Act have resulted in 17,000 providers losing their license to bill Medicare (3). Doctors have ultimate responsibility for all claims billed under their unique provider number, and a physician’s signature on any claim is held as verification of the accuracy and legitimacy of each claim (4).
Increased scrutiny has prompted doctors and healthcare facilities to require their employees to become certified. From an enforcement perspective, staff who knowingly submit fraudulent claims for payment can be held liable (5).
David Womack, President and CEO of PMI, says, "It’s critically important that providers have well trained staff. The physician needs to have confidence that their personnel are running the business correctly so they can focus on quality patient care.”
Physicians dedicate their careers to quality patient care; most have had little exposure to the increasingly complex world of medical claims management. They rely on their billing and administrative staff to stay on top of the guidelines set forth by Medicare and third parties. PMI helps providers adopt higher training standards with specialized courses and certification exams that address these high-risk areas of practice administration.
Womack says, "Taking steps to successfully train and certify staff in these areas means physicians are more likely to submit accurate claims and receive correct payments for their services, and ensure that practice liability is minimized.”
About Practice Management Institute (PMI):
For more than 30 years, Practice Management Institute, also known as PMI, has helped physicians, hospital systems, medical societies, and educational institutions provide comprehensive education and training to medical office staff nationwide. By offering a variety of educational programs and professional certifications, PMI helps to build competency, compliancy, and effectiveness that assures the continued success of their clients.
Since PMI’s formation in 1983, more than 20,000 individuals have earned certification in one more areas of expertise. PMI is recognized by both the Centers for Medicare and Medicaid Services and the Department of Labor for training in: medical coding, third-party billing, office management, and compliance. PMI training helps ease the burden of running a successful medical practice through thorough education and up-to-date training for non-clinical staff, allowing physicians to focus on patient care to improve the experience of the patient. For more information, visit http://www.pmiMD.com.
About David Womack:
David Womack, President and CEO, has been instrumental in PMI’s continued success since 1991. He has helped PMI transition into a cutting-edge leader in medical office staff education and training while developing key relationships with healthcare organizations, hospitals, colleges, and medical societies across the country. His commitment to excellence has helped PMI become an industry leader recognized by both governmental organizations and healthcare systems across the country.
1. "Incorrect Medical Coding Corrupts the Core Data Used by Health Care Facilities, Has Negative Consequences Throughout Health Care Industry." Integrated Healthcare Executive. N.p., n.d. Web. 05 May 2017.
2. "55% of E/M Claims Incorrectly Coded - What’s Your EMR Software Doing to Help?” HealthFusion, June 24, 2014.
3. The $272 Billion Swindle." The Economist. The Economist Newspaper, 31 May 2014. Web. 05 May 2017.
4. College, From The. "Who Is Liable for Coding Mistakes?" The Rheumatologist. N.p., 01 Oct. 2010. Web. 05 May 2017.
5. U.S. Department of Justice Memo, "Individual Accountability for Corporate Wrongdoing” aka, the Sally Yates Memo, September 9, 2015.