Wiki Coding/Billing A/R combined or separate?

[sgugliotto@hoacny.com]

I work in a 3 location practice, with 20+ MD's plus many APP support staff. We have in-office coding and billing. The certified coders work with the E/M's, HCC's, questions, education, and auditing. The billers/AR team deal with getting the claims out cleanly and any denials. They ask the coders for their expertise as needed. My question is: How do similar size practices divide up the tasks between the Coders and billers/AR in comparison? Are they kept as two separate entities or do you combine the two and if so, how? Also are they all in-house staff? Thank you for any insight you can provide.

 

[amyjph]

In a similar sized practice they worked in tandem and communicated often however, were kept separate. If a denial or complicated appeal came up that would be escalated to coding. Coders also worked coding related rejections in the clearinghouse. A/R staff worked by payer a work queue of denials, correspondence, etc. Coders need to focus and code. A/R needs to work A/R, etc.
There is no way they can be kept completely separate. Everyone involved in the cycle has to be able to communicate even from appointment scheduling to the payment of the claim and patient collection & everything in between.
You also don't want what are usually more highly trained and highly paid employees like coders doing non-coding related tasks better suited for a biller or A/R rep.
I think it depends a lot on how your revenue cycle is set up, the tasks assigned to each team, size and type of coding. Are there managers and supervisors to help triage some of it. Do coders get constantly bombarded by providers directly with questions and issues? There is a lot of variance for this. Do your coders do "from scratch" 100% abstracting, do they only work exception edits? Are they expected to code, field calls, do audits, educate, etc. Are they dedicated to only one type of coding in the group such as E/M or do they go between procedures, E/M, surgery, etc?

MGMA has info that may help.

https://mgma.com/membership/types/organizational-membership?utm_source=digital&utm_medium=search&utm_campaign=mem-gen-feb-2023-compsupport&gclid=CjwKCAjw__ihBhADEiwAXEazJiDiWi5WvUYiV2V3jNy_ZixvwpxT3v2qsHfMpz8sUQXVZtN5uAbMKRoCPvcQAvD_BwE

 

[sgugliotto@hoacny.com]

Thank you for the response. What you have said makes a lot of sense to me and to what I've always known and experienced. It is good to have confirmation and feedback from other practices. I appreciate you taking the time to answer.

 

[amyjph]

You're welcome. In my experience in this type they were all in house staff. It also depends on the practice management system being used I feel. It was great when we had CPCAs or CPBs working on the A/R team. It was a good starting point for a newer coder who had A/R experience to be able to transition to coding if a spot opened from the A/R team.
How do you have the workload and queues split?

 

[sgugliotto@hoacny.com]

None of our A/R team are coders although a couple are considering taking that route as they feel it would help them with their denial issues. I have teams of two for each financial class for the A/R. For the coders it used to be separated by physician now they each work whatever E/M's come through and split out the coding by date. I have one coder that in addition to E/M's works surgeon claims and they all do auditing and education.

 

[csperoni]

I personally have only ever worked in a private physician practice (with 2-5 providers) or as part of a huge healthcare organization with hundreds of physicians plus NPPs.
In a smaller practice, you may even have the same person doing all the steps. Or 1 person more senior, with others to assist. Always in house by my experience.
In my current huge healthcare organization, the billers, coders, and A/R people are rather segregated. A/R for some insurances are outsourced overseas. We communicate really only through the computer billing system. It can create some miscommunication errors, or someone not fully understanding how a particular task should be handled. Remote working has (IMHO) exacerbated some of those issues.
Your situation is more medium sized. The best revenue cycle employees understand the full cycle, even if they are not experts in all of it. I think it's small enough to keep everything in house. But certainly don't have your most senior (aka highest paid employees) waiting on hold with an insurance company. 2 separate teams is a good split. But the 2 teams are still part of the larger team of the entire practice. It should never be "us" and "them". You are all one big "us". That needs to come from attitudes of supervisors/managers of the teams. Everyone on both teams should be willing to teach other members on either team about an issue that they have particular knowledge about. CPC-As often do great billing and A/R work since they have a grasp of that other end. I think it's a great place for all coders to start, but that's for another thread...