Grow Your Own Coders - Amazon Web...

1

Date

Presentation by

www.LibmanEducation.com

Grow Your Own Coders:Training Options for the Modern

HIM World

Presentation by

Pamela Haney, MS, RHIA, CCS, CIC, COC

Director of Training and Education

Libman Education

And

Meredith McCollum, MBA, RHIA, CCS, ICD-10 CM/PCS Trainer

Compliance Manager

HCTec Partners

Healthcon 2016

April 13, 2016

www.LibmanEducation.com www.HCTecPartners.com


Changing Healthcare Environment

Increasing use of EHR

Decrease in need for

dictation/transcription

Lack of highly skilled credentialed

hospital coders

ICD-10 implementation

Increasing audits

www.HCTecPartners.com

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Just add coders….



The dilemma….

Need for inpatient coders

Local community colleges focused

on AAPC coding curriculum or

RHIT track

Newly credentialed coders lack

experience

Coder proficiency varies widely


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Coding Certifications

AHIMA

– Primarily facility coding

– CCA, CCS, CCS-P

AAPC

– Primarily professional services coding

– CPC and specialty certifications

– New facility credentials: CIC, COC

Other companies offer coding credentials

Criteria: quality of the training and employer

acceptance


Certified Coders are Key!

Trained and Certified Coders will:

Ensure you receive appropriate and accurate

reimbursement

Submit claims that can be paid on the first

submission (result = faster reimbursement!)

Verify documentation in the medical record

supports services billed

Provide value to your organization


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Certified Coders Offer:

Proficiency in adjudicating claims for accurate medical coding for

– Diagnoses

– Procedures

– Services in provider-based settings and facility settings

Proficiency across a wide range of services, including

– Outpatient Surgery

– Emergency Department

– Observation

– Inpatient



In-depth understanding of medical coding rules and

regulations

Sound knowledge of compliance and reimbursement

methodologies, including

– Medical necessity

– Claims denials

– Bundling issues

– Accurate charge capture and reporting

Ability to integrate medical coding and reimbursement

rule changes into reimbursement processes


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Knowledge necessary to correctly code diagnoses and

services

– Anatomy and physiology

– Medical terminology

– Disease processes

Utilize the patient’s medical information to verify services

performed, including

– Validation of services provided

– Query providers when necessary

– Evaluate quality of documentation to support claims


OIG May 2014


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OIG Report Findings

GAO: federal government made $62.2 billion in improper Medicare and Medicaid payments in 2013

GAO : “most state and federal programs did not closely examine Medicaid management care payments but focused their program integrity efforts on fee-for-service claims.”

CMS: payments distributed without correct documentation accounted for most of the inappropriate payments.

A bipartisan Senate Special Committee on Aging report: the rate of improper payments in Medicare’s fee-for-service program increased from 8.5% in FY 2012 to 10.1% in FY 2013.


OIG Work Plan 2016

Hospital’s use of outpatient and inpatient stays under

Medicare’s two midnight rule

– Target: comparing hospital stays in previous year to

effective date of two-midnight rule on 10/1/13

Inpatient claims for mechanical ventilation

– Target: MS-DRGs that require mechanical ventilation

Selected inpatient and outpatient billing

– Target: Claims that may be at risk for overpayments

Medicare payments during MS-DRG payment window

– Target: outpatient claims during inpatient stays


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Who would make a good coder?

Healthcare Staff:

– Transcriptionists

– Billing/charge entry

– CDI

– Clinical staff (RN, Med Tech, etc)

– Medical Assistant

Staff who possess both explicit and implicit

knowledge


Explicit Knowledge:

Formal training

Foundational knowledge

– Medical Terminology

– Anatomy & Physiology

– Pathophysiology (Disease Process)

– Pharmacology


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Implicit Knowledge:

On-the-job training, experience, and know-

how

How healthcare services are provided and

by whom

How healthcare institutions work

How to read a medical record

Understand the language of medicine

Sequencing of events

Knowledge of reports


Training Options

Employer provided (on-the-job

training)

Community College

Specialized training providers

–Professional Associations

–Workforce training companies


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Training Options

Is online learning the right answer for me?

