Saturday, July 11, 2009

Coding Mgr Handbook: Ch 3: Staff Training

Chapter 3: Staff training

* Hiring of Staff
* Generic Sample Interview Questions
* Cross training of Staff and Teamwork Concepts - Team building
* Disciplinary Action (disciplining your employees)
* Communication issues with your staff
* Training & Continuing Education - Tools for the job!
* Goal setting for coders and managers
* Coder Productivity
* Incentivize your coders
* Benchmarking
* Remote Coding - Outsource Coding: Do I? Don't I?

Hiring of staff is always a challenging endeavor for any manager, much less a coding manager. Coding staff come in many shapes, sizes and skill sets. You want to find the most qualified, skilled, talented, and dedicated person you can find. But, you have to balance budgetary "cost" that is allocated for new employee salary(ies). Then you have to find someone who will "fit in" with the other employees, buy in to the company "culture", and be productive quickly.

Certified staff such as RHIT's, CCS, CCS-P's, CPC's, CPC-A's all have their place within the coding departments. Most large facilities request that all their staff have some sort of coding "credential". Those credentials may not necessarily provide "proof" that the person is a "good coder", but at least it provides proof, that they were able to take the test and pass. You would be remiss in your hiring practice, if you did not provide an independent coding test, or even a medical records filing test etc.. prior to hiring an employee that will be working in the coding department. (regardless of what area they are going to work in).

If you do not have success in finding coding staff that is already certified, you may have to “grow your own”. What I mean by that, is that many times if you do not have the opportunity or ability to hire someone who is already a certified coder (CCS, CCS-P, CPC etcc) You may have to spend the time getting them the training within the organization, (by teaching yourself) or by sending them to class or training outside of the workplace. (i.e. community college, adult learning center etcc) Either way, it is always a good investment of time and money to have certified staff. Certification simply ensures that the employee has been educated in the minimum of coding criteria, and guidelines, HIPAA, Privacy, Security, and basic coding.

If you elect to hire a coding position, looking at the resume is the easy part. The hard part is the interview process. You always want to hire the best, so having a good set of interview tools is essential to the coding manager’s toolbox. The resume, gives you a blind look at the coding skill sets that the applicant has elected to disclose. If you choose to interview that applicant, it’s a tricky process to ask the applicant the set of questions, that will give you the information you need to make an informed decision about them and how they function as an employee. It’s this information that you have to rely on. You need to know if this person can perform the minimum job functions, work well with your team and “fit into” your coding department culture, then ultimately be a successful employee for your department, facility or practice.

Most offices or facilities have strict interview guidelines. Many times, the Human Resources department will do the first round of “screening” interviews and send to you only those they deem to be a “possible fit” for your department. If you have to do the interview process yourself, a little extra time and attention to detail can save you the “poor employee” or “poor fit” for the applicant down the road. This means you should be diligent about checking references, and consider doing a formal background check if needed. Don’t be afraid to have the employee sign a release of information from their previous employer(s), or school transcripts or records to disclose items of interest for you.(see figure 3_1) There have been instances of coders being involved in medical billing fraud or convicted of criminal activity that was not disclosed in the resume, or interview process. Unfortunately checking references, and background is very time consuming, but is extremely important you you as a manager, to learn behaviors about the applicant, and their the work “personality”.

If you are hiring an applicant right out of school, consider making a call to the educational provider, and inquire about that student’s attendance, work ethic regarding study habits, homework, if they met deadlines appropriately, and even their grades if it applies to the coding position. (i.e. such as anatomy, terminology, coding, transcription, HIPAA, privacy, security, filing etc..)

In the nuts and bolts of the interview process be sure that your questions are appropriate and applicable to the position that you are hiring for. Your human resources departments can help guide you in the legalities of what are/are not appropriate questions to ask during the interview process.

Prior to interviewing, the job description, and job functions should be readily accessible for prospective job applicants to review and have a copy of. When the applicant arrives for the interview, be sure to had the applicant another copy of the job description and job functions. You want the applicant to know what the expectations are of the job, the job “functions” and the standards of the department that they will be held to.

During the interview, ask applicants behavior based questions such as how they’ve handled previous work scenarios, and ask for situations that had a positive outcome, and also those situations that had a negative outcome and what (if anything) the applicant learned through the process. It is through those scenario’s that you will get and idea of how the applicant functions in specific situations, and how their thought processes and decision making skills measure up to what you are looking for in an employee. You will want to look for the applicant who handles both positive and negative situations in a professional manner.

