Four Tips For Hiring And Maintaining Quality Coders

By Author: Celena Rose
Total Articles: 146
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Make sure you choose the best when hiring new coders for your organization, because scraping the bottom of the barrel could cost you big bucks and legal hassles galore.


If your coders don't know exactly what they're doing, you could see lots of claim denials and lost revenue. And if that's not bad enough, federal prosecutors are increasingly arguing that providers who hire inexperienced billers are acting in "deliberate ignorance," says Jack Pivar, who oversees compliance at EFS Royal Care Pharmacy in Norwood, N.J. Using this reasoning, the government could view any mistakes these coders make as "intentional" and could therefore levy false-claims charges against the provider, he warns.


Following these expert tips will help you separate the good from the bad among a sea of coding applicants:


1. Test coding applicants- When a prospective employee interviews for a coding position, give him a test, said consultant Jane Wilkinson-Bunch at a recent teleconference. Give the applicant a hypothetical scenario and make sure he codes it correctly. While you're at it, make ...
... sure he knows how to handle a certificate of medical necessity, said Wilkinson-Bunch, president of Jane's Billing & Consulting Services in Marietta, Ga.


2. Look for the warning signs of an unsure coder - Often coders who aren't entirely sure of themselves will cling to the middle of the road in their coding, says Peg Hutchinson, Assistant U.S. Attorney for the Eastern District of Pennsylvania. That is, they usually won't use low- or high-level codes because they believe the middle ground is safest.


This method is bad not only because it potentially deprives the organization of proper reimbursement but it could also put you at risk for charges of upcoding, experts say.


3. Check applicants' certification- Your best bet is to hire coders who are certified by the American Academy of Professional Coders or another reputable coding authority, says consultant Joyce Thomas with Medical Reimbursement Specialists in Diamond Bar, Calif. Certified coders will cost you a bit more, but they are "certainly worth it," Thomas says, because AAPC requires them to earn continuing education units to maintain their coding certifications . That means you can rest assured they know what they're doing.


4. Keep your established coding staff on their toes- Don't stop paying attention to coders once you've hired them. Codes and procedures change regularly, so "provide continuing education classes every quarter as you get your Medicare updates and advisories," Wilkinson-Bunch said. That way, coders who were top-notch when you hired them will stay ahead of the game and you'll stay in the black and off authorities' radar screens.

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