The three year Medicare RAC demonstration that was conducted in California, Florida and New York demonstrated that one of the biggest areas where improper payments were identified was due to improper documentation by the physician.

As a practice administrator you may wondering how to ensure physician documentation leads to proper coding in the billing cycle. You may also be wondering how to go about improving the documentation of the physicians that work in your practice. Proper training and education is critical to ensure that physician documentation is compliant and that it leads to accurate coding and billing.

As the Medicare Recovery Audit Contractors (RACs) roll out nationwide, it's now more important than ever that your practices administrative and physician staff work together to assess documentation risk areas that may be a potential audit risk to your organization. That way once these areas are identified, you can implement proper training and education for your physicians so that any documentation weaknesses will improve and your audit risk will be reduced.

During the demonstration period, approximately one third of improper payments identified by RAC auditors were cited as improper due to the fact they did not meet Medicare's medical necessity criteria for a particular service. Another significant amount of claims were identified as improper was due to the fact there was not enough documentation on requested medical records or information could not be gathered in time to respond to the RACs request. During the demonstration, through March 2008 improper payments totaling more than $391 million were recouped due to medical necessity criteria not being met, with another $74 million being recouped for insufficient documentation.

Here are a few steps your organization can perform to ensure that you will be RAC ready.

Identify Any Risk Areas

The first step is to assess your practice's documentation to identify any areas of risk. By examining past medical records, your practice can identify any areas of risk and the things your physicians may need additional training and education on. This review can be conducted internally if you feel that you have qualified staff that can conduct an independent review of your physician's documentation.

If you don't feel competent about your internal staff performing the review, it is definitely worth considering hiring a qualified third party audit firm to come in and do a base line audit of all of your physician's documentation to identify any compliance issues.

The key whether you do this internally or utilize a third party is to make sure and involve both your clinical staff and administrative staff. Everyone needs to be informed of any defined goals, progress and issues identified so that everyone will buy into doing whatever it takes to correct the identified issues and bring your organization compliant.

Provide Education and Training

If issues are identified, your physicians must be open to receiving training and additional education so that they can learn how to properly document patient encounters. This will greatly reduce your organizations audit risk in the future.

Make sure and also include your administrative and billing staff in the education process. Make sure and use real-world examples from your practice in you training as this is vital to ensuring your organization's documentation is thorough enough for clinical and billing needs.

Training and education should be provided by certified professionals that have the coding and documentation knowledge relating to your specialty.

Education and training should not be a onetime thing but an on-going practice that is implemented into your organization's goals and objectives. The rules and regulations of compliance are constantly changing so it's critical that your organization continued to obtain proper education to ensure that your organization is current with compliance requirements.

Engaging both your physicians and staff in the process of RAC preparation is critical because it ensures that your organization will be as prepared as possible should the RACs select your organization for an audit.



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Medical billing work is a very popular work-from-home option. This line of work is a very profitable career, but also a demanding opportunity. However, if you approach medical billing the right way, you can earn anywhere from $30,000 - $100,000 per year.

One of the main aspects to be aware of in the medical billing field is the large number of illegitimate companies trying to sell you junk. These companies disguise themselves and go to great lengths to appear legitimate. At times, some are legitimate too. The problem with many of these legitimate companies is that they will over-commit and under-deliver.

At times they will sell expensive specialized software, and other times, they will promise you lists of doctors seeking medical coding and billing service providers. Unfortunately, many of these lists are completely made up. No one wants to hand over their hard-earned money to a scammer or careless and unreliable companies, for practically nothing in return. So do your research on any company you are considering purchasing materials or services from.

This line of work does have some requirements, including: a personal computer, special billing software and sound understanding of industry terminology. In order to locate the most effective medical billing course, find out the individual prices for the software and the training.

The medical billing codes are the most important knowledge asset required for this line of work. The codes are assigned to practically everything, such as diagnoses, procedures, health professions etc. Apart from the codes, other important billing details include what to do if the accounts collectible are not paid by the patients or by their insurance company etc.

If you are willing to undergo a training and acquire the appropriate billing software, and are eager to work independently, medical billing might be a good fit for you.

Time is the biggest constraint when it comes to medical billing. In fact, it is common that medical bill review professionals work 10 plus hours per day. However, don't be too aggressive in taking work, as too much work may turn into a problem in itself.

The good about medical billing is that it can free you from having to report directly to a boss. If you decide to become an independent bill review professional, you will be able to work at home, close to your family, while still earning money for your household. In many instances, you will be able to earn more than with a nine-to-five job, since you will be deciding how much work to take on. If you are personally motivated and have ambitions, medical billing might be right for you.

How much work can you expect? Well this varies from company to company. Some companies require 30-50 medically coded invoices per week, others require more or less. Basically, if medical bill review is your sole income, you can decide to take as much work as you wish.




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Medical billing and coding training courses costs a lot, that is why it is very important to find the most valuable course. This article will describe the vital aspects of an effective training course.

A good course will get you up to speed with everything required to become a successful medical billing professional. The majority of the training can be completed online. Online courses are more convenient, and are usually preferred by most people. A thorough training course usually takes about 6 to 12 months to complete. More extensive training, such as an associates' degree programs or bachelors' programs, may be up to 2 to 4years, respectively.

Before you spend your hard earned money, make sure that your training course is accredited by one of the following organizations and bodies: Commission on Accreditation of Allied Health Education Programs, American Health Information Management Association or Regional Accrediting Bodies.

A solid training course will provide you with the necessary expertise for medical billing and coding. This includes being comfortable with registering patients' information, performing an insurance verification, preparing and posting transactions, charging patient accounts, coding and billing insurance claims and collecting patient payments.

By the end of the training, the students usually have a solid understanding and substantial knowledge of the medical terminology and abbreviations, communication techniques, various insurance plans (Commercial, State, Federal insurance plans, etc.), the Accounts Receivable cycle (i.e., registering patients, accounting transactions posting, insurance claim forms' completion, collections, etc.), as well as medical coding and billing itself.

The requirements for the majority of the training courses include: keyboarding proficiency, basic understanding of Microsoft Word, and a good command of written English. Students are usually not required to have any health care work experience.

It is a good idea to take a course provided by a local university or college. The overwhelming majority of these courses are accredited so you don't have to worry about whether your education will be acceptable. Registration takes place at the university or college where medical billing course is being offered. Registration can at times be done over the telephone or online. These courses are usually conducted online, and students may be completely saved from the trouble of traveling to school. Therefore, it's a good idea to search out a university or school which offers the best courses at the lowest fee, without worrying about how far it is located.

A big advantage of medical billing training courses is that they are usually self-paced. You can complete the course at your own pace. For most of the courses, you will get at least 6 months to complete the it (depending on the course). However, if you think you need more time, you can usually extend your course by at least another 6 months.

Some bill review courses may qualify for federal aid, while others don't. If you require financial aid, you should immediately seek additional information at the school or university, where you plan to register. However, there are courses which provide a loans for their students. You should also check with a particular course provider, to find out whether they provide student loans.




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