When I graduated from college 15 years ago, there was a big local trend in my area to train RHITs to become utilization review (UR) case managers. In case you haven't heard of UR, they are typically nurses who review medical record documentation against criteria from insurance companies to help the doctors know when it would be best to discharge patients and they help arrange post-hospitalization care if needed. There was a local company created by an RHIT who received her first post-grad job from none other than my mom (also an RHIT) and she promised me an interview when I graduated. See? Networking is important!
Once I graduated, I called in the favor and met with her HR recruiter. The only problem was, I had just finished doing a lot of coding at an internship and I had fallen in love with it. Believe it or not, at that time there were no open coding positions. I used to joke that the only way I would get hired as a coder is if someone moved out of state or retired! So I took the interview at the UR company and it sounded okay. It sounded like something I could do and they were willing to train. They were even willing to give me raise once I passed my RHIT exam.
And then I got the call from my internship supervisor. She was excited to tell me that they had just run the numbers and decided they needed another outpatient coder. She really wanted to hire me as an inpatient coder, but this is what she could offer me to get my foot in the door. It was more money than the starting position at the UR company, but less than I would make at the UR company once I passed my RHIT. But I didn't care about the money, I wanted to code. So I took the coding job and graciously declined the UR position. And I was told by the HR recruiter at the UR company that there was no future in coding - the future was UR.
I'm sure there are still some RHITs out there doing UR, but within a few years of beginning my coding career, the coding industry exploded. We had OIG investigations and new code-based payment systems and a seemingly endless list of things to keep the job new and fresh. Now I look back on that time 15 years ago when I wondered if I was making a mistake because I followed my gut rather than looking at trends. And then I look forward at the challenges we're facing in the future of coding and can say with a resounding "hooray!" - I think I made the right decision!
Is the Future EHRs?
These days I'm starting to hear it again - "Go into electronic health records (EHRs), there's no future in coding." What?! That's absurd! I'm not here to tell you there is no future in EHRs, but don't let anyone tell you there's no future in coding either. The health information management (HIM) field has historically been divided into operations, i.e., managing patient health information, and coding.
These days the most innovative thing to hit operations is the EHR. More hospitals are moving toward EHRs that will allow for better accessibility to patient health information for continuity of care. There are programs popping up everywhere to close the education gap between HIM and information systems and the term "health informatics" is the new buzz term for the early part of the 21st century.
I have a lot of colleagues who are are firmly embedded in EHR implementations. As a matter of fact, my company is an EHR implementation company. But most of us currently working in the field know that while there is an absolute future in EHRs for any HIM professional, coding is not and never will be a dead-end career. And if you can understand how coding relates to EHRs and vice versa, you can be very marketable.
RHIT vs. RHIA
When I received my RHIT, I assumed I would go into management like my mom. She was an RHIT who had been everything from a coder in her early career to director of HIM and quality for a small psych hospital. RHITs are not typically managers, though, they are usually more ingrained in technical work. The associates program for HIM that precedes the RHIT certification exam is loaded with classes on the technical aspects of managing patient information - including coding - with a few management classes thrown in. The bachelors program that prepares one to sit for the RHIA exam is less technical and more management.
What we tell folks is, if they want to manage an HIM program, become an RHIA. If you want to be a technical worker, like a coder or cancer registrar, become an RHIT. But this isn't a hard and fast rule. I recently talked to an RHIA student who really thinks she wants to be a coder, but her fellow students are telling her there is no future in coding, the future is in managing EHR implementations. She really wants to pursue coding, though.
Follow Your Bliss
I'm not really one for corny sayings like "follow your bliss" but this is your career we're talking about. No matter what your educational background - RHIT or RHIA - if you're trying to decide between coding and EHRs, don't let anyone else influence your decision. Even if you're an RHIA who wants to be a coder or an RHIT who aspires to manage some day (it can and has been done!), go after what you want.
And don't let anyone tell you there is no future in coding or EHRs. All I see for the future of HIM is opportunity in every direction I look.
Showing posts with label HIM. Show all posts
Showing posts with label HIM. Show all posts
Sunday, December 5, 2010
Thursday, August 19, 2010
What Does ICD-10 Really Mean to New Coders?
If you haven't heard yet, the coding system is changing on October 1, 2013 from ICD-9-CM to ICD-10-CM and ICD-10-PCS. I have told a lot of new coders and coding students that this gives them a more level playing field when it comes to getting hired on as a coder. But 2013 is still 3 years away. If you are graduating soon and will be looking for a coding position, what does ICD-10 really mean to you? Should you start training on ICD-10 now so that you are well-positioned for the coding switch?
Why ICD-10 is a Good Thing for Wanna-be Coders
I always start with the prerequisite disclaimer when I talk about coders: I am a coder, so I can poke a little fun at our idiosyncrasies. Many coders don't like change. And that's part of what makes them so successful as coders - the ability to work in a routine environment coding patient record after patient record. So to coders who really dislike change, ICD-10 is like an atomic bomb. I've heard some say they will retire or find a new line of work when ICD-10 is implemented. Add those open positions to the decreased productivity that is inevitable with the implementation of a new coding system, health care reform, and the current national coder shortage, and what we have is an awesome opportunity for new coders to enter the field.
