Saturday, 18 February 2017

Medical Coder's Wages and Pay

Medical coder pay

If you are an entry level medical coder in the United States your pay usually starts at $11 to $13 per hour, an individual with experience of 2-5 years can earn $15-$18 per hour, highly experienced medical coders with specialty certifications can earn as much as $23 per hour, or more. Here is a breakdown of typical factors that can strongly affect the medical coder's take home pay:

Training – Industry specific training and credentials are probably the biggest factors influencing take home pay right along with years of experience.

Experience – Your work experience plays another important role. High recommendations from a former employer who attests to your experience and value to the company speaks louder than anything else in the healthcare industry. This could be your strongest negotiation point when discussing pay.

Company Size & Setting – Large companies may be able to offer higher wages than small businesses. The local job market situation also influences pay rates and the value you bring to the businesses.

Geographic Location – The location of the job can have a big influence on salary. Jobs in a metropolitan area is usually higher compared to small cities and urban areas.

Specialization – A specialty also affects wages. Some medical coders are highly specializes, or consultants in specific areas of the medical and healthcare coding and billing industry. Others are mentors at workshops, professional speakers at seminars, or authors of textbooks and teaching materials.

Self-Employed – Your employment type also affects how much money you can make. While as an employee you are likely on a per hour compensation with incremental wage increases over time, you will set your own rates as a self-employed individual. 

A few years ago AAPC published a detailed article and charts on their website that shows how much medical coders typically earn along with a separate list of salaries by specialty and salaries by title. You can probably still find the article if you use a search engine and query: "AAPC wage study and comparison for medical coders".

As of January 1, 2012, medical billing reimbursement claims must be submitted electronically using the Accredited Standards Committee (ASC) X12 Version 5010, the new version of the X12 standards for Health Insurance Portability and Accountability Act (HIPAA) transactions. 

Implementation of HIPAA Version 5010 will require changes to software, systems and perhaps procedures that you use for billing Medicare and other payers.

Level I compliance means "that a covered entity can demonstrably create and receive compliant transactions, resulting from the compliance of all design/build activities and internal testing." 

Level II compliance means "that a covered entity has completed end-to-end testing with each of its trading partners, and is able to operate in production mode with the new versions of the standards."

HHS permits dual use of existing standards (4010A1 and 5.1) and the new standards (5010 and D.0) from the March 17, 2009, effective date until the January 1, 2012 compliance date to facilitate testing subject to trading partner agreement.

It is extremely important that all medical billing staff and consultants are aware of this HIPAA change and in compliance. 

Tough Decisions: Online Medical Assistant Program or Campus Based?

Online medical assistant student

No one can tell you which type of medical coding and billing training program is right for you. Ultimately, you are the one who must choose which path to take to learn your skills. 

Part of your decision will be based on how FAST you want to be done and finished with your training, tuition cost and how quickly you hope to land your first real medical assistant job.

Rule of thumb is that self-paced online courses can be finished the fastest if you apply yourself, however, on the flip side, doctors may not be easily persuaded or convinced to hire you without having direct experience and hands on practice which you would have gotten in a campus based training program. 

All too many former medical coding and billing online students have learned a painful lesson.

As with any kind of education, there are things to be aware of and different programs have their pros and cons. Making a wise choice and informed decisions puts you into a position where you won't have to regret it later. 

Should you decide that going with a web based program better fits your schedule, budget and personality than bear in mind that no matter which online school you choose you have to ask certain questions BEFORE signing up for anything. 

First and foremost check out the fees that the online nursing charges for their courses and find out their refund policy. It is common practice of all reputable online vocational training schools to be up-front with their fees, since they realize it is important to new students to know how much they will be paying for the course. 

Putting forth a sincere effort to discuss all fees person-to-person over the phone helps to build trust in the school.

You will need to check out the course requirements before signing up for anything.  Each school has different requirements that must be met before entering their program. 

