As healthcare providers and facilities look to fill coding positions, recruiters and human resource directors are doing their best to lure prospects into the fold.

Medical coders essentially provide the framework for all medical reimbursement responsibilities; without them, providers wouldn’t get paid. The sheer number and detail involved in reporting medical procedures, and the ever-increasing demand for data collection and analysis (both from government and private agencies), compliance issues, and variations in coding courses have spurred an increased demand for medical coding professionals.

The problem is that finding qualified individuals to fill basic coding positions has become increasingly difficult. Healthcare facilities from across the nation have felt the pinch and are finding creative ways to ensure that their needs will be met.

The ability to work from home and the use of flexible scheduling, along with offering more competitive pay and a low-stress work environment, are among the most effective recruiting strategies that healthcare providers are using to recruit coders.

Telecommuting
A good example of addressing the reality of establishing a home coding system that works is a news story about a hospital in the southwest that has 900 beds, 30,000 inpatients and 220,000 outpatient visits each year. Twelve fulltime coders, five part-time and two quality reviewers were traditionally employed, with plans to expand adding additional coders.

Since the hospital is located in a major metropolitan area, many people did not want to drive to the downtown area. The hospital was using an EMR (electronic medical record) system, allowing access to it remotely. The administration ultimately approved setting up a couple of coders at home. It worked.

Municipal planners have initiated studies relating to attempts to lessen the commuter traffic in every metropolitan area. They discovered that with work at home options and flexible scheduling, there was a measurable effect on productivity from the employees. That was certainly predictable. Not to mention the decrease of congestion on the roads and benefits of decreasing pollution.

This strategy has worked so well that the hospital has had a 190% retention rate since making the switch to remote coding. A natural result (from our standpoint) was the coding staff job satisfaction increased substantially as did production to the extent that no new staff needed to be hired over a period of two years.

New Opportunities
There is a larger demand for data collection and data analysis and significant newly enacted compliance issues and law requiring more companies to do coding audits (retrospective analysis). Career advancement opportunities move into compliance consulting, data analysis for reimbursement and internal coding audits. But the basic coding skill sets are required to move to any of those levels.

What Qualifications are Needed?
The credentials and experience needed to fill hospital coding positions can depend on several variables: whether the facility is rural or urban, a teaching hospital or research center, as well as the facility’s specialty areas. Most try to hire coders with certification. Coding skills depend on a wealth of experience. Most coders learn outpatient coding (and physician services is included in outpatient) and, then some move on to learn inpatient coding.

Clearly, the educational process plays a significant role in the current coder shortage. They’re not being trained fast enough to fill the need. Experts in human resources encourage people to go to e-learning to save time and get into the field. Degree’d programs are out there, but not required to do the job.

Advice to wannabee coders is to carefully examine the training curriculum, which should include courses in terminology, law and ethics, coding, and billing. Coding and billing work hand in hand in light of today’s compliance and regulatory issues as well as Medicare and Medicaid issues.

Many experienced healthcare professionals are turning to coding as a way to use their healthcare background in a new way. For example, many who have been engaged in ancillary care or nursing often cross over to learn coding skill sets because a coding position offers greater schedule flexibility, consulting opportunities and home-based working applications.

The Future
Human resource departments view coding as one of the up-and-coming “hot jobs” and believe it’s important to educate people that there are indeed other health care fields besides patient care that are challenging and profitable.

You hear much in the news particularly in the medical community about electronic health records (EHR) and/or electronic medical records (EMR).  An EHR is a technological method to input individual health records in a digital form where they are stored and accessed with a computer.  The records may include single locations (clinics/hospitals) or a site that stores multiple records accessible by careproviders from virtually anywhere.  A variety of types of healthcare-related information may be stored and accessed in this way.

What Type of Information Might be Included?

