Long gone are the days in which physician practices could rely on a single office manager to oversee operations and perform the coding and billing. Today’s practices are under an almost unfathomable amount of scrutiny by auditors and payers, requiring a highly specialized knowledge of the healthcare system. Couple that with electronic medical record (EMR) implementations, the Affordable Care Act, and the recent transition to ICD-10, and you’ll find that many practices are struggling simply to stay in business.

In fact, many practices have joined larger groups, hospital networks, or Accountable Care Organizations because of the option to share compliance risk and resources among various participants. ICD-10 and other regulatory requirements have also inspired a trend toward hiring credentialed coders who can help physician practices navigate regulatory changes with ease.

Physicians are beginning to realize that selecting a code in ICD-10 is not a straightforward task. Physicians must choose from among hundreds of codes in an EMR dropdown menu. Even the narrative descriptions for many of these codes differ from their ICD-9 counterparts. Physicians either take the time to choose a correct and specified code—and therefore lose precious productive time—or they simply choose the first code that pops up regardless of its accuracy or specificity. Neither of these scenarios is good for the business side of the practice.

In a post-ICD-10 world, certified coders provide an added layer of financial security by:
  • Validating code accuracy and specificity, which can, in turn, ensure accurate reimbursement and outcomes reporting
  • Determining whether documentation supports code assignment (i.e., Do clinical indicators and other details documented in the record match the code assigned?)
Once this information is verified, billers are able to submit a clean claim with a lower likelihood of denial. Without this added level of review, practices run the risk of sending bills that are subsequently denied and that must be appealed or written off.

In addition to promoting accurate code assignment, certified coders also enhance these other business processes within the practice:

  • Clinical documentation improvement (CDI). CDI serves as the backbone of a practice, ensuring that patient severity and complexity is captured within the documentation.
  • Compliance. Certified coders establish ongoing internal audits that target E/M code assignment, diagnosis code assignment, and other high-risk areas identified by the Office of Inspector General and Recovery Audit Contractors.
  • Training and education. Certified coders provide training for all physicians and other staff members about important regulatory and coding changes, keeping everyone one step ahead of auditors.
  • Process improvement. Using data analytics and other tools within the EMR, certified coders monitor denials and identify/address the root cause of any problems. This is critical in ICD-10.

Looking for the right credential

Various organizations offer coding credentials and certifications; however, MMI’s Registered Medical Coder (RMC) credential is the only one in the industry that requires an annual retest to ensure ongoing competence. The retest measures coders’ knowledge of important CPT, HCPCS, and ICD-10-CM code changes that affect all specialty areas the majority of practices. An RMC-credentialed coder must also meet these requirements:

  • Passing score of 76% or higher on the initial certification exam. Note that this is more stringent than any other coding certification industry standard. 
  • 12 CEUs annually.
  • Ability to demonstrate proficiency working in an online environment. MMI’s courses and certification exams are entirely online.

MMI’s stringent standards for coding certification directly benefits physician practices seeking to maintain the highest degree of compliance. RMC-certified coders are able to identify areas of coding and documentation improvement and articulate important industry changes and their potential effects on the practice. By enabling prospective—rather than retrospective—compliance, RMC-certified coders enhance operational and financial efficiencies. A practice that employs a certified coder is ultimately a more profitable and compliant practice.

About the Author

Dari Bonner, RMC, CCP, CHCA  Dari Bonner serves as the Chief Training Officer at the Medical Management Institute (MMI) where she is able to bring her 22 years of healthcare experience to the table. Dari has extensive consulting & project management experience, with her areas of expertise in both the public & private sector, hospitals, outpatient service centers and large & small physician practices.

About the RMC

The Registered Medical Coder (RMC) certification is ideal for medical coders & billers in the physician office and outpatient setting. The credential is licensed through the Nonpublic Postsecondary Education Commission (NPEC) and is administered online through the Medical Management Institute (MMI). MMI is A+ accredited through the Better Business Bureau (BBB) and has been in business for nearly 30 years. MMI offers online medical coding training to prepare for the RMC Certification Exam.