Standards for judging coding and billing performance should go beyond simple measurement of denial rates. To achieve better assessments, you also should weed out other causes to accurately measure their effect on the bottom line. While practices may have more sophisticated instruments for measuring the performance of their billers and coders, managers are prone to use denial rates — or a clean claim or first pass error rate, if they use a scrubber or clearinghouse — as shorthand.
“Frequently, the performance of a medical coder is judged on the denial rates alone, without looking at the real reason for [the denials],” say Andria Jacobs, RN, MS, CEN, CPHQ, chief operating office of PCG Software Inc. in Las Vegas.
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