Questions and Concerns for Coding Professionals in 2020

As the role of health information management (HIM) professionals continues to evolve, we must prepare for significant changes and trends in medical record coding in 2020 and beyond, including the move to value-based reimbursement, single-path coding, coding social determinants of health (SDOH), and reporting directly to revenue cycle. As HIM and coding professionals prepare for the year ahead, it’s important to recognize the pressing questions, concerns, and challenges facing coders just entering the field, coders pursuing a new position, and coding managers.

Advice for New Coding Professionals

• Is this an organization that offers experiential learning and support?
• Will I have reasonable time to grow without being expected to know everything at once, or will I have to hit the ground running?

Breaking through without experience in any sector of the healthcare field can be difficult and at times discouraging. It’s not at all uncommon for people in the coding field to search for up to a year before finding a job.

Coding professionals new to the field should consider these for suggestions as they look for a job and begin their careers:

• Make finding a job your job. Market yourself consistently across various social media outlets such as Facebook, Twitter, and LinkedIn.
• Participate in local chapters of the American Academy of Professional Coders (AAPC), AHIMA, and the Medical Group Management Association (MGMA). Look beyond attending meetings by connecting and communicating with others. Pursue educational opportunities that these organizations offer.
• Ask members of your family as well as your friends if they have connections to people who work in healthcare facilities. For example, you might have a cousin who has a friend who works at a hospital—that is a networking opportunity.
• Pound the pavement and apply to open positions in person. This approach may sound archaic in a high-tech world, but it can still work. Some small medical practices are open to this approach. Sometimes, coders fill out many applications online, but eventually received a job offer simply by walking into a small practice that had an opening that had not been posted online.

Experienced Coders Pursuing New Jobs

Single-path coding, which is a consolidation of facility and professional fee (pro-fee) coding, requires additional training to become proficient in both outpatient facility and pro-fee coding. Cross training on both sides is essential. Coders reporting to revenue cycle have opportunities to gain experience on the billing side, which expands their knowledge base and makes them more marketable. Coding for SDOH has productivity concerns as coders must have knowledge of specific factors such as transportation, living conditions, employment, and more. Use of SDOH codes can provide a more comprehensive account of the patient’s circumstances and guide referrals to proper resources. Even experienced coders need training to ensure understanding of these determinants.

Priorities for Coding Managers

1. Variety of experience and expertise: Though specialized training is needed for areas such as anesthesia, cardiology, and orthopedics, a variety of experience and expertise can be a valuable asset. For example, two candidates may have the same certifications but entirely different backgrounds. The candidate who has multifaceted experience in billing, coding, denials, and compliance may have an advantage over the candidate whose experience is limited to inpatient coding. Given the shift to single-path coding, more managers are looking for coders who are cross trained on facility and pro-fee coding.
2. Independent and resourceful: In today’s fast-paced environment, managers need coders who can independently conduct research in response to questions and difficult coding challenges. If a hospital is performing a new procedure, the coder should research the procedure to gain a clear understanding of how it is performed and coded.
3. Reliable: Value-based reimbursement demands dependable coders who consistently meet and maintain quality and productivity standards. However, if a coder is struggling, I encourage them to ask for help when needed. Coders need to know they can rely on their managers for support. It’s a collaborative team effort.
4. Proactive: Attention to detail enables coders to identify changes that might impact coding before it becomes a large problem. In one case, a facility restructured its surgery form, placing “HIV positive” at the top right corner of the form where “hypertension” had been. As a result, some physicians erroneously categorized patients as HIV positive. Fortunately, a coder caught the error.
5. Professional: Coders are expected to communicate and interact in a professional manner. In an era of posting immediate reactions on social media, attention to proper grammar, spelling, and punctuation is often lost. Professional verbal and writing skills are critical to clear communication that supports accurate coding and documentation.
6. Certification: A coding certification is typically required for any coder seeking a new position or career change. It is recommended that coders research the job requirements and certification expectations prior to applying for a position. This step will help determine which certifications are most important to achieve and maintain for your area of interest. Many hospitals want facility coders to hold AHIMA’s certified coding specialist (CCS) certification, the gold standard credential that prepares coders for both inpatient and outpatient facility coding. On the physician practice side, a certification in professional fee coding is likely a job requirement. Also, with the move to single-path coding, certifications in both facility and pro-fee coding are strongly recommended.

Catrena L. Smith (CSmith@kiwi-tek.com) is the audit and education manager at KIWI-TEK. She is a frequent speaker and presenter of webinars on topics involving coding, billing, documentation improvement, and compliance.