Practice Page: Education and Training in Medical Coding, Billing, and Audit Regulations Is Essential for Healthcare Providers

Educational development for healthcare providers in all settings has become progressively important due to increased penalties and consequences from the Health Insurance Portability and Accountability Act. Understanding the fundamentals of coding, billing, and audits will reduce the risk of unnecessary audits or fines, yet practices are constantly scrambling to manage the onslaught of code changes, maintain compliance, and stabilize profitability. The key to staying up to date with the new guidelines and regulations is education and training.

In May 2012, the Office of the Inspector General (OIG) released “Coding Trends of Medicare Evaluation and Management Services,” which reported an increase of 48%—from $22.7 billion to $33.5 billion—in physician billing of evaluation and management (E/M) codes from 2001 to 2010. The OIG’s recommendation to the Centers for Medicare and Medicaid Services was to provide educational outreach to physicians on E/M services and to focus on determining appropriate codes and criteria used to determine levels of E/M billed. Outreach education, according to the OIG, includes, “face-to-face meetings, seminars, and workshops.”¹

To provide the education necessary to maintain accurate and complete documentation, the ACR provides a one-day educational coding course that will enable you and your staff to demonstrate knowledge in coding for rheumatology services. The restructured educational course will be detailed and comprehensive, covering in-depth areas of coding, compliance, and specific policies and procedures. When coupled with the rheumatology coding certification program, the course serves as an advanced curriculum on auditing, billing, and practice management.

The coding series will review the fundamentals of medical coding and the ways to support an effective and efficient rheumatology practice. Specific topics include:

• Principles of reimbursement for both government and private payers;
• Correct medical record documentation;
• Accurate coding documentation;
• Coding, billing, and documentation regulatory guidelines and requirements;
• Sequencing diagnoses accurately;
• Principles and guidelines for medical necessity;
• Confidentiality and privacy rules; and
• Strategies for self-auditing charts.

The course will include hands-on training in coding and documentation for rheumatology procedures and diagnosis, coding compliance, and personalized training to assist you and your staff in managing your billing effectively to secure proper reimbursement.

The ACR emphasizes the importance of continuing education and training in coding and billing as a critical element in effectively managing rheumatology practices. Coders are instrumental in keeping physician practices compliant by coding documentation accurately, properly reviewing medical records, and staying up to date with code changes. The ACR’s educational sessions are designed to meet the needs of all employees at any level. There will be some concentrated training to help participants respond to regulatory changes and identify areas of deficiency.

Medical coding practices are changing. Educate your staff and yourself on updated coding principles to prevent decreases in reimbursement and coding productivity. Take advantage of these educational opportunities by visiting the ACR website for educational programs and dates, or contact Antanya Chung, director of practice management, at achung@rheumatology.org to arrange a course in your area.