Some companies prefer to have applicants take personality tests and find them useful in the hiring process. However, a personality test is no guarantee that the applicant will “fit” into your department’s culture.
In the interview, be sure to as the same questions to each of the applicants. You will also want to administer a coding or skills-type test to each applicant. I have found that some skills that you take for granted (i.e. typing, 10-key) your applicant may not be proficient in. If you are asking your applicant to type 45 wpm, then be sure to test them to ensure they meet the criteria.

As a manager be on the lookout for employees that come in with a pre-determined or “scripted” answers to questions you may ask. Another area of concern are applicants who give one-word answers, or will not elaborate. Some simply give “too much” personal information, or include negative comments about previous employers. Nerves will play a part for some applicants, however a bad attitude may not show itself on the first interview, so be prepared to interview candidates 2 or 3 times, looking for different ideals. A negative or bad attitude may also come out in the form of bragging, acting as a “know it all”, or being offended by the fact that they have to take skills testing, or personality testing. Then there is the opposite of the bad attitude, is the applicant who appears lifeless, or dis-interested, or possibly even bored. Do not ask personal or confidential questions. (i.e. how old are you? Are you planning to get pregnant? Are you married? Divorced?) Do not ask the applicant to reveal any type of confidential or proprietary information about their previous employer(s)

If you’re hiring a coding/billing type position give a skills test that appropriately tests the overall skills of the applicant. You will want this test to include basics about CPT, ICD-9 and HCPCS, coding conventions and guidelines (1997 and 1995) , auditing, HIPAA, privacy and security, modifiers, claims, appeals and coding from documentation.

Here’s a listing of some generic interview questions you may want to ask during the interview process. You don’t have to ask them all, but this list is a broad scope of many generic interview questions to help you find the right employee for your coding job opening.

Generic Sample Interview Questions
 Tell me about yourself?
 Can you give me 3 words to describe yourself?
 How would your friends/co-workers describe you?
 Why should I hire you?
 What can you do for us that someone else cannot?
 What are your short term and long-term goals?
 What have been your achievements to date?
 Are you a team player? Please give me an example?
 What is the most difficult job situation you’ve faced and how did you tackle it?
 Describe for me a situation involving a conflict with a (your) supervisor?
 How was it resolved?
 What is your greatest weakness? And how can that benefit you in this position?
 What is your greatest strength… and why is it applicable for this job?
 What do you like best/least about your present job
 What qualities do you think make a successful manager?
 Describe your ideal boss/manager/supervisor
 How does your job fit in to your department and company?
 What do you enjoy about this industry?
 Give an example of when you have worked under pressure.
 What kinds of people do you like working with?
 What kind of people do you find it difficult to work with?
 Give me an example of when your work was criticized.
 Give me an example of when you have felt anger at work?.
 How did you cope and did you still perform a good job?
 Give me an example of when you have had to face a conflict of interest at work.
 Do you prefer to work alone or in a group? Why?
 This organization is very different from your current employer - how do you think you are going to fit in?
 What are you looking for in a company?
 How do you measure your own performance?
 What kind of pressures have you encountered at work?
 Are you a self-starter? Give me examples to demonstrate this?
 What changes in the workplace have caused you difficulty and why?
 Give me an example of a time you did not meet a deadline, how did you correct the situation?
 Think of a time when you worked in a group, and one of the group was not doing their part. How was the situation rectified? What was your role in that?
 With multiple tasks, deadlines, and priorities, how do you determine the priority of which should come first, second etc…
Then add in the CPT coding specific interview questions such as:

Basic Sample Coding Interview Questions

 Describe for me the differences between ICD9 coding for Outpatient and Inpatient coding?
 What are the differences between the CMS 1995 auditing guidelines and the 1997 auditing guidelines?
 What is Terminal Digit filing?
 What is color wheel filing?
 What is a CMS 1500 used for?
 Describe the major reimbursement methods in healthcare: OPPS, RBRVS, APC, DRG’s?
 Describe the purpose of coding and linking in the billing process
 What is the difference between a UB92 and CMS 1500 form?
 What is the role of a third party payor?
 What encompassesMedicare Part A services? Medicare Part B services? Medicare Part D services?
 What is HIPAA
 What are some typical Fraud/Abuse and compliance issues within coding and billing departments?
 What is the use of “E” codes?
Lastly, give a 25 question“mini” coding based test to assess minimum coding skills in regard to:
 Basic Anatomy & Terminology
 Coding Conventions & Guidelines
 ICD9 diagnosis coding
 CPT E&M Coding, procedure/surgical/medicine coding, modifier application
 HCPCS coding
 Billing and claims submission
 3rd party payor guidelines
 HIPAA, Privacy and Security
 Release of information (medical and billing records)
 Claim submission, forms and appeals.

