Billing and Coding. Who Cares?

Reimbursement? Who cares? In short, YOU should.

Scenario 1:

It is time for your annual review and you've been working hard all year. You've stayed late to see extra patients and come in occasionally on your days off to cover the shifts of sick co-workers. You decide that you are going to ask for a raise based on the extra efforts that you've put in, but when you do the office manager states that everyone has been working hard so that alone does not justify a raise. Where do you go next? Your next step should be to present objective data. You should be prepared with not only the number of hours that you have put in this year, but also with your revenue (which you get from your billing records!) If you are able to show that you have increased your billings by a significant percentage, you're more likely to get something extra than if you just say you've been "working extra hard". Know what you are being reimbursed - check your billings bi-weekly or monthly to stay on top of it.

Scenario 2: 

You are working for a small family medicine practice with a couple physicians. You are the only PA. The family practice employs a billing and coding specialist to bill for all visits and procedures completed at the practice. You don't know much about billing and coding so you leave it up to the "specialist" to take care of all that. After all, you care about is seeing patients, right? This year, Medicare decides to audit the practice that you work for and they find several fraudulent mistakes in your billing. You have apparently been upcoding* several office procedures and double billing for some office visits. You are now facing criminal charges for defrauding the federal government and are facing jail time and a $300,000 fine. You try explaining that you never actually did any of the billing yourself, but in the eyes of the law, you are still at fault. Know what codes are appropriate. This is a two-way street. Don't overbill, but don't under bill either. Under-billing can be misconstrued as favoritism toward certain patents or it can just hurt the bottom line of your business. Its a Goldilocks and the three bears thing... not too much, not too little... but just right.

Both of these scenaios are real and they show the importance of understanding reimbursement/billing/coding. You've worked really hard to become a PA, don't lose it all because you didn't want to be bothered with the paperwork of billing. 

*upcoding = adding additional codes so that you are paid more money than you should get

Pic: http://www.tormont.com/en/Products-in-English/English-Products/GOLDILOCKS-AND-THE-THREE-BEARS/102518-118-1042.aspx


  1. So very true!! Especially true for surgical pas!

  2. Absolutely, I am navigating those waters currently!

  3. Wonderful blog & good post.Its really helpful for me, awaiting for more new post. Keep Blogging!
    Medical billing and coding programs