Psychiatry Coding & Reimbursement Alert

Half your concerns about billing will be reduced by finding the person that fits the bill.

Your psych practice can benefit a lot in terms of increasing revenue, reducing denials, and avoiding audit issues by selecting a solid coder. Follow this eight-step strategy to find that right person to handle billing issues for your practice.

1. Why Hire a Coder at All?

Having a coder in your practice helps ensure you are submitting accurate claims that will bring in the reimbursement your providers deserve for the work they have done. The coder can analyze and translate the providers’ notes and then assure that the right codes are assigned for billing. Coding efficiently and accurately can be challenging and having a dedicated coder can only benefit your practice.

2. Determine What You Need

You will first need to determine exactly what your practice needs. Create a written job description that sets out clear expectations for a new hire; this will go a long way toward helping you screen resumes and draft appropriate interview questions.

Keep in mind: You may want to look for a coder who has experience in your practice’s specialty, as she will be more familiar with the specifics and nuances of that specialty.

"Physicians often prefer a coder with experience in their specialty to ensure accuracy and capture of all the billable codes, and psychiatry is no exception," says Kent Moore, senior strategist for physician payment at the American Academy of Family Physicians.

On the other hand: "On one hand (the more popular hand), a physician would want a coder with a defined stream of knowledge in the specialty of the physician," says Suzan Hauptman CPC, CEMC, CEDC, manager of physician compliance and auditing at West Penn Allegheny Health Systems in Pittsburgh. "However, there is a smaller group of physicians that would like to see the well-rounded coder as s/he may be able to find things that may be missed by a specialty focused coder."

3. Look in the Best Places

Once you know the exact job you need to fill, you need to decide how you will advertise the position. "Word of mouth is the best form of advertising," Hauptman says. "However, more and more, I see groups, head hunters, and the like reaching out through LinkedIn, the AAPC, and conferences."

When you’re hiring a coder, one of the best places to start looking is through local chapters of national associations such as the American Academy of Professional Coders (AAPC) and American Health Information Management Association (AHIMA).

"Many coders will begin searching for positions online," Moore says. "For instance, they may look to their nationally recognized certification organization for job leads. Both AAPC and AHIMA have a portion of their web sites devoted to job openings, through which prospective employers and coders can find each other."

Don’t forget: If you have someone in your existing staff already who could successfully code with a bit of additional training, consider that option before going outside the practice.

4. Don’t Be Afraid of New Coders

Another good place you can look for coders is at local colleges with medical coding and billing courses or degrees. Many practices are worried about hiring just-graduated students because they lack experience. But such candidates are often still eager to learn and have the basics fresh in their minds.

Remember: Your best bet when looking at brand new coders is to focus on their coding education and other skills, such as computer knowledge, organizational skills, and personality,which are important to the job. Keep in mind that there is a big difference between a two-week course and an associate’s degree from a local college that includes a coding certification.

"Being a certified coder for many years, I would initially say that having the credential tells me your basic knowledge level; however, I also take into account the person and their personality as it would fit with the culture and personality of the current work force," Hauptman explains.

5. Ask the Right Questions

The interview process is key when hiring for any position, and hiring a coder is no different. You want to ask a variety of questions to gauge the candidate’s coding knowledge and experience, evaluate other skills the person may have, and get a feel for whether she will fit in with your practice.

Here are a few sample questions you may want to include in your interview:

Are you familiar with Medicare and private payer regulations? If so, which payers? 

How do you stay updated on policy and code changes?

Which procedures have you most often coded in your current and prior positions?

Do you have EMR experience? If so, did the EMR select the code for you, or did you use the data in the chart to select the code yourself?

How many charts/cases do you typically code in one day?

What is your average coding accuracy percentage?

Tell me about a claim that was denied due to your coding. What happened, and how did you fix it?

Do you have medical coding certification? If so, which one(s)? If not, are you planning to get certified?

What is your experience with coding for psychiatric services?

How would you describe or explain the structure of the new CPT^® codes for psychiatric services? What do you see as the major differences from the previous codes?

What do you perceive as the biggest challenges in diagnosis coding for psychiatry? 

6. Give a Test

A good measure of a potential coder’s actual ability to code real-life scenarios is a coding test. Consider having job candidates complete a short coding quiz that focuses on the type of cases they will see in your practice. You’ll be able to see where the person excels and where you may need to provide additional training if you go ahead with the hire.

"Many skills tests are designed to test the knowledge of coding for that position and don’t need to be complicated," Moore says. "An easy way to test is by taking several psychiatric service or E/M service notes and having the coder you’re testing code them."

Suggestion: Create a 10- or 15-question quiz that incorporates CPT^®, ICD-9, and HCPCS coding using scenarios that are common in your practice. You should also include some challenging questions requiring in-depth knowledge of topics such as modifier use or Correct Coding Initiative (CCI) rules.

Pointer: As medical terminology is equally important, employers usually incorporate a quick quiz on terminology along with the coding test.

7. Verify Credentials

Make sure you verify coding certifications prior to hire by obtaining membership or certification number and use the certifying entity’s website or call their membership department to check if the certification is legitimate.

For example, "if you have the person’s name and certification number (member number), you can verify on the AAPC website if the certification is current," Hauptman says.

8. Guard Against Risky Hires

You should also perform a reference check and contact at least two work-related references to verify the person’s previous employment information, including job performance and reason for leaving.

Then, consider performing an actual background check that includes credit history and criminal activity. But don’t forget to provide a written disclosure to the aspirant informing him or her of your plans.

Don’t miss: Check the HHS Office of Inspector General’s (OIG) Exclusions Database at http://exclusions.oig.hhs.gov to ensure the applicant isn’t on the exclusion list for unethical or illegal dealings with Medicare or Medicaid.