Like one foreign language to another, a revenue cycle is similar to translating the work performed by a physician provider into payment. The entire process involves coding the appropriate diagnosis and procedures, billing, filing, and sending the claim to the corresponding payers, and if all went smoothly, receiving the payments from these insurance companies or may be in a form of copayments from the patients.
The Work Environment for a Medical Coder
The options for the workplace have greatly widened since the Covid 19 pandemic allowing most medical billers and coders to work from home. Of course, with proper HIPAA training and certification, working from home is the current trend allowing workers to create and sustain a work-life balance without resigning from their current jobs.
Getting a career as a medical coder or biller (or sometimes both) should be given a lot of thought including the workplace. If a person is interested in a fast-paced, load-heavy environment and does not want to take home tasks, then a hospital is the place to go. If someone on the other hand prefers a controlled environment with limited encounters per day, then a small office physician clinic is the best option. Regardless of the workplace, all medical facilities required skilled coders and billers who can either work in the office or remotely. Though not seen and only silently working, coders and billers are essential to the entire healthcare force and comprise one-fifth of the industry and are still expected to grow in the years to come. This growth is seen partly due to the transition of the ICD 10 coding to the more complicated version of it wherein current coders and billers seem to be unwelcoming of it. A jack-of-all-trades medical coder is highly valuable and is reflective of one’s exposure to different specialties. Most coders are fluid and efficient only in the area of specialties they are exposed to and room for growth and development is thereby limited.
A Physician’s Office
There are many ways a small physician’s office can hire a coder and a biller. They can avail of the full services or sometimes they can just select a particular service that they seem to lack hence not all office clinics are the same.
1. A Multi-physician office clinic. This setup is more fast-paced and requires more clerical and administrative workforce since there’s a lot of discipline to attend to. The organizational component is more structured and the job description per each employee is well-defined. A person doing the medical billing is separate from the one who is doing the coding.
2. A One-physician office clinic. For people working with only one or two doctors in an office clinic, multitasking is such an underrated term. Though the set-up is small, with a limited specialty, and a controlled volume of patient encounters per day yet, the attention of the employees is greatly divided. An employee could be the receptionist, medical assistant, biller, and coder all at the same time. Getting free time or days off is a little compromised since an absence from work can greatly affect the series of workload in the clinic
There are some office clinics that may only require a billing service since the physician himself is capable already of doing the coding himself.
The Hospital Environment
The hospital, being the original playground for medical billers and coders, has its own advantages despite being perceived as a toxic work environment. A biller/coder can separate his work from personal matters if he works on-site. There is also a clear segregation of specialties since the coders working for a hospital are departmentalized. There is however a difference in coding since hospital services are different from that of an office clinic and the reimbursements are done through the hospital coding. The coding flow is unique per specialty however the billing system is centralized. All bills are uniformly submitted and processed by the hospital.
Diagnosis-related Groups
The hospitals are getting the reimbursements through DRG which means that an admitting diagnosis will tell how likely is the risk for management and the severity of the disease. The riskier, the more severe an admitting diagnosis is, the greater the reimbursements. This is only fair for the hospital and the physician attending the patient but this also sets the ground for malicious intent by some facilities and practitioners. They can upcode a diagnosis of a patient so that a claim would be higher and hence can generate more income for the facility. This is a form of medical fraud and continuous high reimbursement can invite unnecessary auditing to the workplace. Physicians doing their own coding are encouraged to have certified coders do the work since an erroneous coding resulting in higher reimbursements, though unintentional can call the attention of the paying insurance and be audited. This can also be avoided by doing internal auditing within the facilities themselves so that lapses in the revenue cycle management whether due to loss or a massive peak in revenue can be identified.