Some Useful Medical Coding Tips & Tricks

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Medical coding is a field on the up. It’s no secret the healthcare sector needs able medical coders. They have the important task of assigning universal alphanumeric codes to procedures, diagnoses, medical services, and equipment. Creativity and general smartness are the hallmarks of a good coder. But you need to follow the rules as best possible if you’re a medical coder. One slipup could mean a patient is given a wrong bill, or wrongfully denied an insurance claim. It’s not the usual sort of coding, and is much more important than ordinary.

If you’re new in the field, it’s best if you learn some tricks of the trade to stay in the safe zone. It’s important if you know the Do’s and Don’ts of the field before you apply for your first medical coding job. Even for those who have begun walking the path of medical coding already, learning some important tips is essential. It helps you see if you are on the right track.  

For those looking to land their first medical coding job, these tips can help!

  1. Educate Yourself

If you’re a medical coder, or want to venture into this field, you need to be knowledgeable. You need to know the human anatomy and the basic terminologies doctors use in your area of coding. But more importantly, make sure you know what codes are used by the staff you work for. It is common practice to use multiple codes. Learn about the speciality you work in. The best way to do that is talking to the staff.

  1. Take a Course

Before applying for your first medical coding job, it’s best to take a course in your specific field of coding. Finding the right course is key to a successful career in this field. Do some research to find a course that’s tailor made for you. It will help you learn a lot in lesser time, and will put you in touch with fellow coders who can help you out in many ways. It’s important to stay in touch with other medical coders who share your area of work. Consulting with them helps you grow continuously.

Find out how you can choose the best course for your medical coding to improve!

  1. Review Accounts Receivable Reports

Make it a point to review the accounts receivable reports on a time to time basis. Check whether the claims have been received. Watching the following aging reports will help you learn about outstanding accounts. Only then can you learn of the stalling of some accounts.

Of course, it’s best to see to it that the account situations are resolved. Ping the payer in case a considerable amount of time has elapsed.

  1. Check Explanation of Benefits

As a medical coder, you are bound to find many unpaid or contested explanation of benefits (EOB). Make it your job as a medical coder to find out if the issue has arisen out of a coding error. A missing semicolon is the regular coder’s nightmare. For medical coders, it can be transposed digits. You can only find out about this when you check the EOBs. Try to involve other members of staff when large-scale unpaid EOBs are in question. It makes everyone check the issue from their end, and helps resolve the issue as soon as possible.

  1. Review and Revise Previous Coding

Look into the existing database to review old claim forms and superbills. Check out which procedures were used in those cases, and see how they were then coded. But keep in mind the work done in those cases was by a fellow coder. No one is infallible. Should you find discrepancies between what was done then and what you would do, you can take it up to the practice manager for discussion.

This will not only help you know of the right way of coding, it will also give you a better understanding of the normal procedure of the work. Moreover, you can find out if you are on the right path if your idea and method proves to be the better of the two.

  1. Request Info at Patient Check-in

Don’t waste any time in getting access to the insurance card and patient details. Make it a practice to get that information right when the patient first checks-in. It’s true that you won’t need that information until you have to code it, but it’s best to keep it ready.

  1. Know the Patient Benefits

It’s best to ping the payer and ask for any remaining deductibles. There can be co-insurance responsibilities or co-payments that might have gone unnoticed. Don’t wait for the patient to admit this. It doesn’t take a whole lot of time to ask them about it. It’s better for the efficient carrying out of the entire procedure.

  1. Review the Documents

It is mentioned above that you should request patient documentation at the first step itself. Now you have it with you, don’t waste time ignoring it until you absolutely have to sort the issue from your end. It’s best to push things forward and get the results ready as soon as possible. Reviewing this information immediately can help you discover if anything is missing which you would ideally want before you get to work. Should that be the case, or if there’s any ambiguity, ask the attending physician about the same.

  1. ‘Incident to’ is only for Medicare

This is something every medical coder usually knows, but it’s vital that you follow this rule. The ‘incident to’ rule states that when a non-physician practitioner treats patients, a physician should be in the same room. The rule further states that only the supervising physician can initiate the treatment. This basically prevents non-physicians from attending to new patients.

Things can be different with private payers. This is why it is of utmost importance that you find out about the rules for each carrier for non-practitioner billing. If you ignore this, you can easily get a repay claim.

  1. Make Things Social

You are one part of the process. The work you do goes directly or indirectly to the payer. There can be pitfalls in either situation. You then have to contact the place where the halt has occurred and get it resolved. It doesn’t matter if it’s the payer or the clearing house that is causing the delay. What’s important is that you work with them in a healthy manner. Maintain a friendly and encouraging attitude to instil the feeling that you are there to help them out with the issue. It helps speed things up.

  1. Get Detailed Payment Information

There can be instances when the claim is not settled as per expectations. This needs to be resolved. If the payer and the provider have a contract, and if the settlement isn’t as per the contract, hold the payer to the contract. If no contract is involved, request the payer to inform you of the method used to settle the claim.

You might find out that a silent PPO was accessed. In this case, it is important you identify the contract in question. Once you’re done with that, request the network, preferably in writing, of your desire to end the association.

Use these tips and share them to become a better medical coder! If you happen to have idle time, try freelancer to get yourself some exciting medical coding jobs!

Dipaparkan 16 Ogos, 2017


Software Developer

Lucy is the Development & Programming Correspondent for She is currently based in Sydney.

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