• Patient demographics
• Medical history, examination and clinical notes .
• Drug use and interactions, allergy and immunization history.
• Laboratory test results.
• Radiology images (X-rays, CTs, MRIs, etc.)
• Photographs, endoscopy, surgery, clinical
• Historical recommendations for specific medical conditions
• Appointments and other reminders.
• Billing records.
• Eligibility information on insurance protocols
• Advanced directives, living wills, and health powers of attorney

What is the Current Method of Producing and Managing Medical Records

First, think of all the variables involved with a record.  The patient visits the doctor’s office, a record is developed there, demographics, history, treatment information, drugs recommended and their interaction, and the outcomes.  The services are then billed and all of the billing from initiation to payment and writeoffs must be maintained.  The patient may be referred to another care element, laboratory, x-ray, etc., and that entity then establishes its own record.  It returns the results to the referrer which are now added to the referrer’s patient record.  Now there are two distinct records created for the same patient.

When a patient is hospitalized, the same process is required.  The hospital creates all of its treatment records, billing and payment information.  The related treatment records are provided to the physician who managed the care of the patient.

When the patient is referred to a specialist, s/he then needs a copy of the patient record, and in turn, develops her/his own version, communicating the findings back to the referrer.

Medical facilities typically pay the highest costs per square foot for the space they occupy.  Physical storage requirements for the potentially huge amount of hard copy data that is placed in file folders and filed in file cabinets is costly.  When the hard copies are no longer required to be maintained, electronic methods are used to scan and store them.

With storage in so many different locations, transporting or communicatring the information for review by a provider is time-consuming and may affect the quality of care.  The way the information is communicated is the very core of the need for Health Information Portability and Accountability Act (HIPAA) regulation and the compliance requirements.  HIPAA requirements were designed to protect health information.

With all of the disparate participants involved in managing the record, in the early 1990s, an estimate was made that one in seven (14%) hospitalizations occurred when medical records were not available. Additionally, one in five lab tests (20%) were repeated because results were not available at the point of care.

Implementation of electronic medical records are estimated to improve efficiency by 6% per year with the expectation that a fair amount of the cost of an EMR would be offset by the savings gained in not repeating unnecessary tests or require hospital admission.  Not to mention at all the costs of litigation involved in the issues of quality of care.

Standardization is the goal for EMRs as well.  Currently, handwritten paper records are associated with poor legibility (contributing to both medical coding and medical billing errors).  EMR would help with the standardization process to include forms, terminology, abbreviations, data input and retrieval.

What are the Potential Benefits?

• Access to a full record reduces medical errors (which improves quality of care) since the problems and treatment history are ideally available immediately, rather than through other slower forms of communication (phone, fax, and snailmail)
• Increase physician and staff efficiency, and reduce costs
• Standardization of elements of health care documentation and interchange of such information
• Data collection for clinical and epidemiological analysis

Implementation to Date

Aside from the Veterans Administration Healthcare system, the vast majority of healthcare transactions in the United States still take place on paper, a system that has remained unchanged since the 1950s.

As of 2000, adoption of EHRs and other health information technology (HITs) (such as computer physician order entry (CPOE)) was minimal in the United States (outside of the VA system). Less than 10% of American hospitals had implemented HIT, and 16% of primary care physicians used them.  In 2001-2004 only 18% of ambulatory care encounters utilized an EHR system.  In 2005, 25% of office-based physicians reported using fully or partially electronic medical record systems (EMR), an almost one-third increase from the 18.2% reported in 2001. However, less than one-tenth of these physicians actually had a “complete EMR system” (with computerized orders for prescriptions, computerized orders for tests, reporting of test results, and physician notes).

The healthcare industry spends only 2% of gross revenues on HIT, which is meager compared to other information intensive industries such as finance, which spend upwards of 10%.

What is the Government’s Position?

With federal directives pushing for the HER, in September of 2008, Congressman Stark and eight co-sponsors introduced the Health-e Information Technology Act of 2008.  According to Stark, chairman of the House Ways and Means Subcommittee on Health, the bill is designed to promote the adoption and meaningful use of health information technology.