Coders who learn ICD-10 in school will likely be called upon by their new employers to share their knowledge of the new coding system with more established coders. Getting into ICD-10 on the ground level means more opportunities for new coders in the future.
Why ICD-10 Coding Jobs Won't be Super Easy to Land
While the need for more coders trained in ICD-10 will be there in 2013 and the codes themselves will be different, the one thing that makes a coder truly special will not change: navigating the medical record, deciphering medical terminology, and applying coding guidelines. These are skills that are not easily taught in school - this is the "experience" that employers are looking for when they say they want two to three years of coding experience. And while new coders right out of school will have oodles of exposure to the ICD-10 code sets, experienced coders will have that other type of experience - the type that goes beyond looking up a code in a book. That skill will still be coveted by employers.
I talk to a lot of people who are pondering changing careers and getting into coding because of what they've heard about ICD-10 and the future need for more coders. But just because we're nearing this massive change doesn't mean that it will be any easier to get hired as a coder in 2013 than it is now. There are many considerations you need to make in determining when ICD-10 training is appropriate for you.
What Kind Of Coder Do You Want to Be?
I have been trained in ICD-10-CM and ICD-10-PCS. The only reason I am trained is because I intend to do a lot of ICD-10 training myself and those who are getting educated now are the educators. I recently had someone tell me she planned to wait a couple years to get trained in ICD-10 because she heard it was so different from ICD-9-CM and she didn't want to have to learn a dying coding system. So let's start with the first question you need to ask yourself: What kind of coder do you want to be?
This is important because ICD-10 is divided into two code sets: ICD-10-CM for diagnoses, which will be used by all health care settings, and ICD-10-PCS, which will be used only by hospitals for reporting procedures. CPT will not be impacted by ICD-10 implementation and the format of ICD-10-CM is very similar to ICD-9-CM (granted all the code numbers are different!). I see the transition from ICD-9-CM diagnoses to ICD-10-CM being relatively easy (notice I said relatively - it will still be a bear!).
ICD-10-PCS is a whole different story. The procedure portion of ICD-10 is set up like no codebook we've ever seen. There is no tabular listing - only a series of tables that allow the coder to "build a code." Furthermore, the level of detail and the coder knowledge required to code an ICD-10-PCS code as opposed to an ICD-9-CM procedure code is astronomical. For example, there is one ICD-9-CM procedure code for repair of an artery. In ICD-10-PCS, the coder will need to know which specific artery was repaired and how that repair was approached.
So when people say ICD-10 is very different from ICD-9-CM, I have to ask, which code set? While the code numbers and code format will be drastically different, the way we code will be the same for ICD-10-CM as it is now for ICD-9-CM diagnosis coding. But ICD-10-PCS is like... well, CPT on steroids. The level of detail in ICD-10-PCS coding is much more specific than what's required even by CPT standards.
Why the long explanation? Well, if you plan to code for a physician office, you won't need to learn ICD-10-PCS. So I say, go ahead and learn ICD-9-CM now because the main change for you will be the code numbers themselves (and a couple of coding guidelines). If you plan to code for a hospital, you need to be prepared for a whole new game with procedure coding when ICD-10 is implemented. The good news is, ICD-9-CM procedure coding really isn't very difficult, so I don't see anyone "wasting" time by learning it now until 2013.
Do You Want to be More Than a Coder?
Let's get one thing perfectly clear here and now. The implementation date for ICD-10 (both CM and PCS) is October 1, 2013. There will be no push on that date. Everyone will be expected to be up and running on October 1, 2013. Rumor has it that this date will get pushed back, but everything I have heard from government representatives says that there will be no push on that date. So spread the word!
Let me get something else perfectly clear: ICD-9-CM will not "die" out. There will be a need for people to know ICD-9-CM diagnosis and procedure coding after October 1, 2013. Particularly if you work in a hospital, data analysis is often performed based on codes and we often compare case loads from year to year to see which services are growing, which are waning, and which are needed in the community that aren't currently offered. In the calendar year 2013, we will have data from both ICD-9-CM and ICD-10. That means a need to be able to crosswalk between codes for data analysis. And someone within the hospital needs to understand both systems. That might be you.
Take the Next 3 Years to Get Experienced
The biggest complaint I hear from wanna-be coders is that all employers are requiring 2-3 years of experience. So if my math is correct, if you wait 3 years to learn ICD-10 and it takes another 2-3 years to get experience, you won't really be working as a coder for another 5-6 years. Why wait? While it doesn't make too much sense to get trained specifically on ICD-10 right now because you won't remember it in 3 years, it does make sense to get hired on as a coder and start positioning yourself to take on a coding position in 2013. This might mean taking an entry-level position where you are exposed to the medical record, codes, or billing. Don't wait till 2013 because there will be a mad dash and employers who have open positions in 2013 probably won't have time to train someone who is complete green. As a matter of fact, I have been encouraging facilities to make education a part of their organizational culture now to lessen the impact of ICD-10 implementation.
