Certified Medical Coders Protect Provider Reimbursement

Posted by Practice Management Institute on Nov 20, 2017 11:13:00 AM
Practice Management Institute

 

Billing problems are an ongoing point of frustration in medical offices. Errors and denials can quickly snowball, creating big revenue cycle problems. One study from BMC Health Services Research found that time spent coding, filing claims and obtaining prior authorizations, cost the U.S. healthcare system as much as $471 billion in 2012.[1]

Losses from improperly coded claims can add up to hundreds of thousands of dollars each year. The transition from fee-for-service to value-based payment models adds another layer of complexity to an already highly detailed reimbursement system.

Coding and billing staff need a good training foundation and advanced skills to communicate with physicians and carriers on claims and fight for reimbursement that is rightfully due to the practice. The Certified Medical Coder (CMC) is a comprehensive training program and exam for medical office coding professionals. The exam is proctored in a live environment. Candidates write in responses to the questions and each exam is hand-graded. Practice Management Institute’s President and CEO, David Womack, said this method is a more accurate measure of coding competency.

This program is referenced in the Medicare Modernization Act as a training resource for Medicare’s Provider Customer Service program.[2]  CMC classes are offered in health care systems, hospitals and medical societies around the country.

“The instructors are not just teaching them how to pass the test,” said Womack. “They show students how to use their coding books to select codes by hand with specificity and accuracy following current guidelines. They don’t have to rely on technology to choose a code that may not be correct. If a denial comes through, they understand how to determine the problem or contest the appeal. Those that pass the test and earn this certification are more likely to code correctly the first time, limit audit liability, and protect the practice’s financial health, which can save providers thousands of dollars each year.”

CMC certified professionals are able to demonstrate to employers and business associates advanced knowledge to make proper code selections to the highest degree of specificity. The curriculum is taught in classrooms in healthcare systems around the country and available as an online course. The exam and faculty support is included.

PMI offers a full range of classes to help offices deal with compliance issues, coding rules and updates, insurance provider guidelines and patient satisfaction and engagement, which is becoming more and more important for the new reimbursement models that are coming into play. Details on the CMC certification and other classes are available online at www.pmiMD.com.

 

[1] Jiwani A, et al. Billing and insurance-related administrative costs in United States’ health care: synthesis of micro-costing evidence. BMC Health Services Research. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4283267/

[2] Implementation of § 921 of the Medicare Modernization Act (MMA) — Provider Customer Service Program. Pub. 100-20 One-Time Notification, Transmittal 113, Sep. 12, 2004, pg. 8 https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads/R113OTN.pdf

 

Practice Management Institute (PMI) works with health care systems, hospitals, medical societies, physician organizations, and learning institutions across the country to provide training and certification for administrative staff working in outpatient facilities. PMI’s commitment to excellence has earned the recognition of hundreds of healthcare systems, hospitals, medical societies, colleges, and government organizations across the country since its inception in 1984.