The bill builds on measures already proposed in the PRO(TECH)T Act, H.R. 6357, introduced July 23 by John Dingell and under consideration by the House Energy and Commerce Committee.

The new bill includes measures that would provide clear deadlines and standards to spur development of HIT systems, incentives to drive healthcare IT adoption and strong rules to protect the privacy of personal health information.

According to Justin Barnes, chairman of the EHRA (formerly the Electronic Health Records Vendor Association), “There are some good points in the bill around HIT adoption incentives, and the privacy and consent language is much better than (the PRO-(TECH)T Act). But the negatives in this bill outweigh the positives right now.”

Mr. Barnes stated it would modify the HIPAA Act of 1996 and extend to business associates the same protections and penalties that apply to physicians, hospitals and other providers. “This is a dramatic change to HIPAA, and we need to take a closer look at the ramifications and burdens it could place on this industry.”

In addition, patients would be able to request an audit trail of medical record disclosures and civil monetary penalties would be increased for violations of federal privacy rules. “This is of great concern as well and we need to take a closer look at its ramifications and burdens placed on care providers.”

Federal Initiatives and Status

Visit the website of the Office of the National Coordinator for Health Information Technology (ONC).  A good overview of the objectives and progress is available, plus a list of IT related articles.  http://www.hhs.gov/healthit/chiinitiative.html

Summary

The benefits are clear.  The problems are many, but EHRs are becoming more and more of a reality.  As with any major change, the opportunities for newly described emerging jobs, positions and responsibilities will follow.

The health care industry continues to represent the fastest growing segment of our nation’s economy. Increasing numbers of trained career-oriented professionals enter this promising field each year, sharing common goals, interests and needs. To help providers and employees meet their goals we offer certification and continuing education services.  If you are considering becoming a Medical Coding Specialist, we have the resources for you.

Certified Medical Assistant (CMA & CMAA)
Certified Coding Associate (CCA)
Certified Medical Transcriptionist (MTC & MTCX)

Looking to be a Medical Billing Specialist instead?  We also offer Legal Certifications.

The old faithful of industries – health care – booms in good times and bad. You just can’t escape the fact that the human race continues its struggle with disease and its consequences. This means there will virtually always be a demand for health care services with all of the professionals involved in care-giving from billers to doctors. Add the actuarial problem of our aging population with the baby boomers entering retirement in droves, and succumbing to the diseases of the elderly and it is clear there is a demand for services which is steadily increasing.

The Department of Labor predicts that 3 million new jobs will be added to the health care payroll between 2006 and 2016. This makes the medical profession — including occupations ranging from home health care aides to physicians to pharmacists — the number 1 fastest-growing industry in the U.S., an astonishing 7 of the 20 fastest growing occupations are in health care. Look for opportunity in these jobs:

Medical Records, Health Information Its (coders, billers, transcriptionists), practice managers, etc.

If you need to learn how to perform in many of the medical careers, go here:

Training: http://www.med-certification.com/medical-career-training

AND: Earn $100 referral fee for anyone you refer for training

EMAIL: info@med-certification.com

If you are a Medical Transcriptionist and are looking for work, we have JOBS!  You will need 2 years of experience in general medical (acute care) to qualify. Email info@med-certification and include a brief resume.

If you are already trained and need to review available jobs or gather ideas:

Jobs:

http://www.careerbuilder.com

http://www.nationjob.com/medical

http://www.medhunting.com/

http://www.healthjobsusa.com/

http://www.careerjet.com

http://www.mtdaily.com

CBS Certification

This certification demonstrates an individual’s skill and experience in the intricacies of patient billing and accounts receivable management. The individual must also know how coding works and its impact on the billing process. The knowledge should include: Medical terminology, collection and verification of patient demographic and insurance data, insurance processing, statement generation, tracking and managing and reporting receivables, complete understanding of patient privacy issues and the related law. They will have a good working knowledge of various billing functions and responsibilities. Note: CBS includes Health Insurance Specialist Testing (HIS) so do not order HIS separately.

