Most medical practices have heard of AAPC or the American Academy of Professional Coders, the question remains what certification if any is the best for your practice?  As you may already know, the certification can make a bad employee good but can make a good employee better.  Having a certificate does nothing for an individual that does not stay current with ever changing coding rules and procedures.  It also does not give the employee a better work ethic or attitude.

The most frustrating thing for me as a former Medical Practice Administrator is a biller or coder with a poor attitude.  I understand that many billers lack the desire or skills to interact with employees and patients on a daily basis but this was unacceptable in my practice.  I would rather have a coding specialist that has a positive attitude and is willing to do what is necessary to improve OUR practice, even if that means they have to do some AR follow-up.  The one thing that I have noticed with Certification is that it adds a level of confidence or arrogance to a coder that is not sometimes not present when the certification is not present.  Having a coding certificate does less for your practice than it does for your employee and that is a fact.  Certification is in no way a bad thing but you have to be prepared to pay more and may have to worry about losing them to another organizaton.  From a coders perspective, obtaining certification does add value and increase your knowledge which is always the ultimate goal.

From a practice’s perspective a good coder does not need some letters behind their name to make them a better coder.  The question is really concerning whether or not they are actually coding correctly.  And know that just because they are certified, that does not mean that they are actually coding correctly or within compliance.  If you are unsure of your coders ability then it would be wise to have an outside company perform a coding audit to ensure their competence.

Medical Billers Must Avoid Reimbursement Denials
When billing problems occur they will lead to complications, frustrations, and often serious complaints. This is not acceptable and most be avoided when ever possible.

Billing problems are best avoided from the beginning! The means a strategy is needed before you ever start billing.
The following are a few examples of typical medical billing and collections problems that can occur as a result of oversight and error, or sometimes incompetence. Many physicians, particularly Internists, are concerned about reimbursement for concurrent care when they see a patient in consultation on the same day as another internal medicine specialist or subspecialties.

List of Common Problems:
medical coding Confusing and indecipherable bills
medical coding Failure to follow consistent billing cycle, as stated in provider’s policy
medical coding Failure to credit payments
medical coding Failure to deduct payments from balance owed
medical coding Finance charges on billing mistakes/improper finance charges
medical coding Improper filing of insurance/failure to file insurance
medical coding Denial of care due to outstanding balance, even when balance is in dispute
medical coding Denial of care to patients with “pre-paid” coverage, such as HMO members
medical coding Denial of care to children of parents with outstanding balances
medical coding Demanding payment in full from patients with previous bankruptcy filed against provider, even when patient has current health coverage; otherwise denying treatment
medical coding Resurrecting old medical bills, from as long ago as 16 years
medical coding Excessive rates for services; fees above “usual and customary” for many insurance companies
medical coding Coercive and intimidating collection practices by Patient Accounts representatives
medical coding Failure to honor payment agreements made with patients
medical coding Unwillingness to put payment agreements in writing
medical coding Improper notification to consumers that their accounts have been “flagged” for no service
medical coding Refused requests for information and/or clarification of bills
medical coding Overcharges/double-billing
medical coding Charges for goods or services never received
medical coding Upcoding — billing for more complicated procedure than was performed
medical coding Bills sent to inappropriate address or person
medical coding Finance charges to Medicare patients
medical coding Forcing patients with outstanding balances to get treatment at facilities in other counties
medical coding Pushing patients to use credit cards or take out bank loans to pay medical bills in full immediately
medical coding Charging HMO members improperly by calculating members’ 20% co-pay based on the original full price, rather than on the HMO’s discounted price
medical coding Not understanding how patients reach their deductible and what portion of the payment goes to the deductible