Certified coding staff could help avoid claim audits

September 7, 2012

With Medicare and other public and private insurance programs stepping up audit and claim review programs, securing prompt payment by avoiding claim errors has become a top priority for many practicing optometrists, according to the Commission on Paraoptometric Certification (CPC).

With that in mind, the CPC introduced its Certified Paraoptometric Coder™ (CPOC) program in 2011, the first coding training certificate program specifically for optometric office staff.

“Recent Medicare reports confirm that claim rejections, denials, and audits are generally the result of common coding errors, failure to provide all of the necessary documentation, or simple clerical errors such as failing to sign forms,” said Amy Kraemer, CPOT, chair of the CPOC Examination Development Committee.

Utilization of properly trained and certified coding and billing staff can be an effective way to help ensure steady practice cash flow by making sure claims are coded and filed correctly, according to Kraemer.

“Paraoptometric coders are responsible for ensuring that all of the information about diagnoses and procedures for patients is accurate and complete,” Kraemer said. “A certified paraoptometric coder can be the first line of defense against non-compliance and improper coding for the practitioner. Beyond helping to ensure prompt payment of claims, a certified coder can help to maintain compliance with state and federal laws. This is especially important since the government has started focusing on identifying and fining or prosecuting for fraudulent claims.”

The CPOC program centers on mastery of common health care billing code systems – the American Medical Association’s (AMA) Current Procedural Coding® (CPT), the International Classification of Diseases, Ninth Revision (ICD-9), and the U.S. Department of Health & Human Services’ Healthcare Common Procedure Coding System (HCPCS) – and the two major reference volumes optometric office staff use to find billing codes and claim-filing rules – the AMA’s CPT Standard Edition coding manual and the AOA’s Codes for Optometry.

In addition to the coding systems, the program covers anatomy and physiology, medical terminology, medical records, claim filing, and compliance matters.

The coding examination covers both CPT procedure codes and CPT Evaluation & Management (E&M) codes, as well as rules for reporting the proper levels of E&M services on claims.

The CPC’s CPOC Handbook for Candidates outlines a course of study on coding and billing.

A new CPOC Study Map provides a list of study resources, links to online materials, and suggested references according to the subject matter.

The AOA Paraoptometric Section has made available Introduction to Insurance Processing Study Flash Cards and more recently, a series of live webinars for billing and coding beginners.

The CPOC examination is open-book and consists of 150 multiple choice questions. Candidates have three hours in which to complete the examination.

The CPT Standard Edition and Codes for Optometry are the only reference books permitted for use during testing.

“The examination is designed not just to test specific knowledge but to make you think about the code book and say: Now where would I find that?” said Kraemer.

The CPOC examination is administered five times each year (in February, May, June, August, and November) at PSI exam locations around the nation and each June at Optometry’s Meeting®.

Paraoptometrics can still register for this year’s remaining coding certification examinations, which will be administered Nov. 3-17 (registration deadline is Oct. 12).

Applicants must have a minimum of a high school diploma or equivalent, and must have a minimum of two years employment in the medical coding and billing field.

The examination fee is $240.

The 2012 edition of Codes for Optometry and the CPT Standard Edition are both available from the AOA Marketplace online store (www.aoa.org/x12590.xml).

For additional information see the AOA Web site CPC page (www.aoa.org/x4989.xml).

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