Revenue Cycle Management Blog | GroupOne Health Source

Is Your EHR Your Certified Professional Coder (CPC)?

Written by Kaitlyn Houseman | September 26, 2013

The key to successful Electronic Health Record (EHR) adoption is not only selecting the right system, but ensuring you have the right people involved in the process. Many EHR’s pledge the reduction of coding staff because the EHR will allow you to swiftly document, accurately code your progress notes, and auto generate your coding. Sounds easy enough, right? What you might want to consider when listening to the sales demonstration is who is giving the demonstration. As a software vendor, do they have the experience of medical coders and reimbursement staff that have lived the tricks of the trade? Do they understand that sometimes submitting a clean claim requires more than automated claim creation and filing?

Most EHR’s have the ability to auto generate your coding according to the means of your documentation. But does your auto generated coding understand what you “really” mean? Do you know how the E/M levels are calculated in the EHR? How the HPI and ROS are calculated? When your templates are being generated, are you formatting them correctly to pull this information to correctly calculate your automated coding?

Most auto generated claims still require a skilled medical coder to review to ensure that submitted medical claims are compliant with CMS and private payer guidelines. Don’t expect the OIG to ignore you if you use an EHR. Be sure the coding and billing you are submitting is accurate. Don’t rely on your EHR. Modifiers should never be applied automatically; the medical record needs to justify the use of a modifier. When modifiers are reported routinely, without reference to the available documentation, you are leaving the door wide open for an audit.

Billing is not a point and click operation. Coding professionals possess a thorough understanding of the health record’s content in order to find information to support or provide specificity for coding. Certified medical coders are trained in the anatomy and physiology of the human body and disease processes in order to understand procedures to be coded. The job entails much more than simply clicking a CPT and ICD-9 code in your software.

Medical coders are familiar with the contractual obligations they have to the payers they serve. They also keep abreast of the relevant statutory requirements that change on a regular basis. Through continuing education to maintain their credentials and ongoing professional study to stay on top of their field, professional medical coders are the last line of defense against charges of healthcare fraud and abuse.

Your compliance plan needs to help flag inappropriate behavior in an effort to avoid or correct potential improper conduct. Does your compliance plan include coding? Why would it, you use an EHR that does your coding for you.

To summarize:

  1. Even the best computer program cannot substitute for a trained, human professional. Software programs cannot understand documentation the way a person can.
  2. Don’t set yourself up for an audit. Exposing yourself to charges of fraudulent or abusive billing practices only delays payment of your claims.
  3. Do it right the first time. If your claim denies for medical necessity or incorrect coding usage, who is responsible for correcting the claim and turning it back around? Avoid the delay in payment and extra hassle and just do it right the first time.
  4. A professional medical biller is trained to assemble a medical claim to submit to the insurance carrier. A higher standard of compliance to the government healthcare programs and commercial requirements are utilized.
  5. Most importantly, your billing and coding specialists are an integral part of your health care business. They work regularly with providers and staff members to clarify diagnoses or obtain additional information that make sure that the documents are accurate.