Get It Right the First Time

Recently a friend mentioned some advice he often heard as a boy.  His dad would say if you have time to do it wrong and then do it over, you could have done it right the first time.   When it comes to coding and claims filing, perhaps we could learn from this father’s advice to his son.

Did you know that for just a few bucks per claim, you could be practicing medicine in Florida and have an AAPC coder certified in your specialty do your coding remotely from an office in Ohio?  Or Colorado, or Arizona?   It’s so easy and convenient in this technological age!

Remote Coding Protects You

Why do I mention this?   More and more physicians are looking for ways to maximize their earnings and protect themselves from future recoupments.  In this world of RAC Audits, MIC Audits, ZPIC, the OIG, and continual tightening of compliance requirements, wouldn’t it be great to know that at least your claims are being coded correctly and won’t trigger an audit?

Having your coding done by a certified coder reduces your exposure to the highly sophisticated data-mining software that is being used to audit hospitals now and will be used to examine your claims in the future.

Remote Coding Makes You Money

Did you say makes me money?   Yes, absolutely it does!   If you have thought of outsourcing your coding as just another expense, think again.   It’s a proven fact that certified coders pay for themselves several times over by maximizing claim reimbursements while minimizing claim rejections.  A certified coder will also help you as a physician improve your documentation and compliance, again resulting in more income for you.

Remote Coding Cuts Expenses

Outsourcing your coding eliminates the vulnerability that comes from depending on employees. Never again get “surprised” when your in-house coder is out sick, gets pregnant, or leaves for another job offer.   You can reduce staff or better yet, free her up to work with patients as your practice grows.

I am fortunate to have access to around 250 AAPC certified coders.  If you send me an e-mail, I can put you in touch with one in your specialty.

Winston Creath is an independent healthcare consultant working in the compliance and revenue cycle management arenas on behalf of physicians and clinics.  He serves as President of National Business Solutions of GA, LLC.  He can be reached at for questions or comments

A Deadly Combination

Data Mining software is nothing new – it has been available for years.   Like computers, its capabilities have grown exponentially due to technological advances.

Paying on commission is nothing new either.  It’s a good way to get results – if the commissioned person or company doesn’t produce, they don’t get paid.   The more they produce, the more they get paid.  It’s a fine system.

The Marriage

But when Data Mining and Commissioned Compensation were married to produce the Recovery Audit Contractor program, our Government crossed a huge threshold.

Never before had we seen such a program.   It will prove extremely effective from the standpoint of those wishing to squeeze maximum Medicare recoupment dollars from doctors and hospitals.

Somewhere I read that before RAC, there were already more than thirty entities authorized to conduct audits of medical claims. No wonder many physicians have greeted RAC with a yawn.

The Offspring

But in reality, RAC has opened a Pandora’s Box that will define virtually all recoupment efforts from now on.  Here’s why.  Prior to RAC, audits were done by salaried government employees whose income was not affected by how much they recovered.

Now you have contingency fees (commissions) being paid to private contractors based on how much they collect.  Other payers such as Medicaid and major insurance carriers (Aetna, Blue Cross, United Healthcare, etc.) are following Medicare’s lead.

In fact, Medicaid’s version is close to launch time. Of course it has an acronym – are you kidding?  It’s called MIC (Medicaid Integrity Contractors), and although details are sketchy at the present time, it appears to have less restraints than RAC. It was authorized by the Deficit Reduction Act of 2005, and has already gone through the demonstration phase.

Commissioned Bounty Hunting is here to stay folks. Forget everything you thought you knew about audits – there’s no turning back now. It’s the new wave of the future.  Get used to it.

Defensive Action

The only way to defend yourself as a physician is to get dead serious about compliance.  The first step you should take is click HERE and get started.  The longer you wait, the worse RAC and other future Bounty Hunters are going to hurt you.