Staff training unravels healthcare reimbursement issues

By David Womack / Special to Healthcare Facilities Today
November 13, 2017

Billing problems are an ongoing point of frustration in medical offices. The transition from fee-for-service to value-based payment models adds another layer of complexity to an already highly detailed reimbursement system. Coding and billing staff need a good training foundation and advanced skills to communicate with physicians and carriers on claims and fight for reimbursement that is rightfully due to the practice.

Improperly coded claims cost medical facilities hundreds of thousands of dollars each year. Billing errors and denials can quickly snowball, creating big revenue cycle problems.

One study from BMC Health Services Research found that time spent coding, filing claims and obtaining prior authorizations, cost the U.S. healthcare system as much as $471 billion in 2012.

More facility administrators are sending staff to training classes to get up to speed on the latest guidelines. Properly trained staff far outweighs the expense and hassle factor. With so many training options, it is important to find the best fit for your needs.

But not all training programs are created equally. You have to find the best one to fit your needs. It can be a sound investment in your staff and revenue, or it can be money thrown into the wind if you choose the wrong program.

Instructors shouldn’t just teach students how to pass the test; they should show students how to use their coding books to select codes by hand with specificity and accuracy following current guidelines. By doing so, they don’t have to rely on technology to choose a code that may not be correct. If a denial comes through, they understand how to determine the problem or contest the appeal. Those that pass the test and earn this certification are more likely to code correctly the first time, limit audit liability, and protect the practice’s financial health, which can save providers thousands of dollars each year.

There are other important factors to consider such as choosing in-person classroom or online training options. Live courses are easily adaptable to fit the unique needs of the students, and instructors can offer personalized attention to those who need a little extra help. With topics such as medical billing and coding, this is especially important because these are complicated topics and a firm grasp of the material is essential for success.

Many people associate online learning with greater accessibility and cost savings. However, there are also tradeoffs to consider when choosing online training courses over live, instructor-led learning opportunities. For example, participants attending live classes report increased focus on presentations and question and answer sessions. Classroom interactions can lead to a firmer grasp of the course materials, as well as a greater appreciation for the knowledge gained.

Training classes help offices deal with compliance issues, coding rules and updates, insurance provider guidelines and patient satisfaction and engagement, which is becoming more and more important for the new reimbursement models that are coming into play.

In the classroom, students get hands-on practice to utilize new skills before implementing them in the work environment. They also get to meet people from other departments and facilities, and build working relationships that complement and strengthen their own skills and knowledge.

There are drawbacks and advantages for both online and live classroom training. Online training definitely offers convenience and flexibility that classroom training lacks. But I think the value of that face-to-face instruction and classroom interaction is something that is hard to replicate in an online format. The key is that you don’t want to sacrifice the instructor-led component. There is tremendous value in this. The materials are the outline, but instructors bring it all together by explaining concepts and reviewing hands-on exercises. Their real-world experience adds a dimension to the course that is sometimes lacking in online training.

David Womack, is president and CEO of the Practice Management Institute.

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