Honesty Is the Best Only Policy for Medical Billers and Coders

In this day of cyberattacks and stolen identities, it is imperative to guard personal information. For medical billers and coders, it goes a step beyond: They also must follow a strong standard of ethics while protecting patient and client information.

It’s not always that easy, and sometimes the lines are blurred. Regulations regarding licensing and certification in the healthcare industry require that everyone employed in the field has the proper training and qualifications. In addition, the Health Insurance Portability and Accountability Act (HIPAA) of 1996 was passed to ensure the privacy and security of patients’ healthcare information. However, healthcare professionals are tasked with enforcing HIPAA – and sometimes, through human error or breaches, information gets out or is misused. It’s the misuse that must be looked at from an ethical standpoint.

Medical billers and coders keep doctors and nurses on track and organized, and record in clear terms a patient’s medical history. One slip-up with an improper code could mean big trouble for a patient. It could result in the wrong treatment (imagine mistakenly coding a lymphoma, cancer, for a lipoma, a benign fatty tumor). Occasionally, billers and coders are asked to make intentional slip-ups to optimize revenue for the medical facility at the expense of actual documentation. They may be under pressure to “upcode” or “unbundle” procedures to extract more reimbursement from patients or insurance companies. This is just one glaring example of unethical behavior that can present itself in healthcare.

The American Medical Association (AMA) published Principles of Medical Ethics as a general guideline for healthcare professionals to follow. If medical billers and coders are faced with potentially unethical situations, they can refer to the AMA’s guide, and they can keep these things in mind:

• Maintain confidentiality. Don’t access unnecessary patient information or share it with anyone other than the physician, patient or insurance company. Password-protect your computer at work, and keep the screen faced away from others who could peek at the information. Also, keep your conversations about patients as quiet as possible so that those who shouldn’t hear, can’t hear.
• Avoid conflicts of interest. Even if a good friend or relative is being treated at your facility, you need to stay neutral and not give them preferential treatment. You should remain neutral when performing your duties.
• Be honest above all. Don’t code for procedures that were not provided or unbundle charges so as to get more compensation for the company. If you’re being pressured to do something that you know is not right, say something to your employer; don’t shrug it off. If you notice anything questionable, bring it up. For example, some people who are addicted to certain prescription medicines will go from doctor to doctor to obtain an Rx. If you think you’ve encountered such a patient, bring it up to the doctor.
• Keep patients’ rights at the forefront. Patients have a right to be treated with dignity, and you have an obligation to be kind and diplomatic. If you have to phone a patient with information, choose your words carefully – especially if you must leave a voicemail that could be heard by someone else.
• Stand your ground and maintain your personal integrity. Be calm and collected, and do what you know is right. Don’t be pressured into doing something that you know violates the law or is unethical.
• Pay attention to detail. When you’re coding, make sure that your work is accurate. Keep up with the latest information on billing and coding issues. Since your job is to abstract billable procedures from medical records, they must all be documented. If it’s just briefly mentioned and not noted by the doctor as having been done, find out for sure. In other words, resist the temptation to submit codes that are only implied and not documented. Also, watch for discrepancies in medical records.
• Be mindful of your behavior. If you’re a freelance biller or coder working for multiple facilities, keep each one’s policies and practices confidential.
• Use your manager as a resource. If you’re not sure about a code, or if you think a colleague has intentionally misused a code, talk to your boss. Never condone or pardon those who intentionally commit deceptive acts.
• Don’t exploit relationships with patients, clients, employees or coworkers for personal gain.

Medical coding and billing are the heart of healthcare industry. As the U.S. population rapidly ages, people usually require more medical care. Medical coders and billers are needed to handle insurance and patient claims.  MTI College offers a Medical Billing and Coding Professional Diploma Program that can prepare you to enter this in-demand field. You could be working alongside doctors and nurses in a hospital, doctor’s office, clinic, nursing home or other medical facility, using your skills to provide much-needed assistance.

