Why has the business of medical practice consulting grown? There are a few reasons:

Running a medical practice has become more complicated. There are many reasons, including:  the increasing complication of filing insurance claims, the need to manage accounts receivable, the need to comply with OSHA and other regulations, and the necessity of keeping liability insurance coverage in place.

It has become more difficult to focus on the quality of patient care. Medical practice consultants can help busy medical offices preserve the quality of the relationship between caregiver and patient.

Physicians have learned that they can earn more money when their practices deliver care to more patients. This can involve: hiring additional front-desk staff, adding additional care rooms, and hiring support specialists to take blood pressure, do cardiograms, and perform other functions that may not require direct physician care. Medical practice consultants can analyze a medical practice and recommend which of these changes to apply.

And medical practice consultants can review office operations in other ways too. Here’s a list of services offered today by Healthcare Management Consultants Inc. (partial listing):

-  Billing Systems

-  Front Office Training

-  Interim Management

-  Managed Care Systems

-  Management Reorganization

-  Medical Practice Development and Management

-  Operational and Quality Improvement

-  Organization, Administration, Management, and Governance

-  Patient Care Delivery Systems Development

-  Patient Safety Training

-  Regulatory Compliance

-  Revenue Cycle Management

-  Strategic Planning and Marketing

So, where do medical billers and coders fit in the delivery of those services?  The answer is, just about everywhere. As medical offices become more efficient, the demand for billers and coders seems sure to rise. It’s another reason why the outlook for the profession looks so strong today.

1.  Unbundling of codes

a. Unbundling is breaking apart codes that are inclusive of other codes.  This not only affects reimbursement but it is illegal to do and will trigger an audit.

2.  Not coding the diagnosis code to the highest level

a. This is due to the fact that some ICD-9-CM codes need a 4th or 5th digit to be accurate and correct, something that many beginning coders will miss.

3.  Not understanding how to interpret the operative reports

a. For instance, if a laminectomy is performed, but the word laminectomy is not mentioned in the body of the operative report, the coder thinks that it has not been performed.  The physician has described the procedure in the report but not mentioned the term laminectomy; fully understanding how to interpret the operative reports will limit this error

4.  The physician not marking on the encounter form or superbill that they performed an x-ray gave an injection…etc

a. The coder has no idea that these were done unless it is mentioned in the documentation on the chart.  Usually by this time, the coder or biller has already sent the claim out. They then have to submit an amended claim which could result in lost time and money.

5.  Not having access to the provider, surgical tech or the documentation to be able to audit the claim.

a. In the situation where a coder is working off site from the provider’s office, they may not be able to contact the provider or see the documentation from the patient’s chart.  If they have a question about something, they have no way of getting that information unless they have a good relationship with the physician’s office.  Therefore, it takes a team of the physician, surgical tech, medical assistant, front desk staff and the medical records to sometimes get the information they need to code the claim correctly.

6.  Coders and Billers not having access to the Explanation of Benefits.

a. The coders and billers have no idea of any mistakes that have been made when the claim has been denied.  The bigger the practice the harder it is to track and correct these mistakes right away.  Usually, whoever is putting in the payments work the denials.  However, if the coder does not know what is wrong with the claim, they have no way of fixing the problem in the future.

7.  Collecting the patient’s co-pay up front.

a. The co-pay should be collected before the patient sees the physician.  The front desk coders should know in advance what the patient’s co-pay is and if they have met their deductible for the year so they can be ready to ask for it when the patient arrives.  This is an agreement between the patient and the insurance company.  If they continue to not pay their co-pay, the insurance company has a right to drop them.

8.  Undercoding.

a. This happens when the physician actually performs more than he charges for because he is afraid of an audit.  This is just as bad as upcoding; charging for services that were not performed.  This is also illegal and can trigger an audit as well by the OIG (Office of Inspector General).

9.  Physicians not documenting everything they did in the chart even though they may have done it.

a. A physician’s note should be able to stand alone – what the patient is being seen for, the physical examination, the doctor’s assessment and his treatment plan.  If it is not documented, it was never done and is not billable. Sometimes, this is where the coder needs to educate the physician on how to document.

10.  Coder’s not keeping up with their education of what has changed from the previous year or even daily with some insurance companies.

a. Physicians need to realize that a coder’s job has to include continuing education.  If the coders do not have the opportunity for continuing education, they will fall behind in their knowledge of the industry and therefore make mistakes.

That’s a question you should discuss in depth with an attorney and tax advisor, because each structure can present different liability protection, tax liabilities, and reporting requirements. But according to “The Basics of Business Structure,” an article on Entrepeneur.com, here are some basic concepts you need to know:

• A sole proprietorship simply means that you are an individual doing business as yourself. (You can use your own name as the company’s name, or operate under a different company name you create.) Setting up a sole proprietorship is simple, though you might need to register your business with your municipality. The disadvantage is that there is no distinction between you and your company, and you could be personally liable for business debts.

