Wiki Coders posting payments


Iron Station, NC
Best answers
My office manager just asked if I had ever heard that it is illegal for a coder to post payments. Apparently, in a PAHCOM forum, another office manager posted the question. This manager said she has 3 certified coders. Two of them recently approached her stating they could not legally post payments due to a "conflict of interest". Is there any merit to this statement?
Sounds more like someone wanting to get out of doing more work. How could it be a conflict of interest? you can't change anything and you have to post the payments to the correct patient and DOS. I'd like to know where they got their information from.
Best practice policies typically suggest that the people who are responsible for posting or verifying charges (such as coders) should not also be the same people who are responsible for accounts receivable (billers). It's standard accounting practice in many big groups or facilities, designed to avoid having your coding staff engage in coding practices that are done primarily to override edits and inflate reimbursement. There could be a potential that coders who are involved in accounts receivable might be asked to use that information to influence how they are expected to code, instead of coding based on regulatory guidelines.

The billing department is generally under the umbrella of the revenue people, with the coding department being under the Med Info umbrella. With different department managers and separate reporting structures, it can prevent the billing manager from influencing the coding staff to code based on payment alone.

That having been said, it's always a good experience for a coder to have the experience and understanding of how claims are adjudicated so that they can determine if coding (or billing) errors were made that impacted the bottom line. Overall, though, this is why certified coders are held to a particular ethical standard....if coders must be involved in accounts receivable (as they frequently are in small practice settings), they must set aside their billing hats when they are working as coders (and vice versa).

It's perfectly legal for coders to post payments, work denials, submit claims, collect copays and other revenue-cycle related work. What can be challenging (fraudulent, actually) is if they ignore or override correct coding initiatives and other coding regulations in order to get the claim paid.
Thank you

Thank you everyone for your responses. They were very helpful. It was our first reaction to say it was just someone trying to get out of work!

The last post was very interesting. Three years ago, I was let go from a practice I had worked at for 11 years. Our Billing and Coding Departments were split. I was the manager of the Coding Department. When we had a change of administrators, the new one didn't feel my position was necessary and put the coders under the Billing manager.