Many physicians believe that it is unnecessary to employ a Medical Coder because the EMR/EHR software can capture charges quickly and adequately.
Further, they believe, that since the provider has done the work, it is easier for him/her to assign the codes. The practitioner may calculate that the cost of hiring a coder would result
First, there is NO EMR/EHR that can perform automatic accurate coding and billing. The EMR/EHR software misses an entire range of workflow, such as implementing CPT coding guidelines, HCPCS Level II codes, payer policies, bundling issues, medical necessity, adjusting EM codes and modifiers, value-based reimbursement policies, and accounting for constantly changing government regulations. This complex situation is far from automatic.
And as the level of complexity in coding increases, so does the risk of lost revenue and increased liability to government action from the OIG.
Second, most providers are not up to the task of doing coding properly, as most have likely received only “on the job” and trial and error training. There is no way they can perform up to the level of an experienced certified coder. Also, most providers have limited time to devote to coding.
Top reasons for Medical Claims denials and what to do about it Summary: This article reviews reasons for medical claims denials and discusses contravening business strategies, including remote staffing. Reimbursement Rules keep changing The Affordable Care Act requires insurers to report data about claims denials and appeals to encourage transparency in medical insurance coverage.
The Affordable Care Act requires insurers to report data about claims denials and appeals to encourage transparency in medical insurance coverage. Data from Centers for Medicare and Medicaid Services reveals Heallthcare.gov marketplace insurers denied nearly one out of every five claims (19%) submitted for in-network services in 2017 for enrollees. It is not just enrollees who are financial imperiled. Climbing denial rates are significantly hurting the bottom line for providers. If that weren’t bad enough, the government plans to reduce reimbursements soon.