Eligibility

To achieve certification, an individual must have completed an educational training course in medical billing or have 6 months’ experience in a medical provider’s office. Meditec.com’s training course will provide the six-months’ experience for this or any certification test.

Practice and Certification Testing

Cert-blaster: Billing competency related to the complete billing process with case scenarios and exercises on patient profiles, writeoffs, co-payments, delinquent account management, and HIPAA. The practice test simulates the type of questions that are on the certification test. The tests are on-line, take about an hour or so, are open book, and when submitted, you are provided the answers to the questions for your review and further study (if needed).

Exam-Guard: The certification test takes 2 hours, is timed, and the results are immediate and reported to you within 48 hours. The test is reviewed by an instructor prior to issuing the final grade and certificate.

If you would like to learn this interesting career, call us 888-771-1902. Or Read about it Here:Career Training

PRACTICE TEST – $99.00

CERTIFICATION TEST – $239.00

CALL TO ORDER:  801-771-1902

At Med-Certification we monitor the industry trends and flag any problems. With the 25 years experience in training and certifying coders, we know the problems in order to provide appropriate solutions. Here’s the latest:

Emerging problems: Hospital coders are often now required to provide CPT coding which they have not been trained to do. Medical codes include the diagnosis codes (ICD) and physician- provider codes (CPT). Providers in private practice use the CPT codes to describe the service performed in their offices. They use the diagnosis codes to describe the disease, injury or symptom. Hospitals use the ICD codes as well, but until recently, had no application for CPT codes since they are institutional providers.

With the growing trend of physician private practices being acquired or controlled by various health care systems (hospital groups), the hospital entity now is providing the coding and billing of professional (CPT) services and in many cases is becoming centralized, taken out of the physician practice and brought to the responsibility of facility coders. However, the fact has become apparent that in most cases there is a lack of physician-oriented coding experience in the facility setting where the skilled coders in inpatient and/or outpatient services are typically found. Those coders are feeling the pinch, too. They face the challenges of learning to code the physician services. Coding errors on the CPT codes can certainly impact the practice’s bottom line as well as create potential compliance problems, especially in the tangled virtual environment of transmittals, “Change Requests” and official guidelines issued by the Centers for Medicare and Medicaid Services (CMS) for federal claims.

Some of the features of the CPT coding are markedly different than coding for inpatient care, and even though coding for CPT services is somewhat similar to outpatient services, the differences between the two are still numerous, especially considering all of the outpatient prospective payment system (OPPS) rules/regulations. A few simple steps may help the private practice physician to alleviate selected aspects of the transitional stress such as sharing charge  capture documents (e.g., superbills), transferring electronic code tables, and so forth. This data will be immensely beneficial to the facility’s coding staff. But what are the major points of CPT coding that physicians should be aware of before and during practice migration? There are four major audit areas that providers should know to ensure the CPT services are coded accurately and within compliance standards:

1. Aspects of ICD-9-CM diagnosis coding
2. Evaluation and Management (E/M) services coding
3. Modifiers used with the codes
4. HCPCS Level II codes and their respective units reporting for drugs and biologicals.

ICD-9-CM official reporting guidelines fo private practice are the same as those for outpatient services, but certain areas of the guidelines tend to cause confusion for the hospital coders simultaneously performing inpatient, outpatient and the provider CPT coding duties. One area typically found on audit is the incorrect coding of “probable,” suspected,” “rule out” and “versus” diagnosis code differentials as confirmed diagnoses. This mistake is frequently made by inpatient coders also tapped to do periodic outpatient and/or the CPT services, since under inpatient ICD-9-CM coding rules, the inpatient coder can assign a “probable” or otherwise unconfirmed diagnosis with a code for a confirmed condition or illness.

