Advice for New Medical Coders - dummies

By Karen Smiley

Working independently — whether you’re working off‐site, as a freelancer, as a consultant, or as a temp — isn’t a good idea for a novice coder. The liability for errors is too much of a risk to both you and the provider.

Incorrect coding leads to incorrect billing, a situation sometimes known as false claims reporting. Fraudulent or false claims submission is a criminal act with serious penalties ranging from payment being taken back by a payer to imprisonment (if evidence of intent by the provider exists) to exclusion from federal programs.

Part of your job as a coder is to make sure that submitted claims are supported by the physicians’ documentation. If the documentation does not support the claim and the error is discovered, the provider is liable for the incorrect payment and possibly additional penalties and repercussions. If the provider for whom you work is penalized, the next head to roll will likely be yours.

Making this kind of error doesn’t make for a good reference, and it presents a definite challenge in any future job interviews. So be proactive about ensuring that your coding is accurate! If you choose to freelance, remain in close contact with the physician’s office and remember that no question is too small. Getting the answers you need from the doc can you save you, and the provider, a lot of hassle when bills are due.

The best thing you, as a novice coder, can do for yourself and future employers is to find work in a medical office, hospital, or billing company to gain experience in the medical profession. These environments introduce you to all areas of the claims process and make you more valuable to the company.

In these environments, you learn the basics in a solid training program, and you learn the rest on the job. Physicians, if you work directly with them, and experienced coders can be wonderful mentors.

After you gain experience, you can branch out into alternative work scenarios. True, working in your PJs and having a 20‐second commute from bedroom to home office is a lovely idea. But realize that you may have to pay some professional dues before your freelancing dreams can become a reality.

There is no substitute for experience. Exposure to the claims process and experienced billers and coders is the key to shaping you into a fully seasoned and very valuable coder yourself.