Now is the time to hone your skills in coder detective work - where you find information in the medical record, how the patient's symptoms come together in the disease process, anatomy and physiology, medical terminology, and pharmacology. And the good news is, learning this now means you can also apply it to ICD-9-CM now and it will make it easier to make the switch to ICD-10.
Talk to Your School
If you're enrolled in a coding or HIM program or plan to enroll in one, do your homework. Ask the program director or coding instructor what the school's plan is for the ICD-10 transition. They should be referencing timelines like the one posted on AHIMA's website. If they don't have a plan now, you should be concerned.
Don't Hurry Up and Wait
I suppose the best way to sum up this posting is to say this: think of your coding education as a journey rather than focusing on the destination. Go ahead and get trained in ICD-9-CM now - it will not be a waste of time or money. Yes, you will need to train in ICD-10, but if you're credentialed, you will have every opportunity to train through AHIMA and the AAPC. And if you're employed, your employer will be be focused on training as well. Plus, I really do believe that those coders who know both ICD-9-CM and ICD-10 and can analyze and compare data across both code sets will be hot commodities.
Why ICD-10 is a Good Thing for Wanna-be Coders
I always start with the prerequisite disclaimer when I talk about coders: I am a coder, so I can poke a little fun at our idiosyncrasies. Many coders don't like change. And that's part of what makes them so successful as coders - the ability to work in a routine environment coding patient record after patient record. So to coders who really dislike change, ICD-10 is like an atomic bomb. I've heard some say they will retire or find a new line of work when ICD-10 is implemented. Add those open positions to the decreased productivity that is inevitable with the implementation of a new coding system, health care reform, and the current national coder shortage, and what we have is an awesome opportunity for new coders to enter the field.
Coders who learn ICD-10 in school will likely be called upon by their new employers to share their knowledge of the new coding system with more established coders. Getting into ICD-10 on the ground level means more opportunities for new coders in the future.
Why ICD-10 Coding Jobs Won't be Super Easy to Land
While the need for more coders trained in ICD-10 will be there in 2013 and the codes themselves will be different, the one thing that makes a coder truly special will not change: navigating the medical record, deciphering medical terminology, and applying coding guidelines. These are skills that are not easily taught in school - this is the "experience" that employers are looking for when they say they want two to three years of coding experience. And while new coders right out of school will have oodles of exposure to the ICD-10 code sets, experienced coders will have that other type of experience - the type that goes beyond looking up a code in a book. That skill will still be coveted by employers.
I talk to a lot of people who are pondering changing careers and getting into coding because of what they've heard about ICD-10 and the future need for more coders. But just because we're nearing this massive change doesn't mean that it will be any easier to get hired as a coder in 2013 than it is now. There are many considerations you need to make in determining when ICD-10 training is appropriate for you.
What Kind Of Coder Do You Want to Be?
I have been trained in ICD-10-CM and ICD-10-PCS. The only reason I am trained is because I intend to do a lot of ICD-10 training myself and those who are getting educated now are the educators. I recently had someone tell me she planned to wait a couple years to get trained in ICD-10 because she heard it was so different from ICD-9-CM and she didn't want to have to learn a dying coding system. So let's start with the first question you need to ask yourself: What kind of coder do you want to be?
This is important because ICD-10 is divided into two code sets: ICD-10-CM for diagnoses, which will be used by all health care settings, and ICD-10-PCS, which will be used only by hospitals for reporting procedures. CPT will not be impacted by ICD-10 implementation and the format of ICD-10-CM is very similar to ICD-9-CM (granted all the code numbers are different!). I see the transition from ICD-9-CM diagnoses to ICD-10-CM being relatively easy (notice I said relatively - it will still be a bear!).
ICD-10-PCS is a whole different story. The procedure portion of ICD-10 is set up like no codebook we've ever seen. There is no tabular listing - only a series of tables that allow the coder to "build a code." Furthermore, the level of detail and the coder knowledge required to code an ICD-10-PCS code as opposed to an ICD-9-CM procedure code is astronomical. For example, there is one ICD-9-CM procedure code for repair of an artery. In ICD-10-PCS, the coder will need to know which specific artery was repaired and how that repair was approached.
So when people say ICD-10 is very different from ICD-9-CM, I have to ask, which code set? While the code numbers and code format will be drastically different, the way we code will be the same for ICD-10-CM as it is now for ICD-9-CM diagnosis coding. But ICD-10-PCS is like... well, CPT on steroids. The level of detail in ICD-10-PCS coding is much more specific than what's required even by CPT standards.
Why the long explanation? Well, if you plan to code for a physician office, you won't need to learn ICD-10-PCS. So I say, go ahead and learn ICD-9-CM now because the main change for you will be the code numbers themselves (and a couple of coding guidelines). If you plan to code for a hospital, you need to be prepared for a whole new game with procedure coding when ICD-10 is implemented. The good news is, ICD-9-CM procedure coding really isn't very difficult, so I don't see anyone "wasting" time by learning it now until 2013.
Do You Want to be More Than a Coder?