Almost all online self-study programs to become a medical coder and biller require a high school diploma while a few want you to have specific course studies from other schools. 

Some online medical assistant programs, especially those approved by the Department of Education, require competency in complex clinical and technical skills to earn their degree, which can only taught under the direct supervision of a qualified instructor or professional in the field who is familiar with a wide range of medical assistant duties.

There are countless medical coding and billing students who have told us that finding  their own clinical internship site was EXTREMELY challenging and frustrating and some of them gave up, never earning their medical assistant diploma or degree. 

Therefore this is probably the most important part of evaluating a prospective online medical assistant school. 

Certain online programs operate on the same premise of standard schools and might require that their students complete a minimum number of hours in class room study to be eligible to graduate; so, make sure to ask whether a program is entirely web based, or partially web based. 

All that is required should be listed in the course description and should be discussed in person during the review process.

Academic degrees is another area where one should put fourth some effort in research before signing up for anything. If the online program does not offer the degree that you need to get the job you want, then it is useless to you as a school. 

Don't be discouraged, most of the online medical coding and billing schools, and allied health vocational colleges for that matter, allow you to achieve the type of degree that you want.

Worth Your Consideration When Making Career Choices: Phlebotomist

The phlebotomist, the person who draws blood samples from patients arms or finger tips, is a highly specialized, valuable member of the medical and healthcare team as a whole. Without the phlebotomist's skills and services many diagnoses and health assessments could not be as reliably performed.

 Most phlebotomists have a high school education, others have an academic degree in medical technology, some received their training directly on the job under the supervision of a doctor, nurse or experienced phlebotomist, others took a phlebotomy course offered through the American Red Cross, or a community college, others while serving in the military as a combat medic or hospital corpsman role.

A skilled phlebotomist deserves high praise, yet, they are usually paid the least amount of wages on the allied health professional's pay scale, probably because their training is not as extensive as, let's say, an EKG and x-ray technician, or medical assistant. In a way, that is unfair, because there is tremendous value in their services that can never be repaid in money. 

Phlebotomists draw blood for tests, transfusions, donations, or research and explain the procedure to patients who ask.

They must know the circulatory system anatomy and composition of blood along with the medical terminology that goes with it, be able to access a vein, or artery, or capillary blood bed of all kinds of people from young, to old, to obese, to emaciated, to those with veins that roll, to those who easily faint, or are deadly afraid of needles.

They need to understand different venipuncture techniques and the equipment to be used to draw and preserve the blood sample. Additionally, they must know how to read laboratory requisition slips, follow doctor's orders, work safely with patients, handle blood and other potentially hazardous body fluids and know how to clean up blood spills safely and dispose them in accordance with OSHA regulations. 

If any of this is not approached with great care and handled properly, it can result in severe injury, if not death.

Friday, 17 February 2017

How to Choose the Right Vocational Training Program for Medical Billing

Being a smart consumer pays off when choosing vocational training programs especially online. Warning signs and program quality check points do exist...  and there are many excellent educational and vocational training programs offered on the Internet. 

It is the dubious providers of distance and online education that crank out certificates and degrees that are considered worthless on the job market. 

If you obtain a degree or take a course from a shady non-accredited cyber-school you may find that the paper you receive stamped "Certificate" is not recognized by potential employers, and that the course credits may not transfer to other schools. This is where the term "diploma mill' comes to mind.

Diploma Mills Can Make The Unthinkable Real

It simply blows the mind: doctors, clergymen, police officers, teachers, federal employees, such as White House staffers, National Security Agency employees, FBI agents and a senior State Department officials purchased bogus degrees to seek employment, promotions, higher positions and better pay. 

Nowadays, almost anybody can become a doctor, or receive college level and advanced degrees, with almost zero effort. Even medical assistants can find gray area online medical assistant programs without any special pre-enrollment conditions, qualification screenings, or passing grade standards... for just a few hundred dollars. 

