Health Information Management

Pay per view: Coder vs. biller

APCs Insider, June 27, 2008

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Does this match have a referee?

The subject can come up at any gathering of HIM professionals: the friction that can arise between billing and coding departments. Conversation about these conflicts has even reached the blogosphere. A thread on Advance’s HEALTHCARE POVblog began with this classic example:

I presently work in an acute hospital setting as an ED coder. Our billing department is constantly reviewing our dx codes (especially for Medicare/Medicaid) accounts, and they are always asking us to look for additional codes to add so that we can get payment. In fact, one biller in particular actually gets into our accounts and adds codes so that payment can be made. I was always taught in school that billing and coding should be at opposite ends of the spectrum, and that neither should have any clue as to what each other is doing nor have access to each others’ work. Doesn’t this constitute fraud? This situation has more than a few of [us] coders nervous!
Click here to learn more about the friction that can arise between billing and coding departments. Briefings on APCs subscribers have free access to this article in the July issue via their online subscriptions.



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