Let's get one thing perfectly clear here and now. The implementation date for ICD-10 (both CM and PCS) is October 1, 2013. There will be no push on that date. Everyone will be expected to be up and running on October 1, 2013. Rumor has it that this date will get pushed back, but everything I have heard from government representatives says that there will be no push on that date. So spread the word!
Let me get something else perfectly clear: ICD-9-CM will not "die" out. There will be a need for people to know ICD-9-CM diagnosis and procedure coding after October 1, 2013. Particularly if you work in a hospital, data analysis is often performed based on codes and we often compare case loads from year to year to see which services are growing, which are waning, and which are needed in the community that aren't currently offered. In the calendar year 2013, we will have data from both ICD-9-CM and ICD-10. That means a need to be able to crosswalk between codes for data analysis. And someone within the hospital needs to understand both systems. That might be you.
Take the Next 3 Years to Get Experienced
The biggest complaint I hear from wanna-be coders is that all employers are requiring 2-3 years of experience. So if my math is correct, if you wait 3 years to learn ICD-10 and it takes another 2-3 years to get experience, you won't really be working as a coder for another 5-6 years. Why wait? While it doesn't make too much sense to get trained specifically on ICD-10 right now because you won't remember it in 3 years, it does make sense to get hired on as a coder and start positioning yourself to take on a coding position in 2013. This might mean taking an entry-level position where you are exposed to the medical record, codes, or billing. Don't wait till 2013 because there will be a mad dash and employers who have open positions in 2013 probably won't have time to train someone who is complete green. As a matter of fact, I have been encouraging facilities to make education a part of their organizational culture now to lessen the impact of ICD-10 implementation.
Now is the time to hone your skills in coder detective work - where you find information in the medical record, how the patient's symptoms come together in the disease process, anatomy and physiology, medical terminology, and pharmacology. And the good news is, learning this now means you can also apply it to ICD-9-CM now and it will make it easier to make the switch to ICD-10.
Talk to Your School
If you're enrolled in a coding or HIM program or plan to enroll in one, do your homework. Ask the program director or coding instructor what the school's plan is for the ICD-10 transition. They should be referencing timelines like the one posted on AHIMA's website. If they don't have a plan now, you should be concerned.
Don't Hurry Up and Wait
I suppose the best way to sum up this posting is to say this: think of your coding education as a journey rather than focusing on the destination. Go ahead and get trained in ICD-9-CM now - it will not be a waste of time or money. Yes, you will need to train in ICD-10, but if you're credentialed, you will have every opportunity to train through AHIMA and the AAPC. And if you're employed, your employer will be be focused on training as well. Plus, I really do believe that those coders who know both ICD-9-CM and ICD-10 and can analyze and compare data across both code sets will be hot commodities.
Thursday, August 12, 2010
The Shortcut to Being a Coding Professional
About 10 years ago when I was working as a coding supervisor in a hospital, I received a phone call from a woman who was asking me how she could get trained to become a DRG auditor. At that time, there weren't a lot of coding schools and the internet was just catching on, so I referred her to the local community college and their health information technology associates degree program. She went on to tell me that she had a masters degree in an unrelated field and she didn't feel an associates degree was necessary. She also didn't want to be a coder, just a DRG auditor. She had an acquaintance who became a DRG auditor without a degree in HIM, so she figured she could too. She heard there was good money in DRG auditing and she wanted to make good money. All I needed to do was tell her where to get the information.
Okay, a quick side note: DRGs are the result of the codes assigned on a single inpatient claim - adding, removing, or changing a code can potentially change the DRG. For example, I recently reviewed a record for a coder and changed just the fourth digit on one code and it changed the DRG. So wanting to know how to audit DRGs without being a coder is like wanting to perform surgery without knowing how to use a scalpel.
Anyway, at that moment, two things ran through my brain. 1) This woman wants the job I consider to be my next step in the career ladder and 2) She just insulted me by seriously underestimating what it takes to be a successful coder, let alone a successful coding auditor.
The Shortcut to Being a Coding Professional
Each week I jot down blog ideas and often the short snippets scrawled on my note pad show a common theme. This week, the theme is summed up by a quote from Randy Pausch in the Last Lecture (I'm almost finished reading!): "A lot of people want a shortcut. I find the best shortcut is the long way, which is basically two words: word hard." And last night as I watched the last night of performances on So You Think You Can Dance, I was further moved by a simple statement by judge Nigel Lythgoe: "People believe they can be a star without working hard."
Now I am not trying to discount this woman's abilities in her chosen field of study. And although I have 15 years of experience in coding, if tomorrow I decided to be a computer programmer, I wouldn't expect someone to hire me because I have 15 years of experience in an unrelated field. I would have to study and become and apprentice all over again. It's a long journey, but the shortcut really is the long way: work hard. Would there be skills I could bring from my background? Absolutely and I would advertise those skills. But if you take one thing away from this blog posting, let it be this. You could unintentionally insult your potential employer by discounting what it takes to get to their level. And insulted people don't hire the people who insult them.