Coding from diagnostic reports has also been an area of difficulty in scenarios where facility coders are tasked with coding these professional fee services. It is an area of perennial confusion between coders in the various health care settings. The bottom line: in professional fee settings any test findings, impressions or abnormal test values provided in laboratory, radiology, pathology and other ancillary test reports are not coded as specific, confirmed diagnoses unless the treating physician has acknowledged those particular findings, impressions or results, thereby indicating their clinical significance (in the absence of confirmed diagnoses for abnormal labs, there are appropriate code selections from Chapter 16 “Symptoms, Signs and Ill-Defined Conditions” of Volume 1, ICD-9-CM). This can be achieved by the treating physician in a variety of ways but typically is found when the physician signs/initials the test report and frequently adds patient-specific comments or – in the optimal documentation scenario – the physician documents the test results in a confirmatory way in the patient’s progress notes, or other report data, together with commentary or assessment on the test findings.

Evaluation and Management (E/M) services such as office visits, inpatient hospital visits, observation services and other such cognitive services tend to have CPT codes assigned based on the extent of the case documentation and the degree of “key component” fulfillment under professional fee coding. This approach differs significantly from facility E/M coding wherein tally or point systems are utilized, grading the various services and items not separately billable to account for resource expenditures, and adding up the points into a facility level E/M code.

For example, Emergency Department visits can vary in facility E/M levels based on nursing and other assistive services provided to the patient, as well as various interventional efforts and other considerations such as the patient’s age (e.g., an infant might require more intensive staff triage effort), the nature of the presenting problem (e.g., a myocardial infarction presentation will automatically engage certain facility responses accounted for at a specific assessment point value), special care, etc.

While these are also factors in the professional fee assignment of an E/M code, for physicians and nonphysician prorviders, the final code assignment for E/M services is only reflective of the degree, quality and content of documentation of three key components:

• History, physical examination and medical decision making.

These distinct E/M components all mesh together for appropriate code selection under either the E/M Documentation Guidelines which establish the basis of the service and in the chart documentation for E/M codes. Facilities do not follow these E/M documentation guidelines but use their own (internal and rarely formal) E/M facility level point-based gradations. The differences between these two approaches to E/M coding, then, are numerous and significant.

The private practice physician must be knowledgeable enough about the coding process to ensure the EM (cognitive) services will be coded accurately.

Modifier assignment, including both CPT Level I and HCPCS Level II modifiers, differ from facility outpatient modifiers in several ways. The number of modifiers available and applicable to provider coding is much greater than the gamut of modifiers for facility outpatient services.

CPT Level I modifiers reported by outpatient facilities include -25, -27, -50, -52, -58, -59, -73, – 74, -76, -77, -78, -79, and -81. Provider coding allows for nearly all of those particular Level I modifiers except -73 and -74 as well as -27 (note: the -27 modifier is not accepted at this time by

CMS as a payment modifier for facility outpatient services; other commercial payers may accept it) Of the HCPCS Level II modifiers, about 40 modifiers are applicable to facility outpatient services while many more are applicable to provider-fee coding. Therefore, the familiarity by facility coders in terms of modifiers may be limited by virtue of the fewer number of modifiers they have dealt with on a regular basis.

Physicians should also ask in which manner modifiers are assigned to cases by the facility; many facilities have moved from hard-coded protocols (via the chargemaster or “CDM”) to soft-coded protocols (via the HIM Department coders or assigned clinic coders) because of compliance concerns, such as indiscriminately appending modifier -59 (Distinct Procedural Service) on line items regardless of the scenario or supporting documentation. A compliance-oriented health system must ensure that modifiers affecting payment and/or enabling the claims to bypass system edits will be appropriately assigned by coders per the documented case circumstances, not by an automated system. For pro-fee coding this is of paramount importance.

