Wiki Need advice from experienced coders

[mollyj29]

I will be starting a new job in a week at a medical center/urgent care clinic as a biller/coder. It's my first job as a coder and have only minimal experience with work comp coding. I am very grateful that I have been given this opportunity as I know how extremely difficult it is to get started as a coder.

The clinic is under new management, has new staff, and has brought the billing and coding in-house. I was hired as the primary coder and to re-bill old claims that were done incorrectly. They do Primary Care, Urgent Care, Orthopedic Surgery and Sports Medicine, Pain Management and Rehabilitation, Occupational Medicine and Work Comp. I will be going into this position with minimal direction and know it will be challenging, but I am very excited and I'm willing to work hard to help this clinic bring in past revenue.

I'm hoping someone can give me some guidance and advice, some general things to be aware of, tips etc. Anything will be helpful!

Thanks!

 

[greatbiller]

What an exciting opportunity! I have done many A/R cleanups in my career as a biller/coder, and they are definitely challenging.

For any private insurance claims, be aware of the statute of limitations. Any claim past the statute of limitations should be written off.

I would work on one insurance carrier at a time as far as the workers' compensation claims. Be aware of status codes, etc. which are required to designate the claim as a corrected claim or an appeal or State Compensation Insurance Fund will kick the claim back as a duplicate. Make sure you are using the latest explanation of benefits for each claim - it should have the address for appeals, which is frequently an independent bill review company, not necessarily the insurance carrier. Look at each account individually and go through your aging reports in a systematic fashion.

These jobs can be overwhelming, but take it one claim at a time! Keep a spreadsheet of appeals/rebills that you have done, listing pt name, DOS, issue that was appealed, and the final result of the appeal, be it write-off or additional revenue. This is an invaluable tool to show your worth to the practice!

Google workers' compensation seminars - the DWC used to put one on annually - they probably still do, held in either Los Angeles or Oakland, usually in the spring.

Good luck!

 

[MarcusM]

Work comp carriers require the medical report/progress note with the claim and status form. If treating established patient, make sure you are treating the compensable injury only with compatible dx code, ie if injury is lumbar strain, don't use 722.10 as your dx code.