Spending Time in the Trenches
I've been a consultant for over 9 years and the best compliment I receive from a client is when they tell me that they can tell I've worked in the hospital environment and understand the process and issues. It seems simple, but in health care, we do everything differently - especially the business side of health care. Hospitals and physicians have been in business for centuries treating patients. But it's only been the last few decades that it's become necessary to combine the human health care aspect with the concept of running a facility like a business. And that's due to the increase in health care costs and the attempts to try to control those costs. The result is an industry built around human care and retrofitted for finance. How many businesses do you know that operate that way?
When I took a health care finance class a few years ago I already had several years of coding experience and was well versed in how a hospital's revenue cycle works. So as our professor talked about the process, I decided to observe the other students in the class that came from other industries - in particular, an attorney. And as the professor talked about the charge master and codes coming from different departments and payer mixes, the attorney thought it was crazy and unreasonable. It was a completely foreign concept to her. And it will be a completely foreign concept to you too until you get your foot in the door and start observing.
The woman who called me about how to be a DRG auditor eventually got frustrated with me and hung up. I wasn't the first person to give her the community college answer.
Within a few years I was a DRG auditor and I have to say it was one of the hardest experiences I've ever had. We traveled in teams of auditors (safety in numbers!) with our laptops and portable printers. Each time we finished a record that had a coding or DRG change, we printed out an audit sheet and sent the record and audit sheet back to the original coder. At the end of the week, we sat down with the coders and they had the opportunity to refute our findings. It took a few exit interviews and a lot of tough skin to build my abilities as a coding auditor. The terrific thing about coders is that they will dig to find an answer until they can prove they're right. Some of the coders I audited were right. And sometimes (I like to think more often than not!) I was right. My point is, I worked hard and I have a lot of confidence now in my ability to both conduct and defend a DRG audit.
That Annoying Overqualified Coder
I'll never forget my first encounter with a coding auditor. She was very qualified. As a matter of fact, all of my coworkers thought she was overqualified. She was brought in to do an audit of our work and then do some education. We all sat around a table at our first meeting and introduced ourselves. She started. She listed off her years of experience, degrees and credentials, and a long list of states she'd visited and audited. It took her about 5 minutes. And then she turned to her left and looked at me and asked me to introduce myself. My introduction went something like this, "Uh, hi. My name is Kristi and I just graduated and will sit for my ART [now RHIT] exam in October... That's it."
I was humiliated that I didn't have the credentials this woman had. I sounded ridiculous after her 5 minute speech about her experience. Afterward, my coworkers said they found the whole thing hilarious. They were not happy about being audited and most of them thought the consultant was overbearing and way to focused on credentials. They thought my response was perfect. And they all reassured me that no one could possibly expect me to have any experience - I had just graduated!
Now I think back to that consultant. Was she overbearing? Maybe. Did she have experience? You bet. Was she good at what she did? Absolutely. She taught me 2 things: 1) even if you have an encoder, you should always have a CPT code book on your desk because, "The encoder took me there" is not a valid response to why you coded something the way you did, and 2) how to code bunionectomies. That first introduction sticks with me too because now I'm the consultant who to some may seem overqualified. But I will tell you this. It feels so good when someone asks me a question and my answer includes the phrase, "When I was... [a coder, a coding manager, etc]." And I know it gives me credence with the people I'm talking to.
The Brick Walls are There for a Reason
The Randy Pausch quotes will be with me for awhile because so often as I've read this book, I find myself pumping a fist in the air and saying, "Yeah!" I spend a lot of time on thinking and self reflection and much of what Pausch wrote is in line with my thinking. Anyway, another favorite quote is this:
"The brick walls are there for a reason. They're not there to keep us out. The brick walls are there to give us a chance to show how badly we want something."
Yes, it's a quote worth bolding. I have no doubts that if you really want to be a coder and have the skill and talent for it, you will be a coder. The question is, how hard are you willing to work to scale that brick wall? We all started somewhere. People have asked me how I got so far in such a short time frame (15 years). I think I like the answer that Randy Pausch gave whenever someone asked him how he got his tenure so early: "It's pretty simple. Call me any Friday night in my office at ten o'clock and I'll tell you."
Okay, a quick side note: DRGs are the result of the codes assigned on a single inpatient claim - adding, removing, or changing a code can potentially change the DRG. For example, I recently reviewed a record for a coder and changed just the fourth digit on one code and it changed the DRG. So wanting to know how to audit DRGs without being a coder is like wanting to perform surgery without knowing how to use a scalpel.
Anyway, at that moment, two things ran through my brain. 1) This woman wants the job I consider to be my next step in the career ladder and 2) She just insulted me by seriously underestimating what it takes to be a successful coder, let alone a successful coding auditor.
The Shortcut to Being a Coding Professional
Each week I jot down blog ideas and often the short snippets scrawled on my note pad show a common theme. This week, the theme is summed up by a quote from Randy Pausch in the Last Lecture (I'm almost finished reading!): "A lot of people want a shortcut. I find the best shortcut is the long way, which is basically two words: word hard." And last night as I watched the last night of performances on So You Think You Can Dance, I was further moved by a simple statement by judge Nigel Lythgoe: "People believe they can be a star without working hard."
