As many as 80 percent of all medical claims submitted to insurance carriers contain mistakes estimated at $68 billion (1). Approximately 55 percent of evaluation and management (E/M) claims are incorrectly coded resulting in $6.7 billion in improper Medicare payments.(2) Providers looking to avoid lost revenue and serious consequences are raising the training standards of its administrative staff seeking out those who have completed specialized training and certification (www.pmimd.com/certify/default.asp) offered by Practice Management Institute (PMI). 

Watchdog agencies, enforcement, and penalties are on the rise, creating a high-risk environment for physicians. Tighter screening measures adopted by the Affordable Healthcare Act have resulted in 17,000 providers losing their license to bill Medicare (3). Doctors have ultimate responsibility for all claims billed under their unique provider number, and a physician’s signature on any claim is held as verification of the accuracy and legitimacy of each claim (4).

Increased scrutiny has prompted doctors and healthcare facilities to require their employees to become certified. From an enforcement perspective, staff who knowingly submit fraudulent claims for payment can be held liable (5).

David Womack, President and CEO of PMI (www.pmimd.com/certify/default.asp), says, “It’s critically important that providers have well trained staff.  The physician needs to have confidence that their personnel are running the business correctly so they can focus on quality patient care. 

Physicians dedicate their careers to quality patient care; most have had little exposure to the increasingly complex world of medical claims management. They rely on their billing and administrative staff to stay on top of the guidelines set forth by Medicare and third parties. PMI helps providers adopt higher training standards with specialized courses and certification exams that address these high-risk areas of practice administration.

Womack says, “Taking steps to successfully train and certify staff in these areas means physicians are more likely to submit accurate claims and receive correct payments for their services, and ensure that practice liability is minimized.”

 For more information, visit http://www.pmiMD.com.