According to the Bureau of Labor Statistics, the employment rate for medical records and health information technicians (billers and coders) is growing much faster than the average for other occupations. Because more people have access to health insurance these days, claims on behalf of patients are going to increase. If you have a medical billing job, you will be the one to submit the bills for insurance reimbursement. 

Does this sound like a job you would enjoy? Contact MTI College Sacramento today to jump-start your medical billing or coding career.

Sources:

http://www.mb-guide.org/medical-billing-ethics.html

http://journal.ahima.org/2011/04/02/ethical-dilemmas/

https://www.aapc.com/memberarea/forums/12603-deal-unethical-billing-issues.html

http://www.medicalbillersandcoders.com/pressrelease_articles.aspx?ArticleId=87

http://www.hcpro.com/HOM-236942-5728/know-your-ethical-obligations-regarding-coding-and-documentation

http://work.chron.com/code-ethics-medical-coding-billing-specialists-3099.html

http://www.mb-guide.org/medical-billing-ethics.html

http://www.dummies.com/careers/medical-careers/medical-billing-coding/ethics-are-critical-to-the-billing-and-coding-profession/

https://www.ama-assn.org/sites/default/files/media-browser/principles-of-medical-ethics.pdf

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Common Errors in Medical Billing and Coding, and How to Avoid Them

Medical billers and coders are crucial to the healthcare industry. They keep doctors and nurses on track and organized by carefully documenting patient procedures and treatments. In addition, they submit bills to insurance companies, which then pay claims. When a biller or coder makes a mistake, it can delay the claims process, cause a loss of revenue and/or affect a patient’s care.

It’s inevitable that errors occur – especially when dealing with the thousands of codes a medical biller or coder is expected to know. The World Health Organization created the International Classification of Diseases, Tenth Revision (ICD-10), which universally classifies and codes all diagnoses, symptoms and medical procedures. The ICD-10 codes that you, as a medical coder, use make it easy to share and compare patient medical information among various hospitals, regions and providers. They also ensure that the procedure that is billed makes sense with the diagnosis. There is a lot of information to know.

Add CPT® codes, the five-character Current Procedural Terminology codes that are the U.S. standard for the way medical professionals document and report medical, surgical, laboratory, radiology, anesthesiology and E/M (evaluation and management) services, to the equation, and the coder’s job becomes even more complex, with a greater chance for making mistakes.

Knowing the more common problems with coding and billing, and understanding how to avoid them, is key to efficiency in the job.

Here are a few of the more common problems faced by medical billers and coders:

Poor or missing documentation

Sometimes a provider doesn’t give enough information about a procedure, leaves important items out or enters information that is illegible. Unless the coder or biller is able to consult directly with the provider and clarify the situation, a claim request may be submitted incorrectly.

Rejected or denied claims

If a claim request has been submitted incorrectly, resulting in errors found before it is processed, the insurance company will reject the claim and not pay the bill as written. It’s then sent back with an explanation, and the process begins again. In another scenario, a claim may be denied if the payer determines the procedure or charge is not payable. Perhaps it violates the payer-patient contract (i.e., using an out-of-network provider) or is a high-tier prescription that is not covered. A denied claim can be appealed, but such an appeal takes time and can be expensive.

Under- or upcoding

These errors are often intentional and considered to be fraudulent. Under-coding involves reporting less-expensive medical services than the ones that were actually performed. Over-coding is the opposite, and it is a means for trying to receive higher reimbursement than a provider is entitled to.

Unbundling

This, too, is intentional and fraudulent. It’s similar to upcoding, in that it involves charging procedures separately so that the provider receives a greater payout.