Now I am not trying to discount this woman's abilities in her chosen field of study. And although I have 15 years of experience in coding, if tomorrow I decided to be a computer programmer, I wouldn't expect someone to hire me because I have 15 years of experience in an unrelated field. I would have to study and become and apprentice all over again. It's a long journey, but the shortcut really is the long way: work hard. Would there be skills I could bring from my background? Absolutely and I would advertise those skills. But if you take one thing away from this blog posting, let it be this. You could unintentionally insult your potential employer by discounting what it takes to get to their level. And insulted people don't hire the people who insult them.
Spending Time in the Trenches
I've been a consultant for over 9 years and the best compliment I receive from a client is when they tell me that they can tell I've worked in the hospital environment and understand the process and issues. It seems simple, but in health care, we do everything differently - especially the business side of health care. Hospitals and physicians have been in business for centuries treating patients. But it's only been the last few decades that it's become necessary to combine the human health care aspect with the concept of running a facility like a business. And that's due to the increase in health care costs and the attempts to try to control those costs. The result is an industry built around human care and retrofitted for finance. How many businesses do you know that operate that way?
When I took a health care finance class a few years ago I already had several years of coding experience and was well versed in how a hospital's revenue cycle works. So as our professor talked about the process, I decided to observe the other students in the class that came from other industries - in particular, an attorney. And as the professor talked about the charge master and codes coming from different departments and payer mixes, the attorney thought it was crazy and unreasonable. It was a completely foreign concept to her. And it will be a completely foreign concept to you too until you get your foot in the door and start observing.
The woman who called me about how to be a DRG auditor eventually got frustrated with me and hung up. I wasn't the first person to give her the community college answer.
Within a few years I was a DRG auditor and I have to say it was one of the hardest experiences I've ever had. We traveled in teams of auditors (safety in numbers!) with our laptops and portable printers. Each time we finished a record that had a coding or DRG change, we printed out an audit sheet and sent the record and audit sheet back to the original coder. At the end of the week, we sat down with the coders and they had the opportunity to refute our findings. It took a few exit interviews and a lot of tough skin to build my abilities as a coding auditor. The terrific thing about coders is that they will dig to find an answer until they can prove they're right. Some of the coders I audited were right. And sometimes (I like to think more often than not!) I was right. My point is, I worked hard and I have a lot of confidence now in my ability to both conduct and defend a DRG audit.
That Annoying Overqualified Coder
I'll never forget my first encounter with a coding auditor. She was very qualified. As a matter of fact, all of my coworkers thought she was overqualified. She was brought in to do an audit of our work and then do some education. We all sat around a table at our first meeting and introduced ourselves. She started. She listed off her years of experience, degrees and credentials, and a long list of states she'd visited and audited. It took her about 5 minutes. And then she turned to her left and looked at me and asked me to introduce myself. My introduction went something like this, "Uh, hi. My name is Kristi and I just graduated and will sit for my ART [now RHIT] exam in October... That's it."
I was humiliated that I didn't have the credentials this woman had. I sounded ridiculous after her 5 minute speech about her experience. Afterward, my coworkers said they found the whole thing hilarious. They were not happy about being audited and most of them thought the consultant was overbearing and way to focused on credentials. They thought my response was perfect. And they all reassured me that no one could possibly expect me to have any experience - I had just graduated!
Now I think back to that consultant. Was she overbearing? Maybe. Did she have experience? You bet. Was she good at what she did? Absolutely. She taught me 2 things: 1) even if you have an encoder, you should always have a CPT code book on your desk because, "The encoder took me there" is not a valid response to why you coded something the way you did, and 2) how to code bunionectomies. That first introduction sticks with me too because now I'm the consultant who to some may seem overqualified. But I will tell you this. It feels so good when someone asks me a question and my answer includes the phrase, "When I was... [a coder, a coding manager, etc]." And I know it gives me credence with the people I'm talking to.
The Brick Walls are There for a Reason
The Randy Pausch quotes will be with me for awhile because so often as I've read this book, I find myself pumping a fist in the air and saying, "Yeah!" I spend a lot of time on thinking and self reflection and much of what Pausch wrote is in line with my thinking. Anyway, another favorite quote is this:
"The brick walls are there for a reason. They're not there to keep us out. The brick walls are there to give us a chance to show how badly we want something."
Yes, it's a quote worth bolding. I have no doubts that if you really want to be a coder and have the skill and talent for it, you will be a coder. The question is, how hard are you willing to work to scale that brick wall? We all started somewhere. People have asked me how I got so far in such a short time frame (15 years). I think I like the answer that Randy Pausch gave whenever someone asked him how he got his tenure so early: "It's pretty simple. Call me any Friday night in my office at ten o'clock and I'll tell you."
Friday, July 23, 2010
Now Blogging in Two Places!
If you haven't had the chance to check out AHIMA's HI Careers website yet, you definitely should. Besides all the great information for HIM and coding job seekers, they've recently added a series of blogs from industry pros - including yours truly. I will continue with my Coder Coach blog as well - now you just get to read me in two places! Plus, you get the added benefit of hearing from others as we tackle some FAQs about getting hired in HIM.