Begin and end your interview(s) on time. Be conscientious of the applicants’ time, in addition to your own. It is a common practice to do an initial interview, then call back the top 5 candidates for a 2nd or 3rd interview prior to hire. Give a timeframe of when the applicant can expect information regarding where they are in the the interviewing/hiring process. Let the applicant know that you will get back to them within “x” amount of time and do it!.

Make the phone call, or write the letters to those applicants letting them know they have made it to a second interview, or that they were not chosen for a second interview, but thank them for their time and interest in the position. I use a very generic “thank you” template for those applicants that I have eliminated from the hiring process.

Once you get the applicant hired, you should assign that employee an inter-department trainer/mentor. The trainer/mentor will help ease the transition for the new employee. The mentor will have the responsibility of training and educating the new employee (mentee) into a productive member of your team. Peer mentoring and training also provides a low cost way to train new employees. The new employee will also develop more intimate work relationships with these mentors as a peer to peer relationship. It can be rather intimidating to the new employee to have a trainer/mentor who is the department supervisor or manager, and this can potentially lead to uncertain outcomes. With the peer to peer trainer/mentor concept, the trainer/mentor gets the added benefit of building leadership, communication and teaching skills for themselves.

Investing time and effort into quality education and training (and cross-training) of new and existing employees will reward you and your company with more productive, and happier employees. This will also reduce staff turmoil and turn-over, during high stress workloads or situations.

Cross training of staff and Teamwork concepts
As a coding manager you should embrace the opportunity to develop a good department employee cross training program. Cross training programs allow employees to learn and function in different capacities within the coding department. This also encourages understanding of how the different jobs function and affect other areas within the department and the company. This also provides the opportunity for employees to gain additional skills, abilities and knowledge which can improve their outlook and job satisfaction within the department.

Cross training your employees will have some additional budgetary costs, but overall will have a positive impact upon the department. The most tangible benefit is that during times of high workload, or unforeseen employee absences cross-trained employees can step in/step up and provide the manpower to fulfill those critical functions. Or, you may have times when the workload is not equitable, and one area may need more help than another. With cross-trained employees you’ll be better prepared as a manager to meet those unforeseen demands successfully.

Another added bonus to having cross-trained employees is that you eliminate the pressure upon employees if they are absent. Employees can become resentful, that if they are absent (i.e. for vacations, illness, unforeseen situations) , that their work will just pile up, until they return. If staff is cross-trained, the work can continue to flow. This is extremely important in a coding department, as you do not want to interrupt the revenue stream due to employee absence or high work volume.
As a manager, be the first to step forward to be cross trained. Learn to perform the job functions of each employee in your department. You may not be able to perform the job as expertly as your employee, but you will gain the insight as to what it takes to perform that job, and how to manage the workload if you have an intimate knowledge of the job. In addition, your employees will have the opportunity to “train” you in how best to perform that function in their absence. Be the first to step forward during the times of high volume workload, or employee absence to keep the work flowing. This will not only provide you the satisfaction of keeping the department running smoothly, but will show your employees your commitment to them and their job during those situations. It is critical to the success of cross training that the employees who are performing these functions be the ones to cross-train their peers.

Be realistic in your expectations of those who are “filling in” for the absent employee, or during high-volume workload situations. Cross trained employees have the skill sets and education to perform the job, but will probably not have the speed and/or accuracy that the primary employee brings to the job. In some situations, you may need to replace the single absent employee with multiple employees just to keep the department flow from grinding to a halt.

In addition to cross-training, have each employee create a “how to” for their day to day activities within their job functions kept in a readily accessible file or notebook. This “how to” guideline helps the fill in staff perform the basic functions of that position and lessen the perceived pressure of missing an important work piece critical to the job function.

To implement a cross training program, you need to identify the areas and job functions upon which will need to be learned by the trainees. It is wise to have a simple, but formalized plan for implementation. If this is a broad type of cross training, a project manager and a project management system may need to be implemented. But for most cases keeping it simple, will provide the quickest rewards.

 Develop a checklist to outline the conditions of the cross training
 Create a progress report and evaluation form to be completed at specific timeframes.
 Create a skills test checklist (i.e. pass/fail type) and administer at the completion of the training.
 Update, review and re-test those skills at specified intervals after completion of the training (i.e. every quarter, every 6 months, once per year etc…)

(see sample cross training documentation examples 3-6. 3-7, 3-8, 3-9 )


What is the definition of Teamwork/Teambuilding? This is nothing more and nothing less than bringing employees together for a common goal or purpose. As a coding manager, you have to be the “teamleader” for your coding team, but you will be a team-member of the management team, or other corporate team affiliations. You have to know both sides of the team-work/team-building priciples, ideas and practicum. To run a successful coding department you need to make time to build team relationships within your department. It can be difficult as a manager, when your workload is large, and you have little time to “work” at building your team. However, the small amount of time it takes to continually build and enhance the relationships you have with your staff, the more devoted and committed they will feel to you, the department and to the company.

