Medicare and Medicaid are payers (insurers) like anybody else, only they are run by the government with Medicare covering the elderly and Medicaid covering the indigent. Because Medicare is run by the Federal Government, they also take the lead in defining standards, and in fact have been the market's leading force in going electronic with 837s /835s and EFT payments.

Traditionally, surgeons have first performed a procedure and then dictated their operative notes. Working from these notes, the surgeon or office staff would later code the case. EMR coding systems re-engineer this workflow so that the surgeon first performs the procedure, codes the case, and analyzes the code set. Only then is the optimized code set used as an outline for accurate dictation.


An electronic coding system empowers physicians and ensures correct coding with the supporting documentation.

"Before I began using a coding electronic medical record, I let my office coders submit charges," says J. Brian Gill, an orthopedic surgeon at Nebraska Spine Center. "But the new coding EMR placed the responsibility squarely on my shoulders. It also helped ensure proper coding even before I began dictating the operative or clinic record. Finally, knowing the appropriate codes enabled me to document my services properly, resulting in improved reimbursement."

For medical offices to contend in today's high-tech society, electronic medical billing and coding is a crucial part of the process. Experts agree that regardless of size, any health care practice will benefit with an electronic medical billing structure they can assemble, not only to provide quality care, but to keep the office financially solvent.

"You only have around 5,000 hospitals in the country and some national providers like Quest who provide lab services, but you have over 600,000 professional providers like doctors, so the 10% who are getting the huge amount of money [around 60% to 70%] are demanding that payers get electronic," says Turi. "The rest are getting 30% to 40% of the money and they are sending out the paper and that's where the inefficiencies are."

So what about those other health care facilities, which account for more than 90% of all payments being processed? The bulk of providers in the country are still getting paper remittance and getting paper checks.

Making Sense Of It All

According to Blair C. Filler, MD, a member of the AAOS Coding, Coverage, and Reimbursement Committee, private committee surveys continue to show that physicians who code their own cases electronically have seen an increase of at least 25% in reimbursements.

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