“I know so much about medical care, surgical treatments and physicians that I could probably speed through medical school!”

Andrew Borden CCS-P, CPC, is the reimbursement manager for the otolaryngology department at the Medical College of Wisconsin. He is also the president and owner of Flash Borden Coding in Milwaukee and has worked at the Medical College for 15 years.

He first started working in the business at night during high school where he handled accounts receivables for anesthesiologists and physical medicine doctors. “I found the knowledge rewarding and the work interesting and endless.”

So, what keeps you going? “I really enjoy handling patient problems and making them happy. I also like to teach doctors about coding, the insurance system and the ethical use of reimbursement tools. Teaching my peers and gaining knowledge about important medical care and innovations is also a must. And, I have to admit I like to show off from time to time. With a good memory, CPT and ICD-9 books are unnecessary. At work, I’m called the ‘walking CPT book.’”

What do you think about coding boot camp? “It helps to confirm some of those ‘gray areas’ in coding. It also allows you to connect with others and to discuss ethical coding practices.”

Borden explains that he was asked to participate in the coding boot camp and to share his expertise.

3 Top Tips for New Coders

Borden likes to talk to people who are considering entering the wonderful world of coding. He says that people who are thinking about going into coding should do these three things first:

1. Learn their anatomy frontwards and backwards;
2. Determine early on if they want to go into facility or physician coding; and
3. Get some early training – either as an intern or on-the-job.

He adds that, “the coding exam is difficult, and if you don’t prepare, or are too nervous, you will mess up. Confidence is key. Also, make sure to use as much logic as possible to rule out answers and narrow it down to two. Keep your chin up and study to build confidence!

What do you do when you’re not coding? I have three children, two girls and a boy. The eldest is starting high school next year. I also just bought a seven-week old Golden Retriever that is absolutely one of the cutest dogs I have ever seen!   Personally, I think I work too hard, too late into the night, and take my jobs too seriously. Thirty years of golfing (and clubs that are even older) make other golfers amazed at my abilities, especially my short game with my bent wedge. I love tent camping and women. Women are the most amazing creatures!

Be a hero yourself. Join the coding community at Supercoder.com.

Your doctors are depending on you to get your practice on board with the new payment incentives.

As Vice President Joe Biden so eloquently put it, the passage of the health care reform bill this past week really is … um … “huge.” And while it may not have been the VP’s very best day on the job, it’s your chance to shine in your job as a medical coder or biller.

Show your physicians you’ve got your eye on their bottom line learning how health care reform will affect their reimbursement. And we’ve got a good place to start.

√ If you work in a family medicine, general internal medicine, or geriatrics practice, take a look at the percentage of your practice’s Medicare charges that are office, nursing facility and home visits. If these E/M services make up at least 60 percent of your total Medicare charges, you may be eligible for a 10 percent bonus payment for these services from 2011–16, says the AMA.

√ If you work in a general surgery practice in a health professional shortage area (HPSA), your practice is on the short list for 10 percent bonus payments for procedures having a 10 or 90-day global. Learn more about HPSAs here.

√ If you code for behavioral health, your clinicians will see a 5 percent Medicare reimbursement increase for psychotherapy visits.

√ If your practice performs preventive services such as immunizations; preventive care for infants, children and adolescents; and additional preventive care and screenings for women, you may see more patients utilizing these services as Medicare and private plans eliminate cost-sharing.

√ If you work in a family practice or ob-gyn practice that treats pregnant patients on Medicaid, your practice will see reimbursement for smoking cessation services.

Let’s give a shout-out to Supercoder.com’s Torrey Kim for alerting us to this cool link from the AMA. And stay tuned to Supercoder.com for more articles on how health reform will change your medical coding job.

Is the Medicare Physician Fee Schedule like Greek to you? Relax. We’ll explain it to you in plain English.

What, exactly, is the Medicare Physician Fee Schedule? I used to wonder that when I first entered the world of coding and billing. The whole big truth of it seemed like such a mystery that for a few years I (sort of) faked what I knew about the MPFS because it seemed like such a basic question with such daunting answers.

Well, here at My Coding Career we can just learn without posing. Consider this your VERY BASIC guide to the Fee Schedule — whether you’re new brand new to coding or whether, like me, you’ve worked for awhile without having the overall picture.

Every year, the MPFS outlines the rates physician practices will get for the work that they do (with some extra money for practice expenses and malpractice insurance supposedly built in).

Under the Fee Schedule, each CPT® code is assigned a relative value unit, or RVU. The RVUs are adjusted based on the practice’s geographic location — because expenses like the practice’s rent vary across the country. The conversion factor is the national dollar amount multiplied by the geographically adjusted RVU. The fee schedule is a big deal because that’s where Medicare sets reimbursement (and lots of other payers follow suit). It’s also the place where CMS makes a lot of rules for your practice to follow if you bill Medicare.

A draft revised fee schedule comes out every July for the following year, and CMS gives us all a public comment period when we can complain about it. That’s when you hear specialty societies ask to be paid more, not less. The final rule comes out Nov. 1. It sits around here until Nov. 10, when it’s published in the Federal Register. It takes effect January 1, 2010.

What? My physicians are getting a 21 percent pay cut? When you read the announcement from CMS about the final 2010 fee schedule, it may seem like physicians are getting their payments cut by 21 percent. Don’t wig out like I did the first few times I saw the fee schedule come out. CMS has to put that in because they’re supposed to be following an old law that doesn’t work very well. Congress always comes in at the last minute and restores the pay cut, and they’ll probably do that again this year.

Your cocktail party conversation about the MPFS: If you want to sound smart or, okay, help your practice prepare for one of the biggest fee schedule changes in recent years, understand that the 2010 fee schedules axes consultation coding and, generally, increases reimbursement for primary care while dramatically decreasing reimbursement for certain diagnostic imaging procedures.

Tip: You can also use the Medicare Physician Fee Schedule as a cool tool to help prevent denials. Learn the moves here.

Have more questions about how to read the fee schedule? Write me and I’ll show you the ropes, or, more likely, find someone who can. Or, if you have other coding topics you’d like us to cover in ‘My Skill Sharpener,’ write us and ask!