When building your team, you need to develop a strategy to create, and maintain the team for a long-term relationship. As teams grow together, the become stronger than 1 single individual. However, you still want your employees to “excel” at their jobs individually, but bring together their strengths, in addition to the strengths of the others in your department, therefore you have a strong diverse skill set within your coding department.

When working with a team-based approach, make sure that all employees are “bought in” to the concept of team cooperation. All members need to feel that if one member of the team is struggling, the other team members will step up or step forward to help accomplish the goal without seeking personal praise or attention. Team members all need to utilize effective communication skills within the department or team. Are there certain members of the department that function as the “mouth-piece” of the team. If so, that team needs to have some skill building and team-based exercizes to emphasize that each member of the team should have the opportunity to communicate what is going on within their team. In addition, the skill of “listening” is also critical. Many good ideas get lost in the shuffle, if only 1 or two members of the team are always at the forefront. Those in the “silent” majority need to have the opportunity to have their ideas heard and or acted upon.

As the manager, you need to show the department and teams that you recognize their efforts and care about what is going on within the team. In addition, you need to ensure that the department members feel as if their job and mission within the corporate structure is important, and they are a vital link to making it successful. Respect is a powerful force within a team. Respect must be earned and not demanded. Each team-member needs to value and respect the others on the team, and within the department. No one likes to be made to feel that their ideas or values are not worthy of note, or consideration. Respect should be at the top of the code of conduct of what goes on within the department. Embody respectfulness by saying “please”, “thank you”, “pardon me”, as part of your regular conversations with the department. Set the expectation, and others will rise to meet it.

In addition to respect, trust is also a critical value within the department. Employees need to feel that they can place trust in you to perform your job effectively as a manager, in addition to knowing they can trust their peers to also perform their tasks. All job functions are interdependent upon each other within a coding department. No one person can do it all!!! Don’t talk down to your staff or demean anyone on the team. If it does happen – admit your mistake, and take responsibility for your actions. Show your staff you aren’t perfect, but are conscientious to your mistakes and want to rectify them. Learn from your errors, and move forward. I have always adhered to the notion that you learn more from your errors, than you ever do from your successes.

Don’t be afraid to roll up your sleeves and help get things done. Managers who know how to work within their departments as well as “with” their department make their employees look and feel good. This translates into more trust and cohesiveness between all. Come prepared to work everyday with a good, positive, can-do attitude. As a manager, set the bar high for yourself, and try to meet your goals every day. If your employees see you reaching for the top each and every day, this will become an integral part of your departmental culture. In turn, your employees will also take on those traits and encourage their peers to do the same. Be dedicated to observing deadlines and project completion dates and timeframes. Manage your resources and employees, by empowering them to take ownership of the project(s) so that all will be responsible to seeing it through to completion. (and success!) Again, if unforeseen circumstances do happen, and you miss a deadline, or a project has failed, re-group and re-assess what needs to be done, then move forward with the revised plans. Communicate with those above you in regard to the set-back, and communicate to them what your plans are to rectify the situation. Then, coordinate with those on your team, ask for their ideas and options, to see the revised plan into action and completion. You will find as a manager, that each day will bring its own small successes and failures. It’s how you deal with those successes and failures on a day to day basis, that your staff will see and hopefully embody the best model and standard of work.

Below are some tips as to how you can effectively embody the team-work and department cohesiveness needed to succeed as a coding department manager.

 Set the standard!, Dress the part! – Live up to the expectation, and continually improve yourself

 Lead by example! – if you “talk the talk” then “walk the walk”
 Be consistent in your practice of teamwork – set clear expectations
 Respect each member – and be polite (ie – please, thank-you)
 Maintain integrity and ethical standards, be committed to the process.
 Recognize and value your biggest asset – Your employees!!
 State your objectives or goals - get it in writing - refer to it often!
 Create a good, positive work atmosphere, SMILE!!! And take a genuine interest in your employees and their dedication to their jobs.

 Acknowledge and recognize the efforts of all on the team. Especially those who may bring a specialized skill set to the department, or have special talents that are untapped.

