Wiki Claims per day per coder

Katstpaul

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I am the Billing/Credentialing Manager for fairly new FQHC. I am trying to find some documentation regarding how many claims it is reasonable to expect for coders to be able to complete in one day. At this time, we are coding Office Visits, Pediatric Services, and Mental Health visits. It is really not difficult coding as would be Orthopedic Surgery. I believe my staff can produce more but don't want to overload them. Any help would be appreciated.

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Katharine
 
Our billing department goes by the rule of 1,500 - 2,000 claims a month that they bill out. This allows them to answer questions, post EOBs and work any denials. Depending on how difficult a client it is as well as the ability of the biller decides where they fit in that range. A client that has a lot of patient phone calls for instance is expected to send less claims due to the time they are having to spend answering questions. The same is said for someone who is having to work appeals often. However, someone who has a pretty straight account typically can handle more. I know it isn't an official formula but I hope it helps. :)
 
I've also struggled with this and find it hard to make a generalization. There is so much variation in coding and so many factors that can influence how fast a coder can work. For example, what kind of medical records system do they have and how easy is it to navigate quickly? Are they having to work from paper and decipher handwritten vs. typed notes? How good is the documentation and do they have to query providers often for clarification or corrections? What kinds of tools do they have to help with their coding, i.e. are they working from books or are there good electronic tools available? How much data entry is required - are they just verifying and releasing codes that the providers enter or are they having to enter all of the claim information from beginning to end? Lots of factors to consider in evaluating how productive a coder can be. Once you look at all these pieces, it might help to see the obstacles that are slowing production, and also give you ideas about what opportunities there are for improving efficiency. Don't know if this helps any, but that's the approach I take. I'd welcome any input that anyone else might have.
 
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