Some of our clients are reluctant to employ certified coding and billing professionals, believing that anyone with some training can perform the two most crucial medical practice functions after patient care. They usually live to regret this short-sighted perspective, regardless of the purported experience of the employee. This is not to say that it’s impossible to find billers with many years of solid experience, who hone their craft and stay current with developments and trends, but they are rare.
Most positions have an element of on-the-job training and part of this has to do with acclimating the worker to the company’s norms and standards, which are known by someone at the organization. Coding and billing are surrounded by some mystique and when there is training, it can include bad habits and misinformation passed down from one person to another.
Granted, nobody dies in the billing arena due to faulty information, but mistakes can be costly to the practice – in denials, recoveries and even false claims. In smaller practices, many billing directives come from the provider, who is not generally versed in the guidelines and nuances of proper coding and billing. Add to this the reality that few people in the practice can truly oversee coding and billing work, so there are no checks & balances to assure the accuracy of what is billed. Many a practice owner has been lulled into a false sense of security about the billing since money keeps coming in. But as we know, payors dedicate significant resources to data analytics and are adept at identifying patterns and discrepancies that can signal billing or coding errors, and of course, to investigate and recoup monies paid in error.
Some providers mistakenly believe that if one – or even a series of – billing errors occur, they can deflect responsibility onto the biller. When a practice bills a claim, the provider essentially assumes full responsibility for what is billed on his/her behalf. As leaders, there are things we know and things we should know, and not knowing something is not a good defense for errors.
To be sure, there is variability in certified billing and coding professionals, and no one is above making mistakes. But the credentialing process is one layer of vetting that can provide some comfort in the person’s knowledge and expertise. In addition, to maintain the credential, the biller or coder must complete considerable continuing education on topics approved for his/her credential. This benefits the practice and can mitigate the higher wage paid to a certified individual.