AHIMA's HI Careers website
AHIMA's HI Careers website
Friday, June 18, 2010
How the Coder Coach Spends Her Time
You’ve read the blog postings before – I am very passionate about helping folks break into the industry. And as I step on my soap box to tell novice coders to be persistent and network, someone inevitably asks me if I hire new coders. The honest answer is no, but it’s not because I wouldn’t if I had the opportunity. The truth is, as a consultant, I am working with clients who expect - and pay a premium for - experienced coding knowledge. And because I am not in a position to hire new coders, I write this blog, present monthly Coder Coach events, and tweet relevant articles I come across. When I give that answer, the next inevitable question is, “What do you do as a consultant?” So I thought I would take a moment to tell you what I’ve been up to lately – in my day job.
Because I work for a small company, we get a wide array of requests, so to many, my job may seem like a crazy schizophrenic mess. I can’t possibly put down everything I do without writing a small book! So I decided I would take the last couple of weeks and give you the rundown.
I’ve been working with a client for about a year to improve their coding and charging accuracy in the cardiac cath lab. While that may seem simple and straightforward, the client is a large teaching hospital and training the coders isn’t enough – we also need to talk to the nurses, techs, and doctors about documentation. Last week I traveled to the client and presented seven identical training sessions to the nurses and radiology techs in the cath lab on how to improve their documentation. Each presentation was two hours. And that two hour presentation took about a week to prepare for. In between training sessions, there were meetings with cath lab and HIM management and time spent one-on-one with one of the coders who had questions on some cases. I had an extra treat last week when we were invited into the cath lab to see some procedures being performed.
During the evenings last week I put the final touches on two presentations I needed to submit for this week’s AAPC chapter meeting and also met with my boss about a potential new contract that would significantly impact my summer work deadlines. After traveling home, I attended my first board meeting as a director for the Colorado Health Information Management Association where we planned our strategic initiatives for the coming year and I took a few moments to stress the importance of hiring new pros and expressing a need to get more employers on board (I just want you to know that I’m also preaching to my peers!).
This week my time was split between clients as I prepare for training a client next week on injections and infusion coding and follow-up with my cath lab client on the issues from last week and plan the next round of training. I spent several hours analyzing client data and doing a couple of chart audits. Last night I spoke at the AAPC chapter meeting and networked with some folks a bit. Today I will be pulling together the handouts for the next Coder Coach event and again preparing for next week’s training.
Over the coming weeks and months, I have several training sessions to prepare for with clients, client reports that need to be written, and client meetings that need to take place. I am also working on our company’s plan for ICD-10 training, writing white papers on ICD-10 implementation and training and presentations for two AAPC chapter meetings next month. We don't want to think about it, but fall is right around the corner and it's the busy season for consultants as we study the code changes and read the Federal Register for changes to code-based reimbursement for next year. Amid all of these tasks are a myriad of other little “to dos” and more than one project I’m not yet aware of. In my spare time (?!), I blog, network, and do other miscellaneous things for the Coder Coach group and soon will also be blogging for AHIMA's new HI Careers website.
So if you ever ask me what I do and I pause and say, “Um,” it’s because I’m trying to remember exactly what it was I did that day!
Thursday, March 11, 2010
Code Words for Getting Your Foot in the Door
It's the question I am asked most often as a mentor. "How do I get experience if no one will hire me without experience?" The unfortunate reality is that many employers aren't ready to assume the time, effort, and risk associated with hiring a newbie coder. But that doesn't mean that getting a job as a coder is impossible.
If you begin by looking at the job postings in your area for coders and then take a look around your live or virtual classroom at the number of students who will be looking for coding positions at the same time you will be, you can see that it just doesn't add up. In most markets there simply aren't enough coding positions for every coding student. But that doesn't mean there aren't other positions that will allow you to use and cultivate your skills and potentially align you for that coding position.
It can be especially tricky to make your way into a coding position in a hospital if you have no practical experience. The reasons for this are varied: some hospitals don't hire "newbie" coders, some hospitals have so many coding positions open that there are limited entry-level positions available, and some hospitals receive many resumes from both experienced and novice coders and subsequently hire the experienced coders. But this doesn't mean that the door is permanently closed - you just need to know how to nudge it open.
Consider HIM Positions
In the hospital setting, coding is often part of the health information management (HIM) department. While it can be difficult to get a coding position right out of school, it might be easier to get an entry-level position into an HIM department. This may mean assembling or scanning medical record documents, analyzing medical records for missing documentation, abstracting data for core measures and other hospital reporting needs, birth certificate completion, transcribing medical record reports, and working with registries (e.g., cancer, trauma, cardiac).
Many HIM departments promote coders from within when they show promise. Once you have your foot in the HIM department and are working solidly within one of these non-coding positions, though, it is no time to get lazy. Offering to do projects and work on teams that will expose you to coding and coded data is crucial. If you are interested in a coding position, you should never be shy about letting your supervisor know that that is your goal. If a coding position opens up, you need to make sure that HIM and coding management are aware of your interest.