Do I need an instructor?

The Key: Find an education partner

you can work with


What does coder training consist of?

HIM principles and practices

– Confidentiality rules

– Documentation standards

– What constitutes a legal record

– How to know when a record is complete


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Thorough understanding of the

coding classification systems

• ICD-10-CM

• ICD-10-PCS

• CPT



Formal practical experience with

hands-on coding


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Case Study: Maine

Decrease in need for dictation and

transcription

Lack of highly skilled credentialed hospital

coders


Case Study: Maine

Repurposing of a team of experienced existing staff into entry-level coders.

Partnership:

– Synernet (employer of transcriptionists and coders)

– Libman Education (coder education)

Solution: Transcription to Coder Training


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Developing Your Own Coders

Identify key staff

Design program

Create incentives

Training program

Program roll-out

Certification

Internship



Identification of Key Staff

Notified transcription staff of training

opportunity

Screening process

Referral from supervisor

Personal interview

Commitment – time and money


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Careful Selection of Participants

Currently employed transcriptionists

Limited to 12 participants

Knowledge of

–Medical Terminology

–Pathophysiology/Pharmacology

–Anatomy and Physiology



Design the Program

Time/schedule

Budget

Training delivery method

Curriculum

Class size

Expectations

Internship program


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Create Incentives

Tuition reimbursement

Paid time for training

Certification

CEU support



Training Program

Customize training to meet needs

Careful selection of participants

Focused and time–limited effort

Realistic expectations

–On the part of the employer

–On the part of the new coder


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Program Roll-out

Developed organizational policy for training

– Tuition reimbursement

– Paid time for training

– Certification

– CEU support

Reviewed applications

Selection of student cohort



Curriculum

Basic ICD-9-CM Using the Book

– Coding Guidelines

– AHIMA Clinical Workout

Basic CPT – Reading an Op report

– Focus on outpatient scenarios

Also:– Test-taking strategies

– Broaden their perspective


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Structure of Training

Once a week meeting for two hours via

GoToMeeting

– Lecture

– Interactive coding exercise

– Questions and answers

Homework assignments



Measuring Success

Twelve students

Two dropped during the program

Ten successfully passed the CCA exam

All CCA coders successfully employed!


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Food for thought…..

Education is not

the filling of a pail,

but the lighting of

a fire.

-- William Butler Yeats



Questions?

Pamela Haney, MS, RHIA, CCS, CIC, COC

Director of Education and Training

[email protected]



mailto:[email protected]

http://www.LibmanEducation.com

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Beginning the Process


In late 2013, we saw an increased need for ICD-10 education for our consultants.


Initial Education


Determined needs of each individual coder based upon type of coder, and if they were I-10 certified

Initially we set up coders with the A&P assessment, followed by the ICD-10-CM/PCS assessment.

Failed assessments = taking the course

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Determining Needs


Pre-hire coding test

HIPAA Education

ICD-10 Education

Continuing Education


Coding Tests

Coding Tests

Development

Instant feedback

Allows for less human errors in grading

Easy access to update

Keeps records


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New Hire & Yearly Testing


HIPAA Privacy and Security Course

ICD-10-CM & PCS Assessments

Various skills assessments

Profee

SDS

E&M

ER

Home health


Education

A&P Course

Medical Terminology

Coding Foundations Skills

Pharmacology

CPT


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When Coding Problems Arise


Problems identified by audits

Provide specific education Courses

Webinars

Articles

Additional support


Support


Support from Libman Education

Twenty-four hour access turnaround

Excellent problem resolution

Emails with updates and coding tips

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Partnership



Questions?

Meredith McCollum, MBA, RHIA, CCS, I-10

CM/PCS Trainer

Compliance Manager

[email protected]



http://www.LibmanEducation.com

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