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Medicare’s unprecedented attention to halting healthcare fraud has resulted in hospitals, physicians, nursing homes, home health agencies, and other healthcare providers having to give back millions of dollars in paid claims. Today, having certified coders on staff is considered an important compliance and reimbursement strategy. A critical shortage in key personnel, in addition to nursing, has developed in the area of medical documentation “coding” for electronically processed insurance claims.
The mandatory electronic data interchange (EDI) requires that all operations, procedures and services be coded into the American Medical Association’s “CPT” procedure codes, and that medical necessity is proven by choosing a compatible “ICD9” diagnosis code. Medicare, Medicaid and many third-party insurers require patients’ claims to be submitted electronically.
Mistakes in procedure and diagnosis coding result in hospitals, physicians and other healthcare providers to not be paid correctly – or not be paid at all! Then the burden of payment is transferred to the patient or his/her family. Millions of dollars in legitimate healthcare claims are denied each day – because the information was not correctly coded. It’s that simple!
In August, 2000 Medicare implemented one of the most sophisticated payment systems to date: the Outpatient Prospective Payment System (OPPS), of Ambulatory Payment Classifications (APCs), based on the AMA’s Current Procedural Terminology, or CPT codes. Certified coders, those who have demonstrated expertise in CPT coding, are being recruited throughout the United States, especially by hospitals. There are not enough qualified certified coders to go around!
This program provides skills required to be a successful certified medical coders. Upon completion, participants may apply for the “Certified Medical Coder” certification exam of the American Association of Clinical Coders and Auditors. Go to www.AACCA.net for certification details.