RE: Coding position with a hospital-owned physician group

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Karen,



I do this for a hospital but only code for the surgeons at the hospital.
And I only code the pro fee side. So I code from their dictation. The
business office actually sends the claims and does the posting. I do check
on claims to see if they paid correctly and call on some that have not as
well as send appeal letters. They seem to be prone to just write them off
instead of appealing or checking with me to see if it should have paid. I
use their software.



DIANA FRANKLIN, CMRS, CPC

Member American Medical Billing Association

Member American Academy of Professional Coders

(931) 879-9854

dianaf@twlakes.net



Comments

  • edited May 2017
    Karen, if they are part of an ACO or any value-based contracts, you would also want to add something about responsibility for HCC/RAF coding. Also, when I was part of a hospital-owned, we were responsible for auditing the providers' level of service and doing coding training.

  • edited May 2017
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    All of these responses are excellent !! Thanks so much for the feedback.



    Here's the thing - the job description name indicates the pro-side, but the
    body of the job description indicates the need to know DRG's (???).



    Also, I am thinking the design of the job is going to be different based on
    the logistics of the practice(s) - examples: EMR allows physician to code,
    claims are submitted, and up-front errors are for the coder to resolve.
    And/or - all claims denials are routed to the coder for review and
    documentation analysis, then collected for re-education purposes.



    Coding strictly from records for claims submissions - how common is that?
    Would that be considered as a production coder?



    I have a feeling this position is a newly created one, but I'm not 100%
    certain.



    Karen A. Hurley, BS, CMM, CPC, CNA

    President, HPMSI

    PO Box 409

    Parrish, FL 34219

    Tel: (941) 776-4822

    Fax: (240) 368-0059

    Web: www.hpmsi.com



  • edited May 2017
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    Mr. Quintero:



    Thank you so much for this. In your organization, do the physicians code
    their services, the EMR, or is it done strictly by a coder by documentation
    review?



    Karen A. Hurley, BS, CMM, CPC, CNA

    President, HPMSI

    PO Box 409

    Parrish, FL 34219

    Tel: (941) 776-4822

    Fax: (240) 368-0059

    Web: www.hpmsi.com



  • edited May 2017
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    Is the person filling the position a certified coder or is that just a job
    title to be given?





  • edited May 2017
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    This is a position created and presented by an HR department.



    Karen A. Hurley, BS, CMM, CPC, CNA

    President, HPMSI

    PO Box 409

    Parrish, FL 34219

    Tel: (941) 776-4822

    Fax: (240) 368-0059

    Web: www.hpmsi.com



  • edited May 2017
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    It is really hard to answer the question without more information on what
    the HR department is actually trying to create in the position. If the
    physician is going to provide the diagnosis and the CPT codes to bill from
    and the new employee will not have to determine anything then you have more
    of a biller position than a coder. If the new employee is going to be
    looking at document and deciding what is to be billed to the insurance
    company then to me that person needs training, certification, and experience
    on how things work and is familiar with rules and guidelines of insurance
    and billing. A simple title does not mean the person knows how to do the job
    correctly. Anyone can pick up a book and select a code and submit a claim to
    an insurance company but a true coder does more than that.



    From: Karen Hurley CMM CPC [mailto:karenhurley@hpmsi.com]
    Sent: Tuesday, June 14, 2016 6:35 PM
    To: Multiple recipients of list PARTB-L
    Subject: RE: [partb-l] Coding position with a hospital-owned physician group



    This is a position created and presented by an HR department.



    Karen A. Hurley, BS, CMM, CPC, CNA

    President, HPMSI

    PO Box 409

    Parrish, FL 34219

    Tel: (941) 776-4822

    Fax: (240) 368-0059

    Web: www.hpmsi.com



    Since 1996, Celebrating 20 years of Service to Physicians



  • edited May 2017
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    The ad does request that the person be certified, but the title indicates a
    pro-fee position, when the body of the ad states the person needs to know
    DRG's.



    My original question was how those who work for hospital owned practices
    have their jobs designed, as this position may be a new one (as you
    indicate).



    Everything goes back to the creativity of the person who designs the
    position and / or the lack thereof.



    I am waiting on clarification from their HR department...we'll see J



    Karen A. Hurley, BS, CMM, CPC, CNA

    President, HPMSI

    PO Box 409

    Parrish, FL 34219

    Tel: (941) 776-4822

    Fax: (240) 368-0059

    Web: www.hpmsi.com



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