Simple errors

Medical billing and coding require attention to detail, but sometimes negligence causes clerical errors with:

• Patient data (wrong name, date of birth, insurance company)
• Provider details (incorrect address, name, contact information)
• Insurance information (wrong policy number, address)
• Confusing codes (too few or too many digits, wrong modifiers, place of service discrepancies)
• Mismatched codes (entering ICD-10 codes with CPT or vice versa)
• Omitting procedural codes
• Duplicate billing (submitting claims without checking to see if the service had already been paid or reported)

Although these errors are fairly common, they can be expensive. According to Healthcare Business and Technology, doctors lose $125 billion each year because of poor medical billing systems and errors. Most errors can be avoided if the medical coder or biller takes a few simple steps:

• Stay current and on top of code changes. ICD-10 and CPT code manuals are updated annually. Also, if you’re a member of American Academy of Professional Coders (AAPC) or American Health Information Management Association (AHIMA), you are required to complete education credits every two years to help you remain current.
• Be diligent and check your work. Make sure you didn’t add an extra digit or report an incorrect code. Also, verify patient, provider and insurance information.
• Communicate any concerns or questions so that you can note correct information. Doctors sometimes take hasty notes that may be difficult to read. If you’re unsure about a procedure or treatment, ask.
• Follow through to make sure that information was submitted and that claims were paid correctly and in a timely fashion. If a claim is rejected or denied, make sure that the payer included an explanation of benefits (EOB).

Partially because of a rapidly aging U.S. population, healthcare jobs are in demand because as people age, they usually need more medical care. According to the Bureau of Labor Statistics, the employment rate for medical records and health information technicians (billers and coders) is growing much faster than the average for other occupations because people in these jobs are the ones who handle insurance and patient claims.

MTI College offers a Medical Billing and Coding Professional Diploma Program that can prepare you to enter this in-demand field. When you study at MTI College, you train for both positions. Upon graduation from the program, you could be working alongside doctors and nurses in a hospital, doctor’s office, clinic, nursing home or other medical facility, using your skills to provide much-needed assistance.

MTI College’s Medical Billing and Coding Training Program gives you the background you need to enter the exciting, busy world of healthcare. Contact MTI College Sacramento today to jump-start your career.

Sources:

https://www.medicalbillingandcoding.org/common-problems-coding/

https://www.medicalbillingandcoding.org/potential-billing-problems-returned-claims/

http://www.healthcarebusinesstech.com/medical-billing/

http://schoolsmedicalbilling.org/ethical-issues-concern-medical-billing-coding/

http://www.providersedge.com/ehdocs/ehr_articles/America-s_Hidden_Healthcare_Crisis.pdf

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Hair Trends to Expect for Summer

Summer’s coming, and that’s a great time to update your hair with a new cut, color or style. If you’ve been thinking about doing something to change your look, but you aren’t sure what, check out these hair trends for the summer of 2018.

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New cuts and styles to watch out for

There really are no rules anymore when it comes to hairstyles and cuts, but we’ll be seeing more of some looks than others this summer.

• The blunt chin-length bob is going to be popular this summer. Rather than the layered bob of the past, this one is straight cut – quite possibly with choppy bangs. The summer will also see shorter, choppier cuts.
• Bangs will be front and center with stylists this season. From “curtain fringe” to textured or flyaway, bangs will frame faces all over the country.
• Center-parted natural curls will be both stylish and easy this summer, so put your curl relaxer aside and let the ringlets cascade as they may.
• Disheveled, texturized locks will give a sexy bedhead look that shows off a carefree, summery attitude. Even if you have flyaway hairs, embrace them because they’re styling.
• Ponytails in all shapes and forms will make summer hair care effortless. Make a loop, double-bind them or “bandage” them with a wrap-around or two of cloth for a 2018 look.
• Schoolgirl-style hair is coming back for those who prefer a natural, unassuming look. Think long, fishtail braids and pulled-back hair secured with pins.
• Buns offer easy up-do styling, but the way you swirl them will be what makes them trendy. Try a croissant bun for a half-up, half-down hairdo, or turn your braids into a manicured bun. Even if you have shorter hair, you can do a “baby” bun at the nape of your neck.
• Beachy waves will continue to be popular for summer, but they may also appear loose and tousled if you use a lot of product for a “just out of the water” appearance.
• Adornments for your hair may be the biggest trend of the summer. Barrettes are back, and so are wide headbands, scrunchies and hair ribbons. You’re likely to see crystal bangles tied to hair ends and rings or beads placed throughout to accessorize long locks.