 Learn to listen – take the time to hear what your employees are saying to you.
 Confront the fear of change and move ahead in spite of “what may happen”

 Be willing to look at new ways to solve old problems. Challenge yourself and your staff to find new and more efficient ways of delivering services and/or products

 Hold each other accountable for doing their best, even though it may be a new task or learning opportunity.

Disciplinary action (Disciplining your employees)

In spite of your best efforts, there are sometimes, when you end up with an employee who is exhibiting poor performance. You, as the coding department manager, need to put together a disciplinary action plan, or you may have to terminate the employee altogether. No matter which out come you have, it is never easy, nor is it pleasant.

The first step to always remember is to DOCUMENT, DOCUMENT, DOCUMENT! This is same theory that we practice with the physicians that we work for and with. It is a very common saying within coding departments “If it wasn’t documented, it wasn’t done”. I always advise communicating with your upper management and with human resources in regard to any employee disciplinary action or termination. In some cases human resources may have to put legal counsel on retainer. Each state has different laws regarding employee rights and termination.

Most often, companies employee some form of progressive discipline for poor performance. A disciplinary action plan should not come as a surprise to most employees who receive them. Do not wait until the yearly employee evaluation to “spring” this on the employee. By the time you meet with the employee for their yearly evaluation, there should be no suprises one way or the other as to what will be on the evaluation. You should be providing feedback for your employees on a routine and scheduled basis (both positive and corrective) throughout the year.

If you are unaware what “progressive disciplinary action” is, it is defined as a system of discipline where the penalty(ies) increase on repeat occurrences, with the ultimate penalty being termination of employment. The typical stages of progressive discipline are

1. Documented Counseling and/or a documented verbal warning
2. A formal documented written warning
3. A formal Suspension and/or a permanent or temporary demotion
4. Termination.

Depending upon the severity of the employee act or action, , may determine if a progressive disciplinary action plan would be effective. In some cases immediate termination is warranted (i.e. for a breach of confidentiality, embezelment, or criminal act). In other cases such as poor performance, multiple absences, insubordination, unwillingness to participate in team activities, or inability to get along with other members of the department, a progressive disciplinary action plan may be just the incentive to help the employee get back on the road to productivity.

When you have an employee who has previously been very competent, but is now becoming what I consider a “toxic” employee, you need to take immediate action and hopefully avoid the potential poisoning of the office or department. Some examples of toxic employees are ones w ho
 Are rude or threatening to patients and co-workers
 Routinely show up late/leave early with a myriad of excuses
 Push off their work onto others within the department/team (i.e. as in refusing to answer phones)
 Permeate the environment with a negative attitude.
 Gossip about other employees or patients
 Refuse to follow advice, instructions, or direction from peers, team leaders or managers.
 Refuse to follow established office procedures or policies such as dress codes, etc.

The worst part with these employees, is that their behavior sneaks up on you as a manager. Most often, these employees are able to perform the basics of their job, but in the day to day workflow, may go un-noticed by you. This is why it is so important that you are involved with all staff and team-members so that these issues can be averted before it permeates the entire department.
Given the financial realities of a coding department, good coders are few and far between. Hiring and training neww staff is extremely time consuming and expensive. With a “toxic” employee, you have to determine whether to try and salvage the employee and turn around the behavior, or to terminate and begin again.
If you have elected to pursue progressive discipline, begin with

Step 1 – Documented counseling and/or a documented verbal warning.
 As a manager you need to swiftly confront the employee.

 Be prepared to discuss the issue or problem in depth,.

 Outline the problem in detail and present concrete evidence or present specific examples of the issue at hand. .

 Do not use phrasing such as “poor attitude” that may have a different interpretation to you than it does for the employee

 Prepare your notes in advance and schedule enough time to thoroughly work through the issue with the employee.

 Ask the employee how he/she believes that the problem could be solved

 Set the consequences, and a timeline., spelling out in detail what will happen if things do not change.

 Respect the privacy of the matter and of the employee, but include a 3rd party in the room with you to avoid the “he said/she said issues” (such as another department manager or human resources officer)

 Remind the employee, that this is not about them as a “person”, but it is about our business and the success of the department and how they function within the department.

 Have the employee sign the documentation record noting that this is a documented counseling/verbal warning, stating what you discussed and determined to be the plan of action, the consequences if the action plan is not followed through.

 If things don’t improve or the employee does not follow through with their commitment to the action plan, you may need to move to

Step 2 A formal documented written warning
 Follow the basics of what is encompassed in step 1
 Review the failure of the employee to comply with the formalized plan (as outlined in Step 1)
 Remind the employee of the consequences of their actions, and implement those consequences at this time.
 Set a new timeline upon which the employees actions must change.
 Again, have the employee sign the “formal written warning” with the consequences clearly outlined to be either suspension, demotion or termination within the department if they do not comply.

