A career in Medicare and Medicaid coding requires extensive knowledge of all the Centers for Medicare & Medicaid Services policies and procedures. Training programs for certified billing specialists can take anywhere from 10 months to two years and are considered a “hot” job, always in demand.
What is the Difference Between a Coder and Auditor?
After training, coders need to stay apprised of new policies as they come out. One of the more intricate updates to CMS policies covers the three-day Diagnosis-Related Group coding rule and the subsequent 60-day refund policy. As a result of these rules, DRG audits have become increasingly common, so the demand for auditor jobs is also on the rise. Being a certified billing specialist is typically a requirement for an auditor role.
What Is a DRG Audit?
A DRG audit is an examination of the services a patient received to ensure they match the codes billed for the patient’s diagnosis. If an error is found, the codes are corrected, and the payment is recalculated. A DRG auditor can be internal, employed by service providers to review the work of the billing coders, or external, hired on the government’s behalf.
What Is the 60-Day Policy?
If either type of auditor discovers a mistake, they are obligated. If the government finds the error, a letter will be sent to the provider, asking that the difference be returned within 60 days of discovery. If the mistake is found more than six years after the payment was made, then the provider is under no obligation to report it.
Both of these coding careers are in demand, and as a result, salaries and benefits are competitive. More and more employers are considering remote employees for these jobs, so if your personal life is more conducive to working at home, or during non-traditional hours, one of these careers might be the right for you!