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20 CFO / FINANCE 7 Things to Know About Medical Coding, Billing Specialists By Morgan Haefner M edical coding and billing specialists are an integral part of hospitals' and health systems' efforts to optimize revenue cycle management processes. Here are seven things to know about medical coding and billing spe- cialists. 1. Medical coders are tasked with reviewing clinical documentation and designating standard codes using ICD-10 classifications. Medical billers primarily process and make sure claims are sent to payers for reimbursement of services administered by a provider, the American Academy of Professional Coders states. 2. A hospital or a health system may combine the responsibilities of coding and billing into a single department, or may divide coding and billing operations into two separate branches. AAPC states if the po- sitions are separate, medical coders and medical billers work together to assure proper payments and avoid insurance denials. 3. Currently, AAPC has more than 160,000 members worldwide, of which more than 155,000 are certified. 4. e average annual salary for medical coders as of March 29 is $49,872, according to AAPC. Salary data shows the more AAPC cre- dentials an individual earns, the higher their annual salary. e aver- age annual salary in 2016 of members with: • 1 credential (any credential) was $52,605 • 2+ credentials (any credentials) was $60,305 • 3+ credentials (any credentials) was $66,999 5. In 2016, the average annual salary for medical coders and billers in health systems was $52,320, while medical coders and billers in large group practices had an average salary of $49,452. 6. e Bureau of Labor Statistics releases national salary averages for medical billers and coders under the categorization of "Medical Re- cords and Health Information Technicians." According to the BLS, medical records and health information technicians who work in general medical and surgical hospitals had an average annual wage of $43,080 as of May 2015. 7. e medical billing outsourcing market, valued at $6.3 billion in 2015, is expected to reach $16.9 billion by 2024, according to a study published by Grand View Research in October 2016. n CMS Releases Final Rule on Medicaid DSH Calculation: 4 Things to Know By Ayla Ellison C MS issued a final rule March 30 addressing how Medicare and other third-party payments are treated when calculating hospitals' Medicaid Disproportionate Share Hospital payments. Here are four things to know about the final rule. 1. Federal law requires state Medicaid programs to make DSH payments to hospitals that serve large Medicaid and uninsured populations. Under the hospital-specific DSH limit, feder- al financial participation is limited to a hospital's uncompensated care costs. 2. Under the final rule, uncompen- sated care costs include only those costs for Medicaid-eligible individu- als that remain after accounting for payments made to hospitals by or on behalf of Medicaid-eligible individ- uals, including Medicare and other third-party payments. "As a result, the hospital-specific limit calculation will reflect only the costs for Medicaid el- igible individuals for which the hospi- tal has not received payment from any source," according to the final rule. 3. CMS said the final rule clarifies ex- isting policy regarding how hospital DSH payments are calculated. How- ever, the American Hospital Associ- ation disagrees. After CMS released the proposed rule in September, the AHA sent a letter to CMS arguing the rule is more than a clarification and ac- tually establishes new policy. The AHA urged CMS to withdraw the proposed rule. 4. CMS issued its original policy in sub-regulatory guidance in Au- gust. The agency released the fi- nal rule a few weeks after a federal court barred CMS from using sub-reg- ulatory guidance to calculate Med- icaid DSH payments for New Hamp- shire hospitals. n