Make The Doctor See that YOU are the Best Candidate for The Job

Qualified_medical_assistant 

Medical assistant, phlebotomy and laboratory technician, medical billing and coding certifications are reaching a new level of recognition with employers. 

While taking an allied health professional certification exam remains largely voluntary here in the USA, there is definitely a big trend among employers who specifically stipulate in their job ads that a medical office position which needs to be filled requires certified credentials.

Rarely do you see medical assistants being hired without experience and trained directly on the job anymore. Doctors expect more these days. 

These doctors and medical facilities clearly see the benefits of hiring someone with certified credentials; they want someone who has the knowledge necessary to work side by side with health and medical staff to run their medical office or health care facility efficiently and safely. 

Hiring competent and well trained medical assisting staff gives them a certain amount of confidence and assurance.

An example of such a job advertisement is this one randomly picked from the Indeed.com jobs bank today:

XYZ Physician Associates, LLC currently has a full time medical assistant position available working in a very fast paced environment. Requirements: 

Candidates must have six months to one year related experience in a medical office or similar clinical setting. Candidates must also be highly organized, pay attention to detail and be able to multi-task. Computer skills required. 

Phlebotomy experience preferred. Graduate of a Medical Assisting Program. Certification preferred.

Medical assistant training institutions and community colleges know this and are heeding the call by offering medical assistant training programs that lead to desired diplomas and qualifies their graduates to sit for recognized medical assistant certification exams. 

Funding and financial assistance for such training programs is readily available for those who qualify, much of it completely free and must never be paid back if you are, for example, presently unemployed and qualify for educational grants and employment rehab programs.


There are a number of different medical assistant and other allied health occupations certification sponsors, each having their own unique certification requirements.

Their certification exams serve as a valid means of assessing an individual’s specific knowledge and competence in the medical assistant occupation. 

Passing any one of the various offered certification exams adds credibility and credentials to your name by having earned recognized designations in a specific discipline. 

Once you have earned your credentials they are portable to all places you may work now and in the future. This is important because in today’s economy people may have to move to a different location or across boarders to a different state to go where the jobs, or better jobs are.

CPT 81001

81003 - Urinalysis, automated without microscopy

Lab Dept: Urine/Stool

Test Name: URINALYSIS (UA)

General Information

Lab Order Codes: UA

Synonyms: Urinalysis, Routine

CPT Codes: 81001 - Urinalysis, automated with microscopy

Test Includes: Bilirubin, blood, clarity, color, glucose, ketones, leukocyte esterase, nitrite, pH, protein, specific gravity, and urobilinogen

Logistics

Test Indications: Useful as a screen for abnormalities of urine; diagnosing and managing renal diseases, urinary tract infections, urinary tract neoplasms, systemic diseases, inflammatory or neoplastic diseases adjacent to the urinary tract
and dehydration. 

Lab Testing Sections: Urinalysis

Phone Numbers: MIN Lab: 612-813-6280

STP Lab: 651-220-6550

Test Availability: Daily, 24 hours

Turnaround Time: 2 hours

Special Instructions: Send to lab within 30 minutes of collection.

CPT/HCPCS Codes GroupName

81000 URINALYSIS, BY DIP STICK OR TABLET REAGENT FOR BILIRUBIN, GLUCOSE, HEMOGLOBIN, KETONES, LEUKOCYTES, NITRITE, PH, PROTEIN, SPECIFIC GRAVITY, UROBILINOGEN, ANY NUMBER OF THESE CONSTITUENTS; NON-AUTOMATED, WITH MICROSCOPY

81001 URINALYSIS, BY DIP STICK OR TABLET REAGENT FOR BILIRUBIN, GLUCOSE, HEMOGLOBIN, KETONES, LEUKOCYTES, NITRITE, PH, PROTEIN, SPECIFIC GRAVITY, UROBILINOGEN, ANY NUMBER OF THESE CONSTITUENTS; AUTOMATED, WITH MICROSCOPY