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Every color of, under or around the rainbow

Changing your hair color may be the easiest way to showcase your individuality or change your look. This summer, you’ll see a variety of colors and combinations of color.

• Blonde is no longer a single color. New variations include a cool ash blonde that’s just deeper than gray, snow white, blonde-beige, margarine blonde, lightly toasted and rose gold.
• Coffee colorings bring warmth and richness to brunette shades. Think dark chocolate, carob, subtle ombre, mocha latte and chestnut hues.
• Reds are vibrant and flaming, as well as shimmering and coppery, this year. Among the trendier shades, fire-engine red and carrot orange are gaining in popularity. However, If you’re more traditional, you may prefer autumn-colored hair that has hints of pumpkin, russet, bronze, copper and gold. One popular copper-red and bronze-brown blend has been labeled “ronze.”
• Metallics, like buttered rose – metallic pink over blonde – and silver are gaining in popularity.
• Millennial pink – and anything pink, really – is trendy for hair. Watch for colors that range from pastels to bubblegum and hot pink.
  Peanut butter and jelly hair is real. Imagine golden brown with hues of purple throughout that look just like peanut butter and grape jelly.
• Succulent is a multi-toned, varied-intensity color combo that resembles something you might see on a snorkeling expedition. It’s a mélange of purple, magenta, blue, turquoise and sea green.
• Highlighting offers blends of colors, and the style you use can give different effects. A color bleed has a strong root color with perhaps a brighter color at the ends. It sort of looks like you are growing out your color. A chocolate and rose-gold combination, and amethyst roots over platinum blonde, are both considered trendy types of highlights.
• Color melting produces a natural light-reflecting look when complementary tones seem to blend or melt together. Remember ombre with the dark on top and light on the bottom? This is much more subtle, so you don’t see where one color ends and another begins.
• Ecaille uses three or more shades of caramel, golden blonde, honey blonde and chestnut enhanced with shine that’s worked through hair to create more movement that’s especially good for those with thin hair. It’s easier to keep up and doesn’t have to be touched up as frequently.
• Balayage is hand-painted highlights (without foils) that add dimension and give a more graduated, natural appearance with less-noticeable hair regrowth lines.

Do you enjoy changing your hair color with the season, or styling your friends’ hair? Perhaps a career in cosmetology is in your future. MTI College’s Paul Mitchell The School helps you develop the beauty and cosmetology skills you need for a rewarding career. Class size is small, and the one-on-one attention you receive from your instructors – professional hairstylists and estheticians – helps you succeed. Register for the cosmetology program at  MTI College today.

Sources:

• https://www.goodhousekeeping.com/beauty/hair/g3027/best-hair-color-trends/
• https://www.cosmopolitan.com/uk/beauty-hair/beauty-trends/g12451844/spring-summer-2018-hair-makeup-trends/
• https://www.cosmopolitan.com/uk/beauty-hair/beauty-trends/g14012264/hair-trends/
• https://www.harpersbazaar.com/uk/beauty/hair/g38265/hair-trends-spring-summer-2018/
• https://www.elle.com/uk/beauty/hair/articles/g32408/hairstyle-trends-for-2018/
• https://www.refinery29.com/hair-color-ideas-2018?bucketed=true&bucketing_referrer=https%3A%2F%2Fwww.google.com%2F
• https://www.refinery29.com/2018-hair-ideas-trends
• http://www.womanandhome.com/beauty/2018-hair-trends-haircuts-colours-205501/
• http://www.holleewoodhair.com/2015/11/30/ecaille-hair/
• https://www.buzzfeed.com/augustafalletta/melted-hair-color?utm_term=.kjoEk20Xm#.ueZgQoYJd

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