Medical Insurance Billing and Coding

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By Collin McLean

The right staffing, training and education can go a long way in meeting the demands of keeping medical insurance and billing coders at the top of their game. While there are numerous challenges, such as employee retention, industry infrastructure and occasion personal error on occasion, the majority of industry challenges come from a work environment where fewer people are required to do more work.

Medical insurance billing and coding (MIBC) requirements periodically change, and facilities are forced to adapt and train existing professionals to keep pace with demand. An increased workload on coding departments can place a strain on other parts of the department. The more time spent on coding, the less time there is to prepare and adapt to new changes. The more time that is spent on preparing for changes, the less time there is to code.

While many coding organizations consider the benefits of outsourcing, other venues struggling to stay within budgeted guidelines are less inclined to pay an outside source even if understaffed in house. Medical coding departments lose staff due to the obvious reasons, which can include downsizing, firing, voluntary termination and professionals retiring from the industry. These combined activities can leave medical billing and coding departments short of the required help.

Hiring skilled billing and coding professionals can also be a concern in rural areas. The reason being, billing and coding practices may vary from the industry standard; combining inpatient and outpatient services in ways that are challenging for most medical billing coders.

Billing System Slowdowns

As reporting requirements increase and facilities make the migration to electronic records, productivity will naturally take a hit as billing coder's work with hybrid systems consisting of electronic and paper records. In some instances, medical billing coders must double enter coding into the clinical and billing systems. Information can be spotty, whereas some electronic record systems lack a "quick view" summary that provides billing coders with all the information needed. Information must be pulled from multiple sources, leaving an opportunity for information to be missed and errors made.

For many medical billing coders, the challenge of maintaining productivity while producing quality work is ever present. Facilities with unique processes are usually the ones with the greatest challenges, and finding certified medical billing and coding applicants to fill the gap is critical if the revenue cycle is to be properly maintained.

Solutions

Updating billing systems, staying abreast of billing and coding education and training of ongoing guidelines, for existing employees will be a key factor in minimizing workload and managing a reduced workforce.

The challenges experienced in this particular segment of the health care industry are many and ongoing. But when the decision is made to hire new medical insurance billing and coding professionals to fill the gaps left by people terminated, retiring or migrating to other companies or departments, finding and hiring well-trained and experienced individuals is an initial key to success for any business.


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