By Jennifer Ritter, BS, RHIS, CCS
An often discussed theme in the health information management (HIM) profession as well as the 2015 AHIMA Convention is the ability for facilities to grow their own coding professionals. As coding resources continue to be scarce, having an in-house coding training program on any scale is a viable solution to meeting your facility’s coding needs. Two important keys for success are having senior leadership support and excellent coding instructors. However, the most critical and vital piece of any program is having good coding mentors for when those coding professionals start in the production environment. A good mentor can make or break a potentially successful coding professional.
As any coding professional knows, coding is equal parts knowledge and confidence in code selection. Once a coding professional’s confidence is shaken, the decision making process slows to a crawl. Therefore, the initial mentor plays a key role in developing that trainee coding professional’s coding and coping skills. Even after several weeks of guided record instruction, trainee coding professionals require honing of research, critical thinking and decision making skills. These are the attributes they will need to rely on once they are released from the chart review process into the wilds of the production environment on their own. From working closely with their mentor, new coding professionals learn how to defend their coding and ask appropriate questions, as well as learn how the department processes work—such as the steps to take when an operative report is required for coding. Learning how to construct compliant provider queries is another opportunity for the mentor and coding professional to work together. This relationship will provide the coding professional with the foundation they need to continue their growth in the HIM profession.
In the coding professional development program at my institution we realized the importance of mentorship with our first cohort. Circumstances beyond our control dictated the release of nine new coding professionals at once. Our support staff was stretched thin, and placing nine fresh coding professionals brand new to HIM did not work well for those involved. With a lot of patience and understanding, we survived but recognized this could not happen again. A plan and resources were needed. With our second cohort we partnered with one of our coding vendors to provide some of the one on one mentoring to our thirteen new coding professionals. The vendor staff was familiar with our accounts, processes, and guidelines. We also had an excellent working relationship with them. Internally, we streamlined our processes and added additional mentoring staff to handle the other half of our new coding professionals, as well as assist the vendor mentors as needed.
Our new mentoring plan worked tremendously well. Each mentor was responsible for two new coding professionals. The mentor reviewed 100 percent of the cases prior to billing and feedback was given to the coding professional on a case by case basis. The feedback included explanations of why the coding was incorrect as well as any applicable medical information or Coding Clinic references. New coding professionals need to understand why they are wrong and how to not repeat their mistakes. They require a different explanation from what would be given to a coding professional who has been coding for 10 years. Again, patience and understanding on the part of the mentor is required. If mentors were backlogged the day before DNFB, then new coding professional suspended their coding and read Coding Clinic or worked on research topics assigned to them. On average, coding professionals and mentors worked closely like this for about six weeks. By that time, the coding professionals reached 95% DRG accuracy and were ready to be released from training. However, bear in mind that each new coding professional is different, and may require a little extra time.
The relationship between mentor and coding professional is unique. The coding professional looks to their mentor for guidance and confidence. The mentor must be an excellent communicator, educator, and sometimes therapist. When a new coding professional is having a bad day, their mentor needs to reassure them and get them back on track mentally. These mentors must be people that management can count on and trust. Not everyone possesses the ability to be a mentor and that is fine. It’s also important to note that the mentoring relationship does not cease when the coding professional is released from training. The mentors continued to keep open lines of communication with their coding professionals. This is especially important if your staff works in a remote environment like ours. We want to ensure no one feels like they are alone on an island. I also serve as a mentor to each of our new coding professionals since I was their instructor and now manager. I make sure my “door” is always open for whatever they may need. A happy coding professional is a good coding professional.
Since implementing this mentoring plan, we have successfully developed 25 new coding professionals and are in the midst of hiring an additional thirteen coding professionals. All of our new coding professionals are stronger and more confident in their work. They have become excellent researchers and composers of provider queries. Several have even expressed interest in becoming mentors themselves once they have acquired enough experience. Our staff wants to pay it forward, and this is truly priceless—not only for our department, but also for the HIM profession.
Jennifer Ritter (firstname.lastname@example.org) is coding manager and educator at University of Pennsylvania Health System.