A practical guide to striking a coding balance between physicians and coders
Should physicians assign their own codes?
It started with the EHR boom
The adoption of electronic health records (EHR) significantly changed the workflow in today’s physician practices. One major difference is the way in which physicians select evaluation and management (E/M), CPT® and ICD codes. Rather than circle a code on a paper charge sheet, physicians now choose a code from a drop-down menu in the EHR.
In many cases, electronic code selection saves money and streamlines the revenue cycle. Although these efficiencies are beneficial, practices still need to monitor the accuracy of the codes they assign. Without continual monitoring, practices could experience the negative consequences of decreased revenue and an increase in denials and audits.
The risks of physician-assigned codes
Although practices gain efficiencies and reduce costs when physicians assign their own codes, there are also several potential pitfalls to this process.
The benefits of hiring a medical coder
Hiring a certified medical coder can bring many benefits to your organization, including the following
Increased accuracy and compliance
Certified medical coders understand coding guidelines, and they know what it takes to ensure accurate payment and avoid denials.
Reduced need for internal audits
Certified medical coders can oversee the entire internal audit process using automated tools that increase efficiency and avoid the need to select cases manually.
Fewer missed charges
Certified medical coders can more easily capture all relevant charges, resulting in a positive impact on revenue. Coders can also ensure that physicians report all relevant CPT codes as well as any and all diagnosis codes to establish medical necessity.
Reduced risk of overcoding and undercoding
Certified medical coders minimize compliance risk by assigning accurate codes.
Ability to regain the focus on direct patient care
Sixty percent of more than 17,000 physicians say that their EHR detracts from patient care. However, by focusing on accurate and complete documentation, physicians inherently provide better patient care.
Reduce denials, increased reimbursment
Studies show that approximately nine percent of claims, on average, require rework. At an average cost of $25 per reworked claim, physicians can save thousands of dollars in revenue each month by simply focusing on compliant coding.
Strike a balance
Practices using an EHR must ultimately answer this question—will physicians or coders assign codes? Many experts believe that coding should be a shared responsibility, as this model has been proven to decrease coding backlogs and increase coding accuracy.
An appropriate blend of technology and coders could be the right solution for many medical groups. As providers consider whether to hire a certified professional coder or to bring someone into the practice to audit periodically, they must determine whether the services are worth the cost. Many organizations use computer-assisted coding, for example, to achieve its compliance goals with far fewer in-house coders and a reduced need to rely on outsourced coders as well.