Question Codes data entered by billers??

PDecell

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Eugene, OR
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I wasn't sure which forum this should be in so I apologize if this is the wrong one. I work at a CAH with an HBC and coding has always been part of HIM. The hospital does all the coding for hospital and clinic. There was an administration shake up and we (coders) ended up in the Billing Dept. No one, including the supervisor, have any coding education or experience. The new CEO (previously the HBC manager and also no coding knowledge) decided that one of the billers would just enter the codes from the providers' super-bills with no review by coders and the same with ancillary visits. The purpose is to get to a point where they no longer need our remote coders and can save money. The providers don't choose the codes. They dictate the diagnoses and the system plugs in the code so, depending on the documentation , the codes aren't always correct. The billers entering the codes don't have access to the coding software so they don't receive any edits. They're entering codes for mammos without final reports and labs with invalid codes etc. Previous to the shake-up, a clerk would enter the codes for some of the accounts and then the visits would go to the coders to validate the codes so every visit went through the coders. My question is whether this is appropriate or not. It seems that there is a lot of cutting corners in order to get paid and I'm a little uncomfortable. It may be perfectly appropriate, but I just want to be sure. I appreciate any advice. Thanks,
 

Chelle-Lynn

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Modesto, CA
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Your question is a good one that comes up quite often as various facilities and offices try to lower their overhead. There is no "law" or "rule" that requires that coding be completed by a certified coder. Ultimately, it is the facility or physician who is responsible for what is entered and coded on their behalf. In some offices we have seen dual roles where the coder and the biller are one and the same and in other offices we have seen staff coding for the providers who are not either. While it behooves the provider to ensure that the coding that is being completed on their behalf is correct to avoid fraud, fines, and the like...it is not a requirement.

Hopefully, your facility has a compliance or quality manager who is monitoring the new roles and will be able to see the effectiveness of having certified coders. Like I noted ultimately it is the provider or facility who pays the cost of these errors and short cuts.
 
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