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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
www.LibmanEducation.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
2
Just add coders….
www.LibmanEducation.com www.HCTecPartners.com
www.LibmanEducation.com
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
www.HCTecPartners.com
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
www.LibmanEducation.com www.HCTecPartners.com
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
www.HCTecPartners.com
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
www.HCTecPartners.com
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
www.HCTecPartners.com
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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
www.HCTecPartners.com
OIG May 2014
www.HCTecPartners.com
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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.
www.HCTecPartners.com
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
www.HCTecPartners.com
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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
www.LibmanEducation.com www.HCTecPartners.com
Explicit Knowledge:
Formal training
Foundational knowledge
– Medical Terminology
– Anatomy & Physiology
– Pathophysiology (Disease Process)
– Pharmacology
www.LibmanEducation.com www.HCTecPartners.com
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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
www.LibmanEducation.com www.HCTecPartners.com
Training Options
Employer provided (on-the-job
training)
Community College
Specialized training providers
–Professional Associations
–Workforce training companies
www.LibmanEducation.com www.HCTecPartners.com
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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
www.LibmanEducation.com www.HCTecPartners.com
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
www.LibmanEducation.com www.HCTecPartners.com
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What does coder training consist of?
Thorough understanding of the
coding classification systems
• ICD-10-CM
• ICD-10-PCS
• CPT
www.LibmanEducation.com www.HCTecPartners.com
What does coder training consist of?
Formal practical experience with
hands-on coding
www.LibmanEducation.com www.HCTecPartners.com
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Case Study: Maine
Decrease in need for dictation and
transcription
Lack of highly skilled credentialed hospital
coders
www.LibmanEducation.com www.HCTecPartners.com
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
www.LibmanEducation.com www.HCTecPartners.com
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www.LibmanEducation.com
Developing Your Own Coders
Identify key staff
Design program
Create incentives
Training program
Program roll-out
Certification
Internship
www.HCTecPartners.com
www.LibmanEducation.com
Identification of Key Staff
Notified transcription staff of training
opportunity
Screening process
Referral from supervisor
Personal interview
Commitment – time and money
www.HCTecPartners.com
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www.LibmanEducation.com
Careful Selection of Participants
Currently employed transcriptionists
Limited to 12 participants
Knowledge of
–Medical Terminology
–Pathophysiology/Pharmacology
–Anatomy and Physiology
www.HCTecPartners.com
www.LibmanEducation.com
Design the Program
Time/schedule
Budget
Training delivery method
Curriculum
Class size
Expectations
Internship program
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www.LibmanEducation.com
Create Incentives
Tuition reimbursement
Paid time for training
Certification
CEU support
www.HCTecPartners.com
www.LibmanEducation.com
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
www.HCTecPartners.com
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www.LibmanEducation.com
Program Roll-out
Developed organizational policy for training
– Tuition reimbursement
– Paid time for training
– Certification
– CEU support
Reviewed applications
Selection of student cohort
www.HCTecPartners.com
www.LibmanEducation.com
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
www.HCTecPartners.com
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www.LibmanEducation.com
Structure of Training
Once a week meeting for two hours via
GoToMeeting
– Lecture
– Interactive coding exercise
– Questions and answers
Homework assignments
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www.LibmanEducation.com
Measuring Success
Twelve students
Two dropped during the program
Ten successfully passed the CCA exam
All CCA coders successfully employed!
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www.LibmanEducation.com
Food for thought…..
Education is not
the filling of a pail,
but the lighting of
a fire.
-- William Butler Yeats
www.HCTecPartners.com
www.LibmanEducation.com
Questions?
Pamela Haney, MS, RHIA, CCS, CIC, COC
Director of Education and Training
phaney@libmaneducation.com
www.LibmanEducation.com
www.HCTecPartners.com
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www.LibmanEducation.com
Beginning the Process
www.HCTecPartners.com
In late 2013, we saw an increased need for ICD-10 education for our consultants.
www.LibmanEducation.com
Initial Education
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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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www.LibmanEducation.com
Determining Needs
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Pre-hire coding test
HIPAA Education
ICD-10 Education
Continuing Education
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Coding Tests
Coding Tests
Development
Instant feedback
Allows for less human errors in grading
Easy access to update
Keeps records
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www.LibmanEducation.com
New Hire & Yearly Testing
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HIPAA Privacy and Security Course
ICD-10-CM & PCS Assessments
Various skills assessments
Profee
SDS
E&M
ER
Home health
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Education
A&P Course
Medical Terminology
Coding Foundations Skills
Pharmacology
CPT
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www.LibmanEducation.com
When Coding Problems Arise
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Problems identified by audits
Provide specific education Courses
Webinars
Articles
Additional support
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Support
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Support from Libman Education
Twenty-four hour access turnaround
Excellent problem resolution
Emails with updates and coding tips
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www.LibmanEducation.com
Partnership
www.HCTecPartners.com
www.LibmanEducation.com
Questions?
Meredith McCollum, MBA, RHIA, CCS, I-10
CM/PCS Trainer
Compliance Manager
mmccollum@hctec.com
www.HCTecPartners.com
www.HCTecPartners.com
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