Step 3/Step 4 A formal Suspension and/or a permanent or temporary demotion, or Terrmination.
 With Step 3/Step 4 again document all conversation,
 Outline what steps were taken prior to this one
 Document the failure(s) on the part of the employee to adhere to the corrective actions
 Have the 3rd party available,
 Have the employee again sign the documentation,
 Have HR there, if termination is the elected outcome.

In some companies employees are considered “hired at-will” Employment at will means that employees can be terminated or let go at any time with or without reason. It also means that an employee can quit or abandon the job without reason. Employers are not required to provide any type of notice if they are terminating an at-will employee. However, even if an employee has been hired “at will” some states have employement laws in place that protect the worker in those instances. So, prior to terminating an employee, even if they were hired “at will”, you should have the human resources office, or your legal counsel provide you with guidance in those situations.

If you do have to carry out a termination, most manager agree that this is the part of the job they hate the most. Sometimes, termination is in the best interest of the employee, the organization and even your department employees. Depending upon the circumstances, you may want to consider a couple of types of termination. 1) Immediate termination for just cause, or 2) Termination for non performance.

The firing of an employee does not have to be the worst experience of your management career, but at times it certainly feels like it is. As a manager, you always question yourself about what you could have done differently, or changed to have a better outcome. Sometimes, you just have to do the termination, and live with the consequences to the department. However, take the time to reflect on the relationship you have had with the employee and examine what went wrong, and learn from the experience.

Below outlines some of the steps you may want to consider if you do have to terminate an employee for just cause. Just cause terminations usually happen because and employee threatens violence toward another employee, or commits a violent act, brings weapons to work, views or downloads pornographic or prohibited information to company computers and on(or off) work-time, steals or vandalizes company property, or is caught embezzling funds or commits any other type of criminal activity. In light of the actions above you will want to perform an immediate termination for just cause. These steps will help minimize the “impact” to your department, and hopefully keep all safe.

 Ensure that the employee is not a danger to themselves or other employess (if so, call law enforcement, or security.

 If the employee does not appear to be a danger to themselves or others, notify law enforcement if an illegal or criminal act has taken place

 Remain polite and respectful

 State the offence to the offender calmly and with a witness in the room

 Tell the employee that their employment is terminated

 Collect all company property from the employee

 Allow the employee to pack personal items from their work are if circumstances allow it, if not, have the employees personal items packed and ready to go at the time the termination is taking place.

 Enable the employee to ask any questions about the end of the employment

 Escort the former employee from the building, or utilize security to escort the employee from the premises.

 DOCUMENT, DOCUMENT, DOCUMENT the entire termination proceedings.

The steps to take if the termination needs to be done for non-performance, or non adherence to a disciplinary action plan are spelled out below.
 Ensure via your documentation that the employee was clearly informed about the job expectations and failed to live up to them.

 Ensure that you have the written and signed documents showing that you and the employee attempted in good faith to adhere to the action plan outlined prior to the termination.

 Review with human resources that you have applied the performance standards, and job requirements fairly to this employee, and you have documented the failure of the employee to perform up to those standards.

 Ensure that your progressive discipline action plans were escalated so that you have the documented verbal warning, documented written warning, suspension and/or demotion.

 If the above is in place, the termination consequence should not come as a surprise to the employee.

 Schedule a meeting with the employee and human resources, and inform the employee that they have been terminated from the position and from employment with the company.

 Inform the employee of the reason for the termination.

 Be compassionate and respectful. Maintain the employee’s dignity and allow them to speak or ask questions of you or of the human resources witness
 Collect all of the company property, and allow the employee to pack up their personal belongings, or give them the option that you will pack their belongings up and they can retrieve them after hours.

 Walk the employee calmly out of the building.

 Last but not least DOCUMENT, DOCUMENT, DOCUMENT the entire termination process.

I have included some sample copies for you to use or review for implementation in your progressive disciplinary action plan for your management “toolbox”.

Communication issues w/your staff

Sometimes, no matter how good and how effective you may be as a coding manager, there will be times when you and your staff have communication issues that can be difficult to resolve. Communication is, of course, the bottom line to a successful department, or success of the manager/employee teamwork relationships. As the manager, you will always be looked up to, and expected to uphold the company policies and directives. There will be times when your staff will become angry or put pressure on you during times of high workload, or departmental stress.

