Thursday, April 18, 2024

Best Practices for Managing Medical Billing Codes in Small Practices

Medical billing codes, also known as CPT codes, are a really important part of operating a successful medical practice. The people at explain that these codes help when it comes to communicating vital information to insurance companies about the services provided, while allowing practices to receive proper reimbursements. For small practices with limited staff and resources, effectively managing these codes can be challenging, but it is extremely important for remaining financially viable. 

Understand the Coding Guidelines

The first step is ensuring someone in the practice has a solid foundational understanding of CPT coding guidelines. These guidelines, updated annually by the American Medical Association, provide instructions on how to assign codes to medical services appropriately. For small practices, it is beneficial to have at least one staff member trained and educated in these guidelines. Some ways to gain proficiency are taking courses, studying educational materials, and sitting for a medical coding certification exam. Having coding expertise in-house helps with accurate code assignment.

Use Code Auditing Software

Manual auditing of codes is time-consuming and easy to fall behind on. Leveraging software that automatically audits codes against medical documentation can help small practices stay on top of errors or potential issues. The software flags suspicious or unlikely code combinations, missing required codes, upcoding concerns, and unbundled services. This lets staff quickly identify areas that need attention rather than reviewing each and every code. Some software programs also suggest more appropriate codes based on documentation, which then helps to improve accuracy.

Check Code Denials and Rejection Rates 

Routinely checking reports for denial and rejection rates of billed codes also helps reveal areas that need improvement. High denial rates for a particular code or set of codes might mean inconsistent documentation, inappropriate code selection, or issues understanding a payer’s policies. Use denial reports to track top reasons for denials and train staff accordingly to avoid repeated issues. You might also appeal denials you consider inappropriate or where supporting medical necessity documentation exists. Tracking rejection rates helps determine codes at higher risk for future denials.

Stay Up to Date on Code Changes

Medical billing code sets are updated at least annually with new, revised, and deleted codes. Guidelines around existing codes also evolve year to year. To assign codes accurately, small practices must actively stay on top of these changes each year. Review updated Medicare fee schedules and coding manuals. Check for updates published in coding newsletters or online resources. Not accounting for deletions or major revisions might mean the practice loses out on rightful reimbursements. 

Prioritize Ongoing Training  

With constant code set changes and evolving insurance requirements, ongoing CPT coding education is a must. Smaller practices may not be able to send staff to attend expensive conferences. However, remote or online training programs offer affordable options—some even specialize in the needs of smaller practice settings. Identify cost-effective resources for keeping coders’ knowledge sharp. Consider setting minimum annual training requirements to ensure competencies remain up to par.

Leverage Outsourced Coding Assistance

Even with the above best practices, sparse staffing can still challenge smaller practices’ coding capacities and lead to claim issues. Outsourced medical coding services provide relief for overwhelmed in-house teams. External professional coders stay completely current on medical coding regulations, guidelines, and payer policies. Practices send these outsourcers their documentation, which gets coded by specialized teams. The checked codes then get returned, ensuring completeness and accuracy. While adding costs, outsourcing coding relieves internal burden and reduces costly claim rejections and rework.


Effectively managing medical billing codes presents distinct challenges for smaller practices with limited staffing and high caseloads. However, with strong coding protocols and leveraging available technology and expertise, small medical practices can attain effective control over this vital administrative process.

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