Wiki Coding and Billing

[jackiems]

Hi, I work for a large hospital system and have always done straight medical coding in past jobs and this company also has me doing the back end with denials. I am curious if other coders have to do this? I am struggling with the denials and have been failing my audits.

Thanks

 

[sls314]

Hi, I work for a large hospital system and have always done straight medical coding in past jobs and this company also has me doing the back end with denials. I am curious if other coders have to do this? I am struggling with the denials and have been failing my audits.

Thanks

It's not unusual for coders to serve both roles.

If you would rather do just a straight coding role, there are jobs out there for experienced coders. You could take a look and see if you find something that meets your needs better.

However, if you're just not comfortable working the denials because you don't have enough experience doing it, you could ask for more training/resources to help you get comfortable.

Neither is a bad choice - it just depends on your preference and what kind of work you want to do.

 

[thomas7331]

Hi, I work for a large hospital system and have always done straight medical coding in past jobs and this company also has me doing the back end with denials. I am curious if other coders have to do this? I am struggling with the denials and have been failing my audits.

Thanks

I agree with the advice above - it's not unusual to have people work in both roles. However, working denials involves a different set of skills and background. If you've only done coding and are being asked to take on denials as well and you have no experience in that area, it's essential that you either get some additional training or at the very least work side-by-side with someone who has that experience who can coach you. Don't be shy about asking for help if you need it. With a coding background, it shouldn't be too difficult to learn it, but at the same time you shouldn't be expected to know denials already just because you're a coder.

In my experience, it's not a good idea for organizations to ask coder to just start working denials as if they should already know how denials are worked in your billing system and what the different kinds of denials mean for particular payers your providers contract with. Coding and denials follow-up are really two separate tasks that don't necessarily overlap - employers and managers need to understand this and to support their employees so that they can be successful at the tasks they're assigned.

 

[danachock]

Hi jackiems
I wholeheartedly agree - yes, it was insane my new path/lab role 10 years ago had me faced with denials that I needed to work. It wasn't until the medical company I worked for revoked another company's responsibility that was "outsourced" to tend to anesthesiology charges (clearly less than a year after I started coding pathology) that I found I had not only a professional but a government biller. It is all about training. If you are not comfortable, YOU ADAMANTLY AND CLEARLY NEED TO STATE SO. If you are clearly unhappy ~ PM personally okay, I will tell you exactly what I would do okay in your shoes. Are you the only one working all those pathology denials? If so, your company should be completely boosting your pay/salary and IF NOT ~ jump on LINKEDIN ~ there is such a coder shortage now that if you just posted your basics that those recruiting are aiming for you (my opinion ~ do the profile picture and fill in all those blanks. WE
ARE IN A CODER SHORTAGE. Healthcare facilities don't really care how many (certifications) designations you actually carry. ( I SERIOUSLY just went through this AAPC AND the AHIMA conversation today).
Thank you for listening,
Dana Chock, CPC, CANPC, CHONC, CPMA, CPB, RHIT

 

[amyjph]

Agree with Susan & Thomas. I have hired coders who have zero experience working AR, claims and edits and they found it very difficult to learn and perform even though they may have been very adept at coding. It's a totally different skill set as Thomas described. It is very helpful if coders know and understand the claims cycle, edits and AR but it all depends on the way the employer is set up. In a very large hospital system it doesn't make sense to mix these roles, in my opinion. Coders need to code. In my early experience as a coder coming from an AR and billing background, I found it very difficult to be pulled from concentrating on coding to be asked to go work claims and follow up on edits even though I was experienced at that and could do it.
I think it depends on the practice/health system. In smaller places coders may have multiple responsibilities. I have seen coders be tasked with appeals and AR follow up as well as working clearinghouse edits. In others, coders perform what you describe as "straight coding" only. In others, coders are expected to be "data-entry" type billers who just check over what providers submit but don't actually "code from scratch".

In looking for a role I feel it's very important to ask these questions of the prospective employer. If I was on the provider coding side, I would not want to be an "edit cleaner" or just work modifiers or something like that. You want to have an understanding of how they have their teams set up and the exact duties to make sure you are a good fit. It's not wrong to ask these type questions of the employer. While you may be asked to help out another team or act as a subject matter expert every once in a while, if you don't want to perform AR, billing, denials, etc. you should make that clear.