81002 URINALYSIS, BY DIP STICK OR TABLET REAGENT FOR BILIRUBIN, GLUCOSE, HEMOGLOBIN, KETONES, LEUKOCYTES, NITRITE, PH, PROTEIN, SPECIFIC GRAVITY, UROBILINOGEN, ANY NUMBER OF THESE CONSTITUENTS; NON-AUTOMATED, WITHOUT MICROSCOPY

81003 URINALYSIS, BY DIP STICK OR TABLET REAGENT FOR BILIRUBIN, GLUCOSE, HEMOGLOBIN, KETONES, LEUKOCYTES, NITRITE, PH, PROTEIN, SPECIFIC GRAVITY, UROBILINOGEN, ANY NUMBER OF THESE CONSTITUENTS; AUTOMATED, WITHOUT MICROSCOPY

81005 URINALYSIS; QUALITATIVE OR SEMIQUANTITATIVE, EXCEPT IMMUNOASSAYS

11/21/2010 - For the following CPT/HCPCS codes either the short description and/or the long description was changed. Depending on which description is used in this LCD, there may not be any change in how the code displays in the document:

81000 descriptor was changed in Group 1

81001 descriptor was changed in Group 1

81003 descriptor was changed in Group 1

81020 descriptor was changed in Group 1

URINALAYSIS

CPT CODES: 81000 Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, pH, protein, specific  gravity, urobilinogen, any number of these constituents;  non-automated, with microscopy

 81001 automated, with microscopy

 81002 non-automated, without microscopy

 81003 automated, without microscopy

81005 Urinalysis, qualitative or semi-quantitative, except immunoassays

81007 Urinalysis, bacteriuria screen, by non-culture, commercial kit

 81015 Urinalysis, microscopic only

 81025 Urine pregnancy test, by visualcolor comparison methods

 81050 Volume measurement for timed collection, each 

Correspondence Language Policy/Example Number 4.80000 - Mutually exclusive procedures

For example, CPT codes 81000 and 81001 describe different ways of performing urinalysis with microscopy. The procedure described by CPT code 81000 utilizes a manual process with dip stick or tablet reagent, and the procedure described by CPT code 81001 utilizes an automated process. 

Since both procedures would not be performed on the same urine specimen at the same patient encounter, the two procedures are mutually exclusive of one another.

Thursday, 16 February 2017

Traditional Classroom Instruction vs Distance Education Online

Online or classroom 

Many community colleges now offer medical assistant classes that are strictly web based and hybrid courses where all, or most of the required course work and instruction is done online. 

Our local community college, for example, offers 3-4 credit online courses in accounting, biology, algebra, medical computer applications, word processing, computer sciences, economics, English composition, pharmacology, medical terminology, anatomy and physiology, certification exam prep for Health Information Technology and many more online.

The only time you see enrolled distance education students show up on campus is when they take their mid-term and final exams on paper (if required, because even that can be done online). 

Some schools make provisions for their students to come in once a week for an hour, or two, to review certain skills, especially if they require hands on supervision under the guidance of an instructor, such as, for example a credit hour course in phlebotomy technology, or biology lab.

Do Online Students Fare As Well As Students Who Received Traditional Classroom Instruction? 

Whether students in online or hybrid courses fare better than those in a traditional classroom is debatable. 

Surely, there can be certain challenges and pitfalls in both; for example, self-discipline, commitment and extra motivation to make sure you learn and understand the material is important in either setting, however, a hidden pitfall could be that you might forget to turn in all of your assignments on time without the face-to-face reminder from the instructor and without their classroom peers and face-to-face interaction with faculty some students might not have the extra motivation needed to do the independently study as necessary to excel.

Since online programs utilize the Internet and email students must have access to the Internet (which includes a computer, keyboard, browser, mouse, Internet service and electricity), and have a solid understanding of the computer to access the courses.

