Why Your Practice Needs a Certified Coder and How to Find One

By now, you may have chosen one or more New Year’s Resolutions. However, if you do your billing in house, is hiring a certified medical coder one of them? If not, there are several reasons why it should be. Certified medical coders help practices navigate the oftentimes complex maze of legal and regulatory requirements in healthcare. These highly-detailed and compliance-driven individuals also serve as a financial backbone for the practice, ensuring that physicians are properly paid for any services rendered.

Why certification is paramount
Once upon a time, practices may have been able to rely on a single office manager to oversee operations and perform all coding and billing functions. Today, that’s simply not possible. ICD-10 demands greater specificity, auditors scrutinize claims like never before, and value-based reimbursement continues to take center stage. Hiring and partnering with coders who have received formal training and certification gives physicians the assurance of knowing that these individuals are fluent in all coding guidelines and insurer requirements. Certified coders have already proven their knowledge. In addition, as part of ongoing continuing education requirements, certified coders stay up-to-date on coding and other regulatory changes that directly affect the practice. 

Other benefits of hiring a certified medical coder
Certified coders also ensure:

• Coding accuracy and specificity that translates to accurate reimbursement
• Clinical documentation improvement to help physicians capture patient severity and complexity
• Ongoing internal audits that target high-risk areas
• Training and education for all staff regarding regulatory and coding changes
• Denial management strategies that identify denial trends as well as the root cause of denials

What to look for in a candidate
When beginning the search for a certified coder, be sure to identify the credential (or credentials) that will meet your practice’s specific needs. Following are some examples of outpatient coding credentials:

• CCS-P (certified coding specialist—physician-based)
• CPC (certified professional coder)
• COC (certified outpatient coder)
• CRC (certified risk-adjustment coder)

The American Academy of Professional Coders (AAPC) also offers a variety of specialty coding credentials that indicate a coder’s superior level of coding expertise in a particular specialty area (e.g., dermatology, pediatrics, cardiology, family practice, or internal medicine).

Other credentials that may be useful in the practice setting include:

• CPPM (certified physician practice manager)
• CPCO (certified professional compliance officer)
• CDEO (certified documentation expert—outpatient)
• CPMA (certified professional medical auditor)

In addition to credentials, look for a candidate who possesses these other important qualities:

• Analytical skills. The individual should be able to scour a chart and capture all relevant codes that denote a patient’s severity and clinical complexity. If documentation doesn’t support a particular diagnosis or evaluation and management code, you’ll want someone who will notice this and bring it to your attention.
• Curiosity. Hire an individual who proactively tries to enhance his or her own knowledge not only of medical coding but also clinical conditions and procedures. This individual should have a natural desire to address billing inefficiencies and improve processes throughout the practice.
• Detail-oriented. With so many varying requirements from insurers, you’ll need someone who can sort through the details and submit claims correctly the first time around, thereby avoiding the need to appeal.
• Integrity. Look for someone who makes compliance a priority every day. This individual should also strive to protect patient privacy and confidentiality at all times.
• Interpersonal skills. The certified medical coder you hire should be comfortable interacting with and answering questions from colleagues, providers, insurers, and patients. He or she should also be able to develop positive working relationships with provider relations representatives at insurance companies, local pharmacists, practice management vendors, and others.
• Technical skills. In today’s world of electronic health records (EHR), a certified medical coder must be able to bill and process claims electronically as well as run reports and monitor denials.

What you can expect to pay
The national average pay for a certified medical coder is $38,853 annually, according the most recent data from Payscale.com. You can also view certified medical coder salaries by state. In addition, views the AAPC’s 2015 annual salary survey that includes responses from nearly 18,000 members. Following are three take-away points from the AAPC survey to consider:

• Coders who possess more than one credential tend to earn more than those with only one credential.
• Coder salaries typically increase commensurate with the number of providers in the practice.
• Coders with the CPPM credential tend to earn the most.

Where to find a certified medical coder
Aside from posting positions on job sites such as monster.com or careerbuilder.com, consider looking on LinkedIn.com where many professionals have already uploaded their resumes and provided information about their coding credentials and work experience. Also consider posting the position on the AAPC’s website where you can also verify credentials. The AAPC allows you to post full-time, part-time, and contract positions. You can also participate in Project Xtern and work with non-paid, certified medical coder externs, allowing you to evaluate potential employees before you hire them.

If the individual who currently performs your coding and billing isn’t a certified medical coder, consider paying for his or her certification and ongoing continuing education. You’ll likely be rewarded in dividends from this wise investment. Make 2017 the year in which you take control of your reimbursement.