When under employee scrutiny, how you react to it is important. You have the opportunity to “connect” with the staff and embody the professionalism that they expect of you. Are you prepared to handle such situations as employee criticism?. You need to have your emotional tools at the ready to maintain your “grace under fire. As a manager at one time or another you will be humiliated or criticized for decisions that you’ve had to make. Many times those decisions are made in the best interest of your department or company, but the employee’s may not see it that way, or not understand the full “big picture” of why you made the decision that you did.
When being pressured or criticized keep these tools at the ready:

 Don’t make excuses for your actions. Take ownership and responsibility for them (right or wrong)”
 Keep your cool, and be strong (i.e. never let them see you sweat!)
 Don’t break down and cry, and avoid recrimination
 Don’t think up ways to “get even” and don’t counter attack the criticism.
 Be honest and forthright,
 f needed, apologize for your shortcomings, but be confident and professional
 Lastly, learn from past mistakes, and try not to repeat them.

Then you may have the opportunity to manage a situation that includes angry patients, staff, or physician employees that are lashing out, but the issue may not necessarily be directed at you personally. Many times you can diffuse the situation with calmness and clarity, but other times, it may take a bit more to keep things under control.
 Keep your cool, as the anger is usually not about you personally, so don’t internalize it as such.

 Check your safety – do you need to have a witness?, do you need to call for security?

 Move the issue out of any “public” areas, or “patient sensitive areas”. See if you can accompany the angry person to your office, or an area out of the “limelight”.

 Acknowledge the anger, but try and steer the conversation toward resolution, not just allowing the person to “vent” without a solution to their issue.

 Try and elicit the real source of the complaint or the issue. It may be that what happened today was just the “final straw” in a long laundry list of minor problems, that the person just couldn’t handle any more.

 It may be that the complaint or anger is 100% valid, but it could be 100% not so, but more often it is somewhere in the middle.

 Listen and be empathetic to their complaint or issue. Don’t trivialize it, and don’t “talk down” to the person. Respect their view, even though you may not agree with them.

 Ask what the person would like you to do to rectify this situation, then negotiate if unreasonable.

 Offer an alternative if necessary (i.e if I can’t help you, who do you feel can?)

 Don’t take the anger or the issue personally. Realize that this is just another day, and tomorrow will bring a new set of opportunities.

Training & Continuing education –Tools for the job!

As a coding manager, you staff will always be need to have access to training and continuing education. Coding is an ever evolving job. ICD-9 Diagnosis and Procedure codes are updated on October 1st of every year. CPT procedure codes are updated on January 1st of every year, HCPCS codes are updated quarterly, and the field of medicine itself is ever evolving with new procedures and technologies moving to the forefront of the news on a regular basis. In addition to just the basics of ICD-9, CPT and HCPCS, your staff have to keep abreast of changes by 3rd party payors such as Medicaid, Medicare and high-profile insurance carriers. Your inpatient coders have to worry about DRG’s, APC’s, OPPS, chargemaster edits and errors, and ancillary facility charges.

Your employees need (at the very least) the current year’s coding books that encompass all the coding changes. Encourage your staff to become involved with their coding societies and state and national coding conferences, and allow them to pursue personal continuing education to further their career and employment objectives. Some companies allow each employee a certain amount of educational dollars to be spent at the manager’s discretion.

Be pro-active in coding training and continuing education. Meet with your staff on a scheduled basis to update them, and encourage them to bring items of interest to the “coding roundtable” type meetings. Share the “burden” of who will monitor and mediate these sessions. Encourage and empower ;your coders to share their knowledge with their peers and co-workers. This works hand in hand with cross-training.

Be open to new and ever-changing technologies. Encoders and chargemasters enable coders to work more quickly and efficiently. Look at emerging electronic medical record systems, automated transcription systems, PC’s and the internet for research and oursource coding and billing. Internet and Intra-net usage of prescription management and the personal health record.

Take advantage of continuing education presented by vendors and 3rd party insurance payors. Webinar’s, Audio seminars and data download options can open up many educational opportunities for coders to take advantage of. Ask your staff to attend some of these sessions, then bring back the information to your coding roundtable to be shared amongst your department.

Encourage all your staff to become “credentialed” or “certified”. This empowers the employee to pursue their own personal development, and adds to more job satisfaction, and happiness within the department. Encourage ancillary staff such as medical secretaries, data entry staff, and personal assistants, medical assistants, and clinical staff to join you at your coding roundtable and encourage cross education for those staff members too. You never know when one of your clerical staff may turn out to have a real interest in coding or billing. If they are allowed to be included in these educational activities, you may be able to “find” your next coder or biller just waiting in the wings for their opportunity.