Possible Pitfalls When Utilizing Online Program Technologies

One form of technology distance education schools use to facilitate their programs online is the Blackboard e-education platform, to name just one of many, a technology where registered students log in with their assigned user name and password.

When taking a quiz or exam online there are a number of factors to consider, such as using a reliable computer and compatible browser, a reliable connection and having plug in programs installed such as Java(tm) software, Adobe Reader(tm), and often, running some sort of word processing program, such as Microsoft Office Word(tm). 

If the computer is not operating properly, or the connection is suddenly interrupted, all work could be instantly lost without being submitted and the student is locked out of the test. Often, there are time limits imposed and if a student stays on a page too long the session will time out and renders the student unable to submit the exam.

In addition, there could be an issue with accidentally hitting the Enter button, instead of the space bar or tab. This could lead to having an answer being locked in and submitted with no way to go back. 

Often, the Back button is disabled or causes work to be lost when utilized. When completing the test be sure to click the SUBMIT button to ensure the test is sent to your instructor. Yes, online students often even forget this.

Wednesday, 15 February 2017

Medical Billing Forums and Documentation

Don't Rely On Medical Billing Forums—Documentation Is The Key

Medical_bill_money 

All too often we receive questions regarding specific medical billing issues and matching medical codes in our forum; but that's not just our Medical Billing Forum alone, that's ANY medical coding and billing forum on the Internet is packed with questions regarding specific (CPT) codes and urgent requests for help. 

That way, if something goes wrong they have someone else to blame.

Medical Coding Questions Posted in a Forum

Unfortunately, this tells us that there are medical coders (and medical billers) who, quite frankly, have no clue; they are inadeqately trained, or self-trained, and when they hit a wall, they post their question in a forum in hopes to get answers or find someone (anyone!!!) to give them approval of codes they have somehow come up with themselves. 

This could be a student with a test question, or homework assignment, or a medical coder, or biller already working but that is in over his or her head. One example of such requests posted to our medical billing forum is asking for help with a specific CPT code.

It reads:

"I bill for a rheumatologist. I am familiar with most codes that he uses but last week he gave XYZ-medication (*brand name removed - not relevant for this example) to one of his patients who had a severe drug reaction. 

There was considerable disruption in the office and the direct observation lasted 2 hours. The doctor wants me to bill for his observation services but I am not sure which code to use. I was thinking may be 99058 will fit the bill, but the doctor insists that the code should be time specific since he spent two hours on the patient's care. Can someone please help?"

Medical coding must never be performed without first looking at the original documentation and the final decisions regarding coding issues rest with the provider. 

It must be clearly understood that a forum is not an official organization, agency, or anything else that provides a final decision regarding coding or billing issues. A forum is not here to code visits, to train a visitor how to code, or to recommend which codes to select. 

All a forum, its members and/or guests do is provide limited guidance.  Guidance is limited to what is presented by a poster, however, what is presented may, or may not be true, accurate or correct.

The CMS website, specifically at https://www.cms.gov/MLNEdWebGuide/25_EMDOC.asp states:

"Providers are responsible for the correct submission of claims and response to any remittance advice in accordance with current laws, regulations and standards."

The patient's medical record must show detailed entries as to time, who did what, when, for how long, was it the doctor who monitored the patient directly, or was it delegated to a nurse or a medical assistant, what directives were given, was emergency intervention provided, and if so, how much total direct hands on and face-to-face time from the doctor was involved? When it comes to accurate medical coding, any code selected must be:

Medically necessary documented as being rendered the proper code for the documented services rendered.

Telling a patient to sit in the waiting room for 30 minutes before they can leave after an injection and direct face-to-face attention after an acute reaction can both be described as monitoring, but it doesn't always mean it can be billed it at a higher level.

The Doctor Makes the Final Decision

The provider knows what was done and everything must be coded as it was documented in the patient's records. A medical coder can research a subject, provide suggestions and present supporting documentation from the proper sources to to make a point, however, the final decision rests with the doctor.

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