• A partnership means that you and one other person are doing business together – it is essentially a sole proprietorship operated by two people. It’s easy to set up too, but both partners can be liable for debts. This is one reason that Entrepreneur.com advises potential partners to retain an attorney to draft a partnership agreement ahead of time.

• A Limited Liability Company (LLC) is a relatively new kind of business structure that offers the simplicity of a partnership with the liability protection of a corporation. To set one up, you may need to file legal forms with state agencies and pay registration fees.

• A corporation functions as a legal person in the eyes of the law. It can protect its owners from liabilities, and it can sell stock to raise funds. However, corporations are generally required to pay annual fees, hold stockholder and board meetings, and file reports.

So, what is the best structure for you? That’s a rather complex question. So if you’re going out on your own, meet with your attorney and tax advisor to weigh your options.

If you have been following the news, you already know about the state’s budgetary problems, which have led to cutbacks in state funding for healthcare services, education, and a variety of essential services.

According to the Anderson Forecast, an independent trend-monitoring report issued by UCLA, here’s how things look for California’s overall employment picture in the coming year:

“Writing about California, UCLA Anderson Senior Economist Jerry Nickelsburg notes that despite the recession having officially ended, California’s unemployment rate continues to rise, while local governments continue to shed jobs. The outlook for the balance of 2010 is for little or no growth in the state, with the economy picking up speed slightly by the beginning of next year . . . The unemployment rate – currently at 12.5% – will fall slowly through the balance of this year and should average 11.8% for 2010. Though the state’s economy will be growing, it won’t be generating enough jobs to push the unemployment rate below double-digits until 2012.”

Double-digit unemployment is no laughing matter. Yet high unemployment does not necessarily translate to fewer jobs for medical billers and coders. Here are some factors to consider if you are thinking about working in the state:

• Hiring is happening. When we visited CareerBuilder.com a few days ago and searched for medical billing and coding jobs in California, we found a total of 445 jobs listed. Employers included Healthport, Hoag Memorial Hospital, La Clinica, Maxim Healthcare, Scan Healthplan, Sutter Health, and the UCI Medical Center.

• California has Medi-Cal, it’s own state-funded healthcare insurance program. Claims for medical service must be submitted not only to insurers and Medicare, but (if patients are participants) to Medi-Cal too. The process of billing claims to Medi-Cal can be complex, which can create a need in the state for medical billers and coders with applicable training.

• California is seeing an increase in the number of urgent care centers and other non-hospital healthcare service providers. One example: According to The Urgent Care Association of America, “the number of urgent care centers in the U.S. grew from approximately 8,000 in February 2009 to 8,700 in February 2010.” Urgent care centers are now dispersed widely through the state of California, as are California chiropractors and other healthcare providers that can hire medical billers and coders.

• The need for healthcare services in California remains strong. Even though the California Hospital Association points to a reduction in state funding for hospitals, there are many positive signs. One is that Kaiser Permanente, one of America’s leading not-for-profit healthcare plan providers, has just announced plans to equip 15 California hospitals with 15 megawatts of solar-generated electrical power by the summer of 2011. That’s a significant investment in the state’s hospital infrastructure.

So, is there a future for you in California? It could well be. To keep aware of hiring in the state, we’d recommend visiting CareerBuilder.com’s page of California job listings for medical billers and coders. It’s a convenient way to monitor some of the available jobs in the state.

To organize files . . .

Inclined desktop file sorters keep your working files upright and organized neatly. Because the files in the back of the sorter are positioned higher than those in the front, it is easy to see and retrieve the files you need.

Products: Rolodex MeshTop Sorter ($11.99). Popular office superstores sell other models too (about $11.00).

Wall-mounted file pockets hold files and paperwork in little bins that attach to the wall. We like the clear plastic models, because they let you see what’s inside.

Product: Deflect-o Docupocket (about $10.00 for one). Also see competing models from popular office superstores (about $19 for a pack of three).

Colored file folders let you easily organize projects by color – and find them faster.

Products: Pendaflex CutLess File Folders ($9.00 for a pack of 100). Also see competing products from popular office superstores at similar prices.

To free up desktop space . . .

Rotating desk organizers store paperclips and other supplies in one small “lazy Susan” that takes up very little desktop space.

Products: Deflecto Rotary Carousel Organizer ($21.99). Similar products are available from other manufacturers.

Computer monitor stands lift your monitor a few inches above your desk surface, freeing up desk space for other purposes.

