Wiki Biller or coder

[crystaljos]

Dear All,

When a charge is posted, with the demographic information, by say a biller and sometimes incorrect information is entered, then this passes to the coder to enter diagnosis and service code, is it the Coder's responsibility to verify the demo information since the final charge is being submitted by the coder. any insight to this is welcome

TIA
Crystal

 

[amyjph]

It depends on how the team and specific RCM is set up. In some places coders are expected to fix this, in others it is sent back to the individual who made the error. It is really company/practice specific. There are so many variables.
If the coder knows it is going to get rejected in the clearinghouse, or worse end up with a denial if it even makes it through, would they want to let that go if they noticed it?
In my opinion, the individual who made the error should fix it so they get feedback and understand how that impacts the claim cycle. But again, it all depends on how your revenue cycle is set up. A lot of this starts even at the appointment scheduling and front desk. It's always a big headache if those that are entering demographic and insurance information don't understand how what they do impacts the whole RCM circle.

In teams I have managed, while I didn't agree with coders doing this task, that's the way it was set up by "those above" so they had to fix it. They also had to work the clearinghouse.

Some places have specific edit coders, rejection coders, denial/appeal coders, and first pass coders. How is yours set up? Is it large/small, etc.? Do the coders do "everything"?