Laureen: Jo-Anne is a…
Jo-Anne: Here I am.
Laureen: Oh good…instructor for our PPM course and she’s a coach for a gaggle of students that we have.
We’re really keeping her busy these days. I’ll let her go ahead and answer her question.
Jo-Anne: The question is:
Q: [PPM] “I am thinking of taking the PPM course and wanted to know how much medical billing and coding I needed in order to manage a medical practice?”
A: Although coding and billing are not required for the course, I personally think that you have to take at least a billing course. Consistent cash flow is very important in a practice. The last thing you want is the doctor to ask, “Where my money is?” Physician practice managers have to know the questions to ask to the billing department and they have to look at the age, look at the dates of service, when the claims were filed, why they’re sitting there in 60 days and not paid.
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They sometimes have responsibilities like revealing the encounter forms before they go to the billing department. It’s interesting because they may look at a CPT code like 96372 which is an intramuscular injection and the diagnosis code is a tetanus vaccine. To them, injection is an injection, but we know like based on what Laureen said there are allergy injections, arthrocentesis, trigger point as well as administration of vaccines.
If a manager approves something for billing and to go into the billing office and there’s a clash, the claim will deny, and they have to understand that whole process. Is claims denied because of terminated insurance? The manager needs to work and train the front desk.
Just as an example, let’s say you’re working for a five-doctor group and the doctor came up to you and said, “I haven’t seen money since you hired that new biller eight months ago.” You should never have the doctor ask you that question. You should know ahead of time by reviewing the accounts receivable and looking at the explanation of benefits and the denials, where the denial sources are and work with that.
As an example, if you are looking at an aging and you saw all this Medicare just sitting there and the billing company has no reason why they’re sitting there, it could be something as simple as the manager not understanding what revalidation is, and Medicare has frozen all the money until revalidation is done. It all focuses on the billing and then from there the coding, but bottom line is, it’s cash flow. If there is no cash flow there are no happy providers, just saying that. It’s very important to know the billing and the coding to be a good practice manager. I guess that’s it.
Alicia: Thanks Jo-Anne.
Boyd: Thank you.
Jo-Anne: You’re welcome.
Alicia: Jo-Anne knows because she was…
Laureen: I love your glasses.
Jo-Anne: Thank you. I’m blind.
Alicia: I was just going to say Jo-Anne has been there. She’s run an office and has seen all aspects of that. We’re real lucky to have her input.
Jo-Anne: You know what I wanted to add is a couple of weeks ago when I spoke in West Virginia for the office managers association, they were all office managers and they wanted to know about denied claims and how to appeal them. These professional men and women asked me questions that were pretty complex about billing and the coding and large majority of them were billers and the rest of them over saw billing departments. Just saying that it is important facet of the practice management course.
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