Products: Allsop Metal Art Jr. Monitor Stand ($19.99). Similar products are available from other manufacturers at slightly higher prices.

Under-desk keyboard drawers let you store your keyboard out of the way, freeing up desktop space.

Products: Innovera Standard Keyboard Drawer ($19.00). Similar products are available from other manufacturers at slightly higher prices.

To make work faster and easier . . .

Removable color page markers let you quickly open books to the pages that you refer to most often. They are easily removable, causing no harm to the book.

Products: Post-It 1″ x 3″ Ultra Colors Page Markers ($3.99 for a pack of 200). Similar products are available from other manufacturers.

Adjustable copy holders are mini-easels that sit on your desk and hold documents upright for easier reading. If you refer to documents while you type, these low-cost devices are terrific.

Products: Kensington Adjustable Copy Holder ($8.99). Similar products are available from other manufacturers at slightly higher prices.

To boost your comfort and efficiency . . .

Keyboard wrist cushions make typing more comfortable and may help prevent wrist fatigue.

Products: IMAK Keyboard-Wrist Cushion is like a long bean bag that you position under your wrists ($14.99). Similar products are available from many other manufacturers.

Telephone headsets let you talk on the phone while both your hands are free to type, find files or perform other tasks. No more cradling your phone between your ear and your shoulder.

Products: Plantronics M214C ($15.99) is an economical wired model. Cordless models allow you to move around your office freely and are available from Plantronics and other manufacturers at higher prices.

Oversized calculators offer plus-sized keys and displays that let you handle the mathematical tasks of billing and coding more easily. No more searching for tiny keys or squinting at miniscule displays.

Products: Canon LS 82 ($13.99). Similar calculators are available from many other manufacturers – including some in bright colors that can perk up your work area.

It can be tempting to say yes. After all, logging only a few hours in the evening could provide extra income. If a local urgent care center, chiropractor or other care provider has a backlog of insurance claims to process, the result can be a second income stream for you.

So if you are offered an additional job, should you take it?

Only you know whether you have the extra time to invest in a second or third job. But one other important consideration can come into play:

Did you sign a non-compete agreement with your current employer? A non-compete agreement could have been a separate document that your employer required you to sign – or it might have been a small clause buried in other paperwork you signed when you accepted  your current job. If you signed a non-compete, you agreed not to work for one of your employer’s competitors for a specified period of time after you left your current job.

To learn more about non-compete clauses, take a few minutes to read about them in About.com’s online library of articles about Human Resources.

How enforceable are non-compete clauses? At least one recent court case has raised that issue. In case your current employer decides to question your right to work for another organization, to be safe, you  might consider the issues before you start moonlighting..

So, to moonlight or not to moonlight? It’s a question to weigh carefully as you expand your earnings and build your career.

Is New York State a good place to build a career as a medical biller and coder?

If you have been following the news from New York, things do not look too rosy at first glance. On January 19, New York Governor David Paterson released his proposal for a budget that will attempt to close a projected $7.4 billion deficit for the 2010-11 fiscal year.

According to the Greater New York Hospital Association, that budget “contains major cuts and taxes for health care providers” that will put construction of new hospitals on hold. But the issue is more complex than that, for several reasons:

-     First, Governor Paterson is also trying to pass a new bill that will raise $650 million through new taxes on the sale of cigarettes and sugared beverages. If that bill passes, those funds will be earmarked for improving public health – and that spending could spur job growth for medical information processors.

-     Second, Governor Paterson recently announced that he will not seek re-election. That might not impact the passage of the new bill mentioned just above, but it does throw the long-term prospects for healthcare funding into uncertainty.

A Little Perspective

The 2009 Federal Issues Book: New York Hospital and Health System Priorities, a downloadable report from the Healthcare Association of New York State (HANYS), helps put these recent events in context. According to HANYS, New York State’s 300+ hospitals have continued to offer many opportunities for healthcare professionals.

-     New York hospitals employed 357,780 full-time workers in 2009.

-     New York hospitals also created an additional 671,730 support jobs throughout the state in 2009.

-     New York hospitals paid $26.8 billion in direct wages and fringe benefits to employees in 2009.

-     Every year, New York hospitals provide 2.6 million inpatient hospital stays, 44 million outpatient visits (including 7.9 million emergency room visits), and deliver more than 250,000 babies.

Other trends are at work too. As billers and coders, we know that hospital cutbacks do not always correlate directly to job losses for members of our profession. When hospitals downsize their staffs, for example, they can outsource billing and other functions to outside firms. And as hospitals cut back on services, the result can be an increase in the number of urgent care centers and other non-hospital care providers that employ medical billers and coders. One example: According to The Urgent Care Association of America, the number of urgent care centers in the U.S. grew from approximately 8,000 in February 2009 to 8,700 in February 2010.

