Obtaining reimbursement for services provided involves not only the clinical team but staff in the business office. These staffs include billers and coders, who each have a specific role when it comes to receiving payment for services rendered. Medical billing clerks interpret medical codes and submit bills to insurance companies, patients, and other agencies for medical services. A medical coding specialist is part of the medical records billing department of a healthcare organization, such as a hospital or a clinic. The coding specialist classifies diagnoses and procedures to facilitate billing and reimbursement from Medicare or health insurance companies. It is very important that each one does their job correctly. The medical coding specialist will be the focus of this discussion question.

You have just been hired as the coding supervisor for Big Wheel General Hospital. You were warned before taking the job that there were some issues with the department. However, you decided you were up to the challenge. Your first task, and probably most important, is to review the noted areas of deficiencies and provide a memorandum to the HIMS Director, Betty Kline, on which are the top two issues to focus on first and strategies to correct the issues.

These are the issues you have identified:

Not coding at the highest level.

Bad documentation/Missing documentation.

Not having access to the provider.

Failing to use current/updated code sets.

Under and overcoding.

Unbundling.