In today's busy offices, most staff members are performing multiple tasks to keep the office running as smoothly as possible. On top of this there is "The Incredible Shrinking Budget" that most managers are dealing with when it comes to education and training. They have to consider staff turnover, changing regulations, and differing payor guidelines. Managers need to figure out who needs what training and at what level, which is not always an easy task. So, how much coding experience and education does the front office staff need? Do they all need to be certified coders?

Depending on what positions the front office staff fills will help answer the above questions. Let's start with the reception desk. The reception desk is usually one of the busiest places in the office, especially if both check-in and check-out are performed at the same place. The person checking people out definitely needs to understand something about coding. For example, I consulted in a Dermatology office that was losing money. When I looked at some of their claims, code 17003 (an add-on code for destruction of 2-14 lesions, each) was being reported alone. It was also never reported with any units. The front desk person, who checked patients in and out, did not know one code from another. She entered what the physician circled on the encounter form. Add-on codes in CPT are NEVER reported alone as they must be "added-on" to another code. What I did was copy Appendix D (Summary of CPT Add-on Codes) and hung it up at the desk for her. I told her that when she checked people out, she was to scan that list and if there was a code from that list checked and nothing else, she needed to give it to the office manager.

The payment posters are another group that could be a drain to the office if not properly trained. I was once called in to a large facility to perform an evaluation. They had staff members whose sole job was to post payments into the system. They were heads-down data entry people. It was found that when they received EOBs that were paid at less than the claim amount, they were writing off the balances. On some claims they were writing off entire procedure amounts. What we did was put in place a check list for the personnel that had specific criteria along with directions to follow. For instance, if the EOB payment was 70% or less of the claim amount, then they were instructed to send the claim back to the Coders for evaluation and possible appeal. They did not need to understand the coding, just what to look for to send to the Coders.

So here is my educational wish list for the front office, non-coding staff: