Sharon performs medical billing and coding at Pearson Physicians Group. The majority of the billing and coding is performed using online billing software that allows for electronic transmission of claims. Transactions reports are generated at the end of each month showing the number of claims filed, accepted, denied, and rejected. Kathy, the office manager, receives a copy of all transaction reports. Kathy has noticed that over the past two months there have been an increased number of denied claims due to coding errors. Upon investigation, she finds that in the original claims the diagnosis codes had transposed numbers and the CPT codes pointed to the wrong diagnosis codes. Kathy decides to discuss the increasing number of coding errors with Sharon. After Kathy shares her findings and concerns, Sharon explains, "Since I am notified, almost immediately, when a claim has been denied or rejected, I am able to go back into the original claim, correct the error, and submit the claim for reprocessing. I'm surprised to see the total number of errors on the report, and even though it may seem like a lot of mistakes, it isn't that big of a deal because it only takes a couple of minutes to correct each claim. The office is still receiving their payments."
Kathy is not pleased by Sharon's response. She says, "Sharon, it is important that you realize you are not managing your time appropriately. Resubmitting claims due to minor errors is a waste of time, especially when these continual errors could have been avoided by simply paying closer attention. Your priority, at work, is to be efficient with your time and proficient with your coding skills. Continually resubmitting claims also delays the reimbursement time. I'd be happy to get you set up with some additional training if you think that will help. However, you must know that this conversation is considered your first warning to get the number of errors reduced. I will be documenting our conversation and placing a copy of it in your personnel file."
1. Review the second boldface statement. Was Kathy's reply to Sharon's response appropriate?
2. Review the first boldface statement. Does Sharon's response indicate her understanding of the concerns regarding the continued errors?
