Author Topic: Coding or Billing...Confused  (Read 2813 times)

SnyderKristine

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Coding or Billing...Confused
« on: March 04, 2014, 10:19:40 AM »
Clients have now confused me. I have experience in Medical Billing processes. I know how to take care of claims submission. rejections, denials, AR follo up...etc..

But I can't decide what code the doctor should put for the treatement or interpret the chart.

Now when I offer medical billing services to a client, they ask me are you CPC certified?

What do they mean?

There are no certifications required for Medical Billing, knowledge is sufficient, if you do it well? Then why CPC?

Do all the Medical Billing Business owners offer coding services , do you guys hire a CPC certified person, or you take the exam yourself?

Please help

PMRNC

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Re: Coding or Billing...Confused
« Reply #1 on: March 04, 2014, 10:34:09 AM »
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But I can't decide what code the doctor should put for the treatement or interpret the chart.

Unless you are a coder and your contract specified you will code, you do NOT put codes onto the encounter, the provider would be responsible for that.
YOU do NOT want to code unless 1) you are certified and 2) fully insured with E/O insurance.

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Now when I offer medical billing services to a client, they ask me are you CPC certified?

This is the Certified Procedural Coding certification offered by the AAPC and the ONLY association to give it out. Certification is not required however I've NEVER seen a provider hire a coder who is NOT certified.

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Do all the Medical Billing Business owners offer coding services , do you guys hire a CPC certified person, or you take the exam yourself?

I do not code, I have over 25 years in the health insurance industry and probably COULD code if I wanted to, but I don't. my clients are responsible for coding their own encounters before I get them. Some of my clients have a CPC on retainer or on staff. My mental health providers really don't need one. Medical billing and coding, though they are linked, are not the same. If a medical billing company has the experience and certification to code they can offer it, but it does increase the liability since the medical charts would need to move from the office.. (I make that a no no in my business. I DO NOT take any medical chart out of the office).

Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

SnyderKristine

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Re: Coding or Billing...Confused
« Reply #2 on: March 04, 2014, 11:20:18 AM »
I completely have the same feelings, and I am also scared to even try that.

If I choose to be CPC certified, that will cost me a lot: $300 exam+ $1500 course+ blah blah.. And the exam is not easy. Though I am a Biology Science student but this is too much study and time..

What do you think Linda?

Can I be straightforward and say that I won't do coding...?

PMRNC

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Re: Coding or Billing...Confused
« Reply #3 on: March 04, 2014, 12:02:35 PM »
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Can I be straightforward and say that I won't do coding...?

Absolutely.. it's never cost me a client. If I come across one that wants a coder, that's pretty simple as I network with a ton of them.

You also have to take into account your insurance. Some will argue with me and tell you that you can get away with none.. however that would NOT be smart. E/O is essential in this line of business.. remember we are the second highest regulatory industry out there (second to banking) so NOT having insurance increases your risk. Even without doing coding I have an E/O policy, I still keep my liability low in a few different ways. One way is NO coding, the other way is to let my clients retain all access/rights to software/pm licenses.  Just from those two things alone I'm able to decrease my liability by more than 40%
Linda Walker
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One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

SnyderKristine

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Re: Coding or Billing...Confused
« Reply #4 on: March 04, 2014, 12:13:02 PM »

One way is NO coding, the other way is to let my clients retain all access/rights to software/pm licenses.

And this reminds of something a prospective client said: "He actually wanted me to purchase my own Practice Management Software, and then transfer his data to my PMS, and start billing"

1. Who will pay the cost? How much will it be?
2. How will the data get transferred?
3. And does it mean he is not using any PMS at the moment?

I think I will refrain from coding at this point of time.. If needed will you be able to refer a coder in NewYork  ::)

PMRNC

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Re: Coding or Billing...Confused
« Reply #5 on: March 04, 2014, 12:30:52 PM »
Where in NY are you?

1) they pay cost, it's their responsibility to make sure you received properly coded encounters
2) how data is transferred depends on system in place, providers that have to rely on billing companies to download and transfer from their systems save NOTHING.. you need to have your own system in place. OR if the provider has a system in place it should be YOU that finds the solution for transfer. Having them do the work and then you transferring it direct or to CH is completely ineffective, old school and market is dead on that.  Providers want an all inclusve way to save by outsourcing. They already know they can do the work and hit the transmit button.
3)  I don't think there are any offices left w/out a PM solution already in place.. Today's billing company has to be ready to step in
Linda Walker
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One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

SnyderKristine

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Re: Coding or Billing...Confused
« Reply #6 on: March 04, 2014, 12:51:05 PM »
I am in Brooklyn..

So I understand, I don't have to purchase a PM software for a provider. Though I can advice him, but he will be the one who will purchase and contract with the company..

PMRNC

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Re: Coding or Billing...Confused
« Reply #7 on: March 04, 2014, 01:24:21 PM »
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So I understand, I don't have to purchase a PM software for a provider. Though I can advice him, but he will be the one who will purchase and contract with the company..

Well, that's not exactly what I'm saying.  Years ago I would have said a billing company has to have software and be ready to set up a new provider.. however in today's business most doctors HAVE a solution set up and for them to switch is a royal pain in the rear.. today's billing company can be diversified and market based on their experience and ability to work with the system the provider has in place. I've seen many billing companies turn down clients because the client didn't want to switch software..that's nuts. An experienced and / or trained medical biller will be able to work in any system proficiently.. save the client a nice big chunk of change and work with what they have in place when possible.
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

SnyderKristine

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Re: Coding or Billing...Confused
« Reply #8 on: March 04, 2014, 03:07:12 PM »
I think I will explain this to the client, and he would be happy to continue using his software rather than switching...


SnyderKristine

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Re: Coding or Billing...Confused
« Reply #9 on: March 04, 2014, 03:08:41 PM »
But, I still have this question answered, which certification would I need being a Medical Billing Service Provider: CPC by AAPC or CMRS by AMBA (I just discovered)

PMRNC

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Re: Coding or Billing...Confused
« Reply #10 on: March 04, 2014, 03:19:56 PM »
These are two separate certifications, one is coding (CPC). the other is a medical billing "certificate"   
I can't comment on the certification as I believe it's ONLY as good as the education behind it. Doctor's have no idea of these certifications, if the education is good behind it, fine it's a plus. I think concentrating on your education and experience rather than the initials by your name is a better idea. The CPC is a MUST if you plan to do / offer coding. The AAPC is pretty highly recognized and really one of the only coding certifications known.
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

SnyderKristine

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Re: Coding or Billing...Confused
« Reply #11 on: March 06, 2014, 05:10:18 PM »
Just can't make up my mind on what to choose. I came across three organizations offering Coding and Billing certifications.

AAPC offers CPC for coding and CPB for billing ($300 exam fee + $1595 course)

AHIMA offers CCA n CCS for coding ($299 exam)

AMBA offers CMRS for billing ($325 exam fee + $199 course fee)

AHIMA certification is clearly affordable, but is it recognized...

Any thoughts? Which one would you guys choose??

PMRNC

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Re: Coding or Billing...Confused
« Reply #12 on: March 06, 2014, 05:45:45 PM »
For coding I would only reccomend AAPC.. THEY are a coding educational provider.. that being said, their medical billing course I heard is not that great.. coding is their specialty.

AHIMA is HIM.. much more involved than coding ---   Health Information Management is much more than just coding.. VERY good certification but very involved and lengthy, I think the price you put for $299 is probably JUST the exam. No one passes their exams w/out buying and studying and lots of money out of pocket before that, similar to the AAPC's CPC designation. Purchasing the exam is the last step in countless hours of work and quite a few dollars out of pocket.

I can't really tell you which to go for because you have to decide if you are going to do coding/billing together, or separate.. My personal opinion if you are new at this, pick one for now, my opinion would be billing/practice management, I think you will see it harder to get in for just coding. I think coding is a great ADD on service but I don't think it's going to be a big futuristic career.

Again, please let me tell you that you have to really LOOK at the education behind the courses. There are one or more certifications you mention for billing that are completely irrelevant to physicians.  THERE is NO National Certification for medical billers. Those offering it are offering it "nationally"  big difference IMHO.

You might also want to look at www.medicalbilingstudycourse.com and before anyone gets their panties in a bunch, yes I know the people behind it, helped write the HIPAA course.. but I stand behind it because it's done with the three biggest names in the industry!!

I'm also going to toot my own horn, take a look at what we have to offer. We offer way more than any Association out there in resources, we offer a number of networking opportunities.   You can see our link in my signature.
« Last Edit: March 06, 2014, 05:48:00 PM by PMRNC »
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com