The bonus to a position within HIM is that should a coding position become available, you will already be working for the managers responsible for hiring. You may also be exposed to other areas of health information and data management that you may otherwise miss if you follow the coding track only. The downside to a non-coding position within HIM is that you may still be overlooked for advancement to a coding position if an experienced, qualified external candidate applies for a coding job at your hospital. The dynamics of internal vs. external hires is very organization-specific, though, and there are always exceptions to the rule.
Try Billing On For Size
If you are interested in the billing side of coding, there may be opportunities in the billing (or patient financial services) department within a hospital. Look for positions that require coding skill by reading through the necessary skills. Dead giveaways include positions that require ICD-9-CM or CPT/HCPCS coding experience or "familiarity." Positions requiring "familiarity" with coding typically translate to entry-level positions. This may include working billing edit reports, processing insurance claims, or following up on insurance claim denials.
The benefits of working the billing end of coding are that you will become very familiar with the edit process and what won't be paid based on codes. This could potentially move into other billing-related positions including charge master maintenance. A disadvantage of working in billing is that should you be seeking a position as a coder within HIM, you won't be working for HIM's hiring managers and it could be more difficult to get the position you ultimately desire.
Develop a Plan
Whichever path you decide to explore, you should always take the time to develop a planned career path - even if that path deviates from your career map. Employers want to know what kind of position you are interested in so that they can assess your skill, how to get you where you want to go, and ensure that your career goals are in line with the organization. So take the time to develop a simply laid-out map of where you plan to be professionally within 1, 5, and 10 years.
Whatever path you decide to take, follow it with confidence and commit to learning as much as you possibly can in that position. It will take time to become skilled as a coder and like to many other worthwhile careers, you will get out of it what you put into it. Best of luck to you all!
If you begin by looking at the job postings in your area for coders and then take a look around your live or virtual classroom at the number of students who will be looking for coding positions at the same time you will be, you can see that it just doesn't add up. In most markets there simply aren't enough coding positions for every coding student. But that doesn't mean there aren't other positions that will allow you to use and cultivate your skills and potentially align you for that coding position.
It can be especially tricky to make your way into a coding position in a hospital if you have no practical experience. The reasons for this are varied: some hospitals don't hire "newbie" coders, some hospitals have so many coding positions open that there are limited entry-level positions available, and some hospitals receive many resumes from both experienced and novice coders and subsequently hire the experienced coders. But this doesn't mean that the door is permanently closed - you just need to know how to nudge it open.
Consider HIM Positions
In the hospital setting, coding is often part of the health information management (HIM) department. While it can be difficult to get a coding position right out of school, it might be easier to get an entry-level position into an HIM department. This may mean assembling or scanning medical record documents, analyzing medical records for missing documentation, abstracting data for core measures and other hospital reporting needs, birth certificate completion, transcribing medical record reports, and working with registries (e.g., cancer, trauma, cardiac).
Many HIM departments promote coders from within when they show promise. Once you have your foot in the HIM department and are working solidly within one of these non-coding positions, though, it is no time to get lazy. Offering to do projects and work on teams that will expose you to coding and coded data is crucial. If you are interested in a coding position, you should never be shy about letting your supervisor know that that is your goal. If a coding position opens up, you need to make sure that HIM and coding management are aware of your interest.
The bonus to a position within HIM is that should a coding position become available, you will already be working for the managers responsible for hiring. You may also be exposed to other areas of health information and data management that you may otherwise miss if you follow the coding track only. The downside to a non-coding position within HIM is that you may still be overlooked for advancement to a coding position if an experienced, qualified external candidate applies for a coding job at your hospital. The dynamics of internal vs. external hires is very organization-specific, though, and there are always exceptions to the rule.
Try Billing On For Size
If you are interested in the billing side of coding, there may be opportunities in the billing (or patient financial services) department within a hospital. Look for positions that require coding skill by reading through the necessary skills. Dead giveaways include positions that require ICD-9-CM or CPT/HCPCS coding experience or "familiarity." Positions requiring "familiarity" with coding typically translate to entry-level positions. This may include working billing edit reports, processing insurance claims, or following up on insurance claim denials.
The benefits of working the billing end of coding are that you will become very familiar with the edit process and what won't be paid based on codes. This could potentially move into other billing-related positions including charge master maintenance. A disadvantage of working in billing is that should you be seeking a position as a coder within HIM, you won't be working for HIM's hiring managers and it could be more difficult to get the position you ultimately desire.
Develop a Plan
Whichever path you decide to explore, you should always take the time to develop a planned career path - even if that path deviates from your career map. Employers want to know what kind of position you are interested in so that they can assess your skill, how to get you where you want to go, and ensure that your career goals are in line with the organization. So take the time to develop a simply laid-out map of where you plan to be professionally within 1, 5, and 10 years.
Whatever path you decide to take, follow it with confidence and commit to learning as much as you possibly can in that position. It will take time to become skilled as a coder and like to many other worthwhile careers, you will get out of it what you put into it. Best of luck to you all!
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