A great deal of confusion typically surrounds the assignment of HCPCS-II codes for drugs/ biologicals (with the related units) by facility coders not typically responsible for coding such items (they are most often done with an automated process). In many cases the items such as J0696 Rocephin IM 250mg are “dropped” through the charge capture system to the claims processing module via the CDM from various outpatient clinics, and may not be coded directly from provider documentation. This operational issue accounts for numerous HCPCS Level II code and unit errors found on outpatient clinic audits. Miscoding these products/services can compromise revenue as well as burden the provider with compliance issues. A good solution is to use the provider’s superbill or a workable “cheat sheet.” If these elements are employed and are thorough and up-to-date, it would assist the facility coders of the full complement of HCPCS Level II codes typically engaged by the practice. The facility representatives can then decide if these services should be added to any particular CDM subset in an automated fashion, or if they should continue to be soft-coded by coders.

Transitioning from a private practice into a health system or network setting can bring both rewards and compromises, but in the conversion certain coding and billing issues must be addressed as early as possible. If centralized coding and billing are part of that transition, one of the due diligence issues to address is the level of expertise the health system’s coders have with provider-fee coding. The private practice physician and the facility will avoid revenue compromises and compliance issues by assuring the coders learn the facts on the CPT codes.

If your hospital organization needs help with in service coding training, contact us at http://www.med-certification.com for fast-track training for CPT coding.

Here we have provided some interesting articles, news and information about various related career topics.  Click on any of the subjects and you will find a list of articles to read.  Feel free to share the information with others.

ICD-10 CODING INFORMATION

Earlier this year, officials at the Centers for Medicare and Medicaid Services (CMS) declared that Oct. 1, 2013 would be the firm implementation date for ICD-10, the newest iteration of the International Classification of Diseases (ICD) coding system used on medical claim forms.  The question then became how to handle the transition from ICD-9 to ICD-10, especially as it relates to updating each set of codes during the transition.  CMS officials proposed a “limited freeze,” under which the last regular, annual updates to both ICD-9 and ICD-10 would be made on Oct. 1, 2011. A year later, on Oct. 1, 2012, limited changes would be made to both sets of codes to account for new technologies and diseases.  The next year, on Oct. 1, 2013, limited changes would again be made — but only to the ICD-10 codes, as ICD-9 would be phased out. One year later, on Oct. 1, 2014, the regular annual update to ICD-10 would begin.
In September, the ICD-9-CM Coordination & Maintenance Committee announced that the “limited freeze” proposal had been accepted, paving the way for the transition from ICD-9 to ICD-10 to begin in earnest.

Although ICD-10 codes differ from ICD-9 in several ways — such as the number of characters used in each code and the use of an “x” placeholder — the biggest difference between the two coding sets is the number of codes involved. Because they are more complex and detailed, ICD-10 includes 69,099 diagnosis codes compared with only 14,315 ICD-9 codes.
So far, providers’ progress on switching over to the new codes has been varied. Mostly, people involved are intimidated by the tremendous challenge of the conversion. A major consideration is that MORE CODERS WILL BE NEEDED since the coding process will be magnified significantly, requiring far more codes and detail than were in the ICD-9 process.

Hand-in-hand with preparing for ICD-10 is getting ready for the new 5010 protocol for submitting electronic claims to Medicare and other payers. The 5010 protocol, which goes into full effect on Jan. 1, 2012, replaces the current protocol, known as 4010.  Physicians and other providers who will be using the 5010 protocol have until the end of December to complete internal testing if they want to achieve Level 1 compliance with the new format, Providers and coders (and wannabees) who have questions about either ICD-10 or the 5010 protocol can find resources at the CMS website – CMS.GOV/ICD10/

Is training available for those who wish to learn ICD-10 coding? Meditec and Med-certification are way ahead of the game and will be adding the ICD-10 module before the end of 2011.