Emr Adoption Equals Billing Department Squeeze

If you are new at a job and wondering what the heck is going on, there is probably a good reason for that and it is not that you are crazy. It most training programs, internships, and certification schools, there is little emphasis on the clinical side of medicine or I should say how the doctors do what they do and how it directly effects you.

In a typical billing office, you have four divisions each with their own unique qualifications and skill sets.

These areas of expertise are:
Billing Specialist or Charge Entry Specialist
Coding Specialist
Accounts Receivable Specialist
Data Entry Clerk or Demographic Specialist

It is pretty clear what each of these specialists do but what is not clear is how the practice structure dictates more than anything exactly how labor intensive each of these jobs are. For this article, we will cover the coding specialist's job and how the clinical processes affect the coding work-flow and efficiency. With the rise of Electronic Medical Records, many offices are finding that their office is no longer in need of a full-time coder. Is this true? Not in my opinion. As the former CFO of a large Multi-specialty group, it is important to realize that being technologically advanced in a practice does not substitute the knowledge of a coder. What you find when a practice implements electronic medical records, is that the coder does have more time on their hands because now the physician is inputting charges and the program is telling them how to code. Your question probably is, what does that leave the coder to do? This problem can only be solved when the coder is willing and able to take a step out of their comfort zone and add value to the practice through other means.

Instead of the coding specialist applying modifiers, appending ICD-9 codes, and verifying documentation, it may be time for them to start routinely auditing documentation, charts, E&M visits, and explore ways to increase revenue through better practice techniques. As a coder, when you hear that the practice is implementing a new EMR program, you should not be fearful or concerned for your job but instead should look at as an opportunity to add more value to your organization. You have to be ready for the transition and before it even happens present to the practice ways you would like to spend your expected free time. Trust me, the practice knows that you will have free time and if they are like most practices have already eliminated a billing position in their mind. Typical cost savings realized or expected when converting to EMR, are in the areas of billing and transcription. As a coder, you do not want to be caught off guard by this change but want to face it head on and come up with solutions to utilize your skills to help your organization.

Here are a couple of examples that as a practice manager, I would appreciate and recommend. Learn the EMR system and be responsible for creating custom templates that help the practitioner code more appropriately. Begin to work the AR and streamline operations in the billing office so everyone's job is more efficient. Review the AR and work it if necessary. AR management is something that will never go away. Maybe your practice is outsourcing the patient collection efforts and it is something that can be brought back in house as your free time increases. Is your practice verifying every patients insurance prior to their visit, maybe you do this and explain how by doing this the AR is directly effected. Maybe you conduct bi-weekly coding audits on past records to make sure that you billed correctly according to the notes. Perhaps you take over the credentialing efforts and make sure you are participating with all of the necessary insurers. You could even offer to renegotiate your current insurance contracts which would increase the insurance net revenue by 5-15%.

Each practice is different and their are numerous opportunities to demonstrate the value you add to your organization outside of your coding ability. It is your knowledge that makes you the most valuable person in your billing department and that does not change when EMR is introduced. Do not be afraid of EMR but instead tackle it head on and look at is an opportunity to diversify the application of your knowledge.