As a Physician Office Medical Coder, I am my Physician’s “Money Maker”!
Without the proper coding of Physician Office visits, reimbursement cannot take place.
What is the purpose of the Office Visit?
An office visit is a scheduled appointment with a doctor or other medical professional to discuss and treat health concerns. It allows an opportunity for the patient to discuss healthcare concerns or symptoms. The visit may include discussing treatment options, lab work, or other testing. The provider may also prescribe medication, refer you to a specialist, or provide advice and education. An office visit can occur in various healthcare settings including private physician offices, alternative settings such as Rehabilitation Facilities, Assisted Living Facilities, Rest Homes, Nursing Homes as well as a Hospital setting. Patients seek these office visits with the goal of treatment (prescription, therapy, etc.), and then go home if the condition can be handled at home.
How is it possible for medical coding to take place in the Physician’s Office?
As the Medical Coder, my goal is to meet both the Physician’s and the patient’s needs. Every patient seen today; their encounter must be coded promptly. The amount of time to complete the medical coding process and the number of office visits to code daily will depend on the number of patients seen per provider or the individual physician’s office requirements. Each office must determine productivity standards for each Medical Coder.
My goal is to meet both the Physician’s needs as well as the patient’s needs. Physicians want to be paid for services rendered and for the patient, I submit their claim to the insurance company so that they don’t have to.
What does a typical day of Physician Office Medical Coding look like?
Is there ever really a typical day in a Physician’s Office? You never know what could happen to a patient. A Physician’s Office can be almost as exciting as the Emergency Room. I truly think Physician Office visits will increase as Third-Party payers have more and more of a say in the reimbursement. The goal of the Third-Party Payor is for services to be rendered in the most appropriate setting. Minor symptoms that can be treated in the Physician’s Office will not be reimbursed at the Emergency Room level.
Reports of daily encounters are maintained in the physician’s office software systems. If this process is still done manually, refer to the log of patient visits maintained by the physician’s office. As the Medical Coder, I make sure to locate the documentation for each office visit. Based on the documentation, History, Exam, and Medical Decision Making, I assign Office Visit codes (E&M) plus any procedures that may have taken place (ex. incision & drainage (I&D), Electrocardiogram (EKG), etc.).
Depending on the Medical Coders role in the office, which may or may not include more than just medical coding, additional duties may also be assigned.
I worked with a physician who was just starting his practice. I worked as the Office Manager, Receptionist, Medical Coder, Medical Biller, and Patient Representative. My typical day consisted of many details. I started each day by making sure the Waiting Room was clear of debris and dust and that current reading material was available to the patients. I then greeted the patients as they entered the office at the Receptionist Desk. I always asked patients for their Insurance Cards and Identification Cards and made sure a copy of each was in the patient’s record. Some insurance companies required precertification before services could be rendered. By collecting this information upfront, I had the information to complete the precertification process.
If there was a copay required, I collected the copayment upfront before the patient was called back to see the physician. So, Medical Billing & Reimbursement is a course I would recommend for Physician Office Medical Coders to take. It will explain the copay, coinsurance, and claims processing process.
After I completed my processes, the Medical Assistant/Nurse was notified that the patient was ready to be seen by the physician.
After the patient saw the Physician, my goal was to make sure to set up a return office visit appointment. As I stated at the beginning of this blog, I am my physician’s “money maker”. So, I do what I can to keep business coming back!
Is claim submission a part of a Physician’s Office Medical Coders role?
Depending on the size and rules of the Physician’s Office, claims submission could be a role for the Physician’s Office Medical Coder. Timely submission of claims to the Third-Party Payors is very important. While working with a small physician’s office, my goal was to code and submit claims electronically to Third-Party Payors for all morning visits before I left at 5 pm daily. Then the next morning, I would complete all coding and submit claims for all visits the previous afternoon. There would be a few that may require additional information or clarification from the physician, but these accounts MUST be followed up on daily until they can be coded and the claim submitted.
As the Remittance Advice, a communication tool that confirms a payment has been made and provides details about the transaction that came in for the claims previously submitted, I credited the patient’s accounts and wrote off what needed to be written off. I also prepared Patient Statements for balances due, on the 15th and 30th of each month.
If a claim was rejected or denied, my goal was to determine why it was denied and if it was for something that could be corrected, I worked each claim until I got it paid. I had to maintain good recordkeeping because there would be claims with no notices or payments. Remember, there is a certain amount of time to submit a claim. If I did not submit the claim in a timely fashion, I would not get paid by the Third-Party payers. So, I kept a log of every claim.
Conclusion:
A Physician’s Office Medical Coder is a vital member of the Physician’s office. I am my physician’s “Money Maker”!
I posted this topic on my YouTube channel, CodeMasterCoach. Here is a link: https://www.youtube.com/watch?v=V1sX9y4h7J0&t=325s
Feel free to email me at CodeMasterCoach@gmail.com
