Medical Billing and Coding Comparison

When it comes to medical billing and coding, often the idiom “Too many hands in the pot spoil the sauce” is applied when referring to the number of billing and coding specialists a healthcare practice employs. Medical coding and billing information is extremely sensitive in nature, and therefore should be handled with acute attention to detail and confidentiality. Many practices opt for one specialist with the intentions of restricting the amount of access to patient files and streamlining billing processes.Medical Billing and Coding Comparison

Though the intent of protecting patient privacy is attained, having a single billing and coding specialist comes with the burden of sole accountability for a practice’s remunerations. Practices with larger volumes of patients run the risk of specialists being unfamiliar with specific information for patients, hindering them from catching any patient specific errors in recording, coding and billing. Furthermore, internal audits fall in the hands of one individual, which holds the specialist with the utmost expectation of integrity.

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Errors can be avoided with an active checks and balances system for accounting methods in the practice, it is ultimately the billing and coding specialist’s responsibility to see that patients and third party payers are billed accurately in accordance with state and federal laws. Perhaps the most complex of a medical billing and coding specialist’s duties is properly recording patient information and treatment codes (Adams, Norman and Valentine, 2002). It is imperative that this part of the process is free of error as it shapes the remaining steps in seeking payment for treatments.Medical Billing and Coding Comparison

A single biller has the advantage of becoming very familiar with each patient’s treatments and schedules, allowing them to apply specific focus to the unique circumstances of each patient. Similarly, a practice employing a single specialist can more readily become familiar with the specialist’s routines in billing and coding which allows members of the practice to quickly make adjustments to individual patient’s information as well practice wide procedure without the worry of training more than one specialist to implement the changes quickly.

However, the recording and coding limitations to a single specialist come with volume. Any practice wide adjustments, like coding or payment policy changes, will take significantly longer to implement as only one person is responsible for executing them. This can create a noteworthy delay in the process and subsequently payments, which creates a liability for the practice (Painter, 1998). Once a specialist has properly recorded patient information and coded treatments, the next important step is billing the patient or their third party payer for the treatments a practice provides.

Many insurance companies and government agencies have billing processes specific to their organization and require slight variations in the information they receive in order to issue a payment (Adams, Norman and Valentine, 2002). Practices employing a single specialist must be sure that the specialist is familiar with each payer’s method, which could create an issue if the specialist isn’t able to efficiently learn the processes.Medical Billing and Coding Comparison

Many insurance companies and government agencies have a window in which payments should be submitted, so delays in invoicing these organizations could result in the practice not receiving payment for treatments. Having multiple specialists could hasten the process, but liability comes in insuring that each specialist is familiar with the varying procedures and errors in billing are amplified with multiple specialists. Every reputable healthcare practice performs periodic internal audits to ensure that they are adhering to proper billing and coding procedures.

Federal and state laws mandate that each practice follows the outlined policies, and any deviation from these policies can result in fines for the practice or worse, the loss of patients and closing of the practice (Adams, Norman and Valentine, 2002). It is imperative that the billing and coding specialist for the practice performs these audits with truthfulness, making note of any potentially damaging errors they identify. Practices with multiple billers have the ability to have specialists perform audits on one another, which helps in ensuring the accuracy of the audit.Medical Billing and Coding Comparison

Though this system allows the specialists to be held accountable for their performance, completing multiple audits could result in information being lost or overlooked, errors which are intensified with each additional audit (Painter, 1998). Conversely, practices with one specialists have to operate within good faith when it comes to billing and coding audits. The specialist would be reporting on their own errors, and the fear of being reprimanded could entice the specialist to neglect reporting serious errors.

This creates great liability for the practice, as the practice rather than the specialist will be held responsible for the errors if the practice is audited by their state or federal agencies. The numerous advantages to having a single specialist are somewhat varied from practice to practice. The room for error is lessened with fewer specialists performing billing and coding services for a practice. In addition, a single specialist has the ability to become intimately familiar with the billing procedures for the practice, quickly implementing changes to policy and patient information.Medical Billing and Coding Comparison

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Errors in coding and billing can be amplified when a practice employs multiple specialists, which can cause payments to the practice to be delayed or denied, resulting in losses for the practice. For larger or more complex practices, however, having a single billing and coding specialist can be disadvantageous. The delay in processing payments due to the volume of patients a practice has can create delays and denials in payment similar to that of practices employing multiple specialists.

Furthermore, the practice’s level of auditing liability increases, as the practice is dependent upon the integrity of the medical billing and coding specialist to guarantee accurate audits. In the decision a practice makes to hire a specialist, the practice must carefully evaluate its needs, weighing the pros and cons of having more than one specialist in relation to the volume of patients and structure the practice has in place. These considerations will allow the practice to make the best employment decision.Medical Billing and Coding Comparison