Accurate medical billing plays a critical role in ensuring that physicians get paid consistently and at a reimbursement level that is appropriate for their credentials, the type of treatment administered, and any specialist services they offer. Of course, this reimbursement also affects their ability to do other essential things like pay administrative staff, update their medical equipment, purchase new medical supplies, and even pay their in-house administrative staff.

Errors and missing information in a claim that’s accidentally submitted to the payer can ultimately result in delays or even claim rejections or claim denials. This impacts the cost-effectiveness of your solo or small medical practice. Unfortunately, a lot of solo practitioners are only modestly familiar with medical coding best practices, which increases the risk for medical coding errors.

The risk of medical coding errors and the frustrating delays that can come from them drives many small practices and solo physicians to seek out the services of a medical coding specialist. This might be an administrative staffer that they hire as an in-house employee or a third-party vendor who takes on the brunt of the medical coding services for their small practice.

What Is A Medical Coder?

A medical coder is a medical billing specialist with the extensive training and experience to effectively handle a wide range of medical coding needs. They operate in a variety of settings and their breadth of scope can be influenced by the overall size of the medical practice, the type of physician, and the type of specialty services provided to their patients.

Medical coders are well-versed in the industry’s best practices for data entry and accurate medical billing. They work meticulously to ensure that all information is entered correctly before submitting a claim to a medical insurance provider or other payer institution.

This includes things like:

  • Data entry
  • Reviewing patient notes
  • Reviewing all relevant documentation
  • Accurately updating records
  • Applying all the correct CPT codes
  • Submitting the medical billing data to the payers
  • Monitoring the efficiency of the revenue stream
  • Catching medical billing errors before they are entered into the system
  • Ensuring the physician’s contact information is correct

Staying Up To Date On All Updated Medical Codes

It’s also important to bear in mind that the medical code books are constantly being updated. This in and of itself can be a challenge for in-house administrative staff, solo practitioners, and small practices where a single staff member handles medical billing as only a small percentage of their weekly responsibilities.

Though a medical coder only has one specialty and no other responsibilities to distract them. This affords them the time, opportunity, and acumen to stay up to date on all changes in both the ICD-10 and CPT codebooks. This intimate level of understanding helps them accurately translate the physician’s notes into useful medical codes in a timely and efficient manner.

Is Medical Coding Complicated?

While there is no hard and fast answer to this question, the truth is that a lot of cases that a medical coder works with are relatively simple to interpret and code. Especially for experienced medical coding specialists like those at Operant Billing Solutions.

It’s more complicated cases and specialty physicians tend to incur the greatest coding challenges for solo practitioners and small practices with an administrative staff that is tasked with multiple duties in a day.

In these situations, a medical coder is required to perform more in-depth research, which inevitably takes more time to code correctly. This is only compounded by the flood of new codes that have entered the medical billing system as a result of things like COVID response and other public health crises.

In some instances, this leaves some of the more commonly used codes suspended in a significant gray areas in the medical billing arena. For somewhat complicated or unusual cases, coding guidelines may be confusing to interpret. Fortunately, experienced medical coders can rely on their network of peers and other industry professionals to discuss nuances in online forums, as well as networking with specialists, and access to other confidential resources to help clarify the issue and determine the proper codes.

Part of this exacting acumen comes from things like ongoing training and continuing education as well as access to all current coding-related periodicals. These resources along with industry networking opportunities imbue medical coding specialists with an advanced, and sophisticated understanding of how to meet all medical practice’s medical billing needs.

What Does A Medical Coder’s Work Day Look Like?

Many medical coding specialists work independently or in somewhat smaller satellite offices. This helps to keep their overall operating costs as lean and efficient as possible. The net effect is a smaller fee schedule passed on to the physicians they serve.

On an average day, most medical coders will spend the majority of their time sitting at the computer reading notes and then accurately entering data into a billing system or perhaps searching for information to clarify the documentation in the clinician’s patient notes. If a critical piece of information is missing, they might need to contact the physician to ensure that they have it or that it is correctly entered.

At that point, the entire claim and documentation are proofread again to ensure there are no errors. It is then transmitted to the medical insurance provider or other payer institution. The medical coder then returns to the list of claims they have to process for that day and starts the process all over again.

Professional medical coders also perform periodic self-audits or have their efficiency audited by a third party. This helps to streamline the services they provide as well as help find areas where they can update their training to ensure they are always using the industry’s best practices for every single claim they process.

What Are The Benefits Of Outsourcing A Small Practice’s Medical Coding Needs?

Several benefits come with outsourcing your medical billing needs to a third-party specialist firm like Operant Billing Solutions. Right off the bat, you will enjoy fewer delays, claim rejections and claim denials. This translates into a more efficient revenue stream for your practice.

Outsourcing your medical billing also means you can repurpose your in-house administrative staff to other tasks like providing patients with care or expanding the scale of your practice. This further helps with cost-efficiency as well as maximizing the level of care your patients receive.