The Case for Certification

As a Medical Office Manager, you are faced with many challenges as it relates to practice revenue:

  • Patient visits are down;
  • Reimbursements are down;
  • Patient collections have increased as more and more patients have either high-deductible insurance plans or no insurance at all;
  • You’re faced with the continued threats of additional Medicare cuts; and
  • Your odds of an insurance audit (especially Medicare) have increased as insurance companies look to recoup what they consider to be overpayments.

While you may be looking for ways to decrease practice costs, there is one area in which you should consider making an additional investment – in your billing and coding personnel. Either hire a professional, certified medical coder or consider paying to have one of your top coders become certified.


Insurance billing and coding has become an increasingly complicated process. You need someone in your office who is both responsible and accountable for getting the job done correctly and accurately. Certified coders typically are trained in medical terminology, anatomy and the intricacies of coding. They sit for a certification exam and are required to continue their education to maintain their certification.

Coding rules and regulations change frequently; minimally once per year. The continuing education your certified coder is required to maintain will ensure that your office stays up to date and aware of these changes.

Statistics show that many practices actually undercode because they are afraid of overcoding – even when clinical documentation supports a higher level of service. You may not even be aware that you are doing this but, you are leaving money on the table. Certified coders are trained to select the appropriate code based on the clinical documentation and can help your practice code with confidence.

If your practice is audited, you can be assured that the auditors use certified coders. As a matter of fact, RAC auditors are required to do so. Even the playing field by making sure you have the knowledge and expertise of a certified coder as well.

Do you have a valued coding or billing employee who isn’t certified? Consider paying for them to become certified. You can do this in a number of ways.

  • Have them pay to take a medical terminology and/or anatomy class at a local college and you pay for a Coding Boot Camp and for the actual certification exam.
  • Have the associate pay for the entire process upfront. Once they are certified, you will reimburse them a certain amount for each month or quarter they remain employed by your practice.
  • Offer to pay for the entire certification process up front. The employee makes monthly payments to the practice (ideally through a payroll deduction) for some, all or most of the upfront amount. You ask the employee to make a two-year post-certification commitment to the practice.

Or you could hire someone who is already an experienced certified medical coder. Whichever option you choose, make it a goal to have a certified medical coder in place in your practice within the next 12 months.

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