Mandatory CPC


Salem, OR
Best answers
I am just wondering when Medicare will make it mandatory that physcians have a Certified Coder on staff. Has anyone heard anymore information regarding this? Thanks.
MMA (Medicare Modernization Act) made it "mandatory" that contractors (formerly FIs) have certified coders at specified higher levels of the provider relations chain. As for how many adopted or implemented this mandate, or what time line they're being allowed, I do not know. Actually, I read something in '07 that posed the question of how many contractors are actually abiding by this regulation.

Regardless, MMA did not dictate anything like that on the provider side, just payers only. Hawaii did have something in place that required certification on the provider side, but right now any certification outside that state is by voluntary basis only.

With PPS, Pay for Performance and other CMS initiatives on their way, I do anticipate something like that happening one day. Certainly someone from the Academy (since we've got lobbyists) has more sound information than I, and will hopefully give us an article on that in the coming year.

It'd be nice to see us finally receive the same recognition as nursing staff and some allied health providers, as what we do is arcane to most folks and requires a certain level of expertise not readily available through other healthcare professionals. I guess just keep your fingers crossed????
Kevin, I had to respond to your post.

I actually used to be the CPC for our local Medicare contractor, so at least some of them did pay attention to the MMA; however, when I left they didn't replace me with a coder. There is someone on staff who is going to take the CPC exam, so they are using her as the "coding expert."

There is also the semantics game of the MMA only saying that the contractor has to have access to a certified coder, so it doesn't actually have to be someone in provider relations department. :confused:
I agree with Kevin that PPS, pay for performance, etc will drive the hiring of credential coders to the providers and payers. I work for a payer and am one of only a few coders in our area. However, by demonstrating how valuable coders are to the payer, more payers are hiring coders. This really does work to improve communication and the relationships between providers and payers.

Kevin notes that the MMA has a requirement for payers. Kevin could you expand on that for me. Either through this forum or send me an email at my address listed below.