And here’s one more piece of data that supports the view that New York is a good state for medical billers and coders:

-     According to 2008 data from the U.S. Bureau of Labor Statistics (the most recent data available), 9,200 people in the state of New York were employed as Medical Information Technologists, earning an average of $37,100 a year. According to those same statistics, the national average income for Medical Information Technologists was far lower – $32,960.

So is New York State a good place to build a career in medical billing and coding? We all need to stay alert for news about whether Governor Paterson’s soft drink/cigarette tax bill passes. But as the statistics above show, New York needs us. We’re all hoping that once the recession is over, a boom will occur – both in New York State and nationwide.

Certifications allow medical billers and coders to validate their knowledge and expertise in various medical environments. It will also help you earn approximately 20% more than non-credentialed coders, according to the American Academy of Professional Coders.

These credentials are nationally recognized by employers, physician societies and government organizations.

Being credentialed may also give you and your employer more confidence in your ability to capture lost revenue for the payment risk and protect their practice from unfavorable audits.

As a credentialed billing and coder, doors may open up for you faster in:

•  Physician offices or groups

•  Hospital-associated physician offices or groups

•  Health system-associated physician offices or groups

•  Home health agencies

• Physician groups at a university and or in a teaching setting

•  Compliance auditors or forensic auditors of physician claims

•  Physician billing services

•  Ambulatory Surgery Centers (ASC)

•  Outpatient hospital services not reimbursed by Ambulatory Patient Category (APCs) groups

•  If you are a consultant, educator, legal counsel, physician or other care-giver seeking a credential to demonstrate your command of outpatient medical billing and coding for physician services.

So get certified today if you are working in the field. If you are taking a course, be sure to take the certification exam shortly after your course is complete. There are also preparatory classes offered to help you prepare for the certification examination. Do it for yourself. This is a great accomplishment and will bring much more value to your degree.

The Miami Herald is not the only publication that is optimistic about opportunities for medical billers and coders in Florida. According to Orlandojobs.com’s Employment Outlook for Central Florida report, healthcare jobs are among the fastest growing employment opportunities in Florida. The report points to fast-growing opportunities for physical therapists, registered nurses, licensed practical nurses, medical coders and medical billers.

What’s driving this growth? One significant force is the construction of new medical facilities in the state. One of the more promising could be the planned “medical city” in Orlando’s Lake Nona area. According to a recent article in The Orlando Business Journal, the development of this medical and research park has the potential to create 30,000 high-paying jobs in just a decade.

So, is Florida a good place to start and grow your career as a medical biller and coder? It certainly seems to be. We’ll be watching the trends in Florida and other states in the coming months and reporting on them here.

But be careful. The IRS has some requirements – and traps – waiting for people who break the rules about what can be deducted.  So be sure to follow these steps to avoid trouble.

Read what the IRS has to say. Download Business Use of Your Home, a guide that is published by the Internal Revenue Service. It spells out which expenses are deductible, how much of your home you can deduct as a home office, and more. You’ll also find some unpleasant surprises. Example: If you sell your home for a profit after you’ve taking deductions for a home office in it, you could end up paying capital gains tax on your business. (See page 14 of Business Use of Your Home.)

Talk over your plans with your accountant or tax preparer. Your strategy for taking home-office deductions will vary according to whether you own your home or rent, the physical layout of your home, the amount of time you intend to stay in your current residence, and other factors.

Keep complete records of all deductible expenses. A file cabinet is your best friend in this area. Set up files for office expenses, travel expenses, and all other categories. Also: Print out and file records of Internet purchases, invoices and other electronic documents that you will need to complete your taxes. Preparing your taxes will be much easier if you have all your records in one place.

If you have multiple clients, keep careful records for each of them. You will need to track the income for each of them – as well as expenses that apply uniquely to them – separately. Your accountant or tax preparer can help you set up filing categories to keep everything straight.

Consider using an accounting program to track all expenses and income. Intuit Quickbooks, a program that is available through computer retailers and via download, is excellent. But remember, you have to be diligent about entering all your data into it.

If you bill several clients by the hour, use software to track your hours and income.  Intuit Quickbooks Pro and Premier editions can track billable hours and expenses for multiple clients – plus, they are excellent all-around accounting programs for your business. Also: Some home workers with multiple clients recommend project-management software called Tenrox Timesheet.

And one more consideration . . .

If you are setting up a home-based business, this could be a great time to establish a self-employed qualified retirement plan (SEP IRA) or other retirement plan. You might be able to contribute up to $2,000 a year tax-free. Consult your accountant or tax preparer to learn whether such plans are a good idea for you. Now that you are self-employed as a biller coder with a business of your own, why not enjoy all the benefits?