Grow Your Own Coders: Training Options for the Modern HIM World

Transcription

1 Grow Your Own Coders: Training Options for the Modern HIM World Healthcon 2016 April Date 13, 2016 Presentation by Pamela Haney, MS, RHIA, CCS, CIC, COC Director of Presentation Training and byeducation Libman Education And Meredith McCollum, MBA, RHIA, CCS, ICD-10 CM/PCS Trainer Compliance Manager HCTec Partners 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 1

2 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 2

3 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 3

4 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 Certified Coders Offer: 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 4

5 Certified Coders Offer: 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

6 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 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 6

7 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 7

8 Implicit Knowledge: On-the-job training, experience, and knowhow 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 8

9 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 9

10 What does coder training consist of? Thorough understanding of the coding classification systems ICD-10-CM ICD-10-PCS CPT What does coder training consist of? Formal practical experience with hands-on coding 10

11 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 11

12 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 12

13 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 13

14 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 14

15 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 15

16 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! 16

17 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 phaney@libmaneducation.com 17

18 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 18

19 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 19

20 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 20

21 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 s with updates and coding tips 21

22 Partnership Questions? Meredith McCollum, MBA, RHIA, CCS, I-10 CM/PCS Trainer Compliance Manager 22