Goal setting for coders & managers
So… What’s your goal? What is a goal?Are they important? Can I really achieve them? What’s in it for me? As I discussed in Chapter 1 goal setting is very relevant to all aspects of the coding department. Medical coding requires many different skill sets, and as I covered in chapter 1, goal setting for managers, we also need to help and enable our coding department employees set appropriate goals, and help them achieve them.

Again, the SMART system of goal setting is very applicable and easy to follow. It’s one of those “tried and true” applications that you can easily adapt to fit into the day to day workplace for your coding employees.
The SMART system criteria is as follows:
S = Specify,
M = Measurable
A = Attainable
R = Realistic
T = Timely

As the coding department manager, you may need to be the one to specify what goal you would like your employee to achieve. This can certainly be discussed during any of the 1-1 meetings you have with your employees as an on-going departmental basis.

It gives focus to where you would like the direction of your coding department to go. There will be times when you have to move your staff out of their “comfort zone” and really focus on “ramping up” the productivity, or focusing on a specific activity that is “outside” their coding realm, or perceived “coding job”.
When you specify the goal, it may be something like “I would like you to be able to code XXX amount of emergency department charts per day. You have now specified “what you want them to do, and now have made it measurable – by adding the caveat of XXX amount of charts per day. Now, as the manager, you have to make sure this is truly an attainable goal for your coder. To evaluate if this is truly attainable, research or inquire at some of the other facilities what their criteria is for that specific function. The goal you set forth should “push the envelope” for attainability, but should not make it out of reach. That is why you need to keep perspective of the goal and make it realistic. Of course, setting a realistic goal, does not infer that it will be “easy”. You want to make sure that the learning curve to attain the goal, is in proportion to the goal. The final piece of the goal setting project is making it timely… Be sure to outline a timeline for when you want the coder to be able to code xxx amount of emergency department charts per day. When you set this goal for your coder it should go something like:

Within 3 months, I would like you to be able to code XXX amount of emergency department charts per day. Currently you are coding XXY amount of emergency department charts per day. At facility ABC, their coders code XXX amount of emergency department charts per day, so we should be shooting for the same goal. Let’s look at ways that we can realistically achieve this goal. (i.e. by streamlining workflows, utilizing encoders, providing additional education etc) Let’s work on this goal together, and we will meet weekly to track our progress, assess our successes and failures.

Now that you’ve set the goal, WRITE IT DOWN, MAKE IT PUBLIC! Have each of the employees who are working on this fill out a formal “goal setting worksheet” to have at their workspace, to remind them of the goal and to keep them motivated toward success

Wow! You’ve really got something going on now!!! But as the manager, you will now need to become a “feedback fanatic”. You know that your employees have the ability to do the job, and really “get it in gear” and meet the goal put to them, but how do ou keep them focused on the goal??? You need to maintain and follow through on the scheduled meetings to assess successes or failures of the goal.. Make sure that the feedback includes both positive and negative aspects, but always start and end with the “positives” and couch the “negatives” in the middle. Make sure you use specific examples of the successes and the failures. You may want to meet 1-1 with the coders involved in this, and show them their “own numbers” to attaining the goal, then meet with the entire group and show a “group based” performance number. By diligently providing feedback, you will enable your staff to continue being engaged toward the goal.

Some managers look at only the “successes” they’ve had, but I truly feel that you learn more from your failures, than you ever do from your successes. Failure is the opposite of success, but failure provides you with a unique opportunity to learn from your error(s), and look for new ways to pursue becoming successful or succeeding at your goal. i.e. If you want to achieve more, do more! Don’t limit yourself – explore all options, and think outside of the norm. Sometimes it’s those “light-bulb” moments that really inspire, and spur your staff on to meet goals, or really contribute something of value to the organization.

Coder productivity is always a tricky issue to tackle. Each coding department will have it’s own specifics as to what makes it productive. Some departments have on-site full time staff, others utilize both full and part time on-site staff, while others use flex time, remote coders, and even outsource some coding functions. Not all productivity can be directly related to employees only. Utilization of encoders, charge-masters, electronic billing and medical record formats, automated transcription services, all play a part in productivity of the coding department. Then, couched with all of that, documentation requirements need to be met by the providers, and coders have to be the ones to analze and audit if that is appropriate. So you can see why this is such a difficult thing to wrap up in a nice tidy package.

When looking at your coder productivity, you need to make sure that you are comparing “apples to apples”, and not “apples to ice cream” One way to determine a baseline for coder productivity, is to have all your coders take the same coding test within the same timeframe. I would then take all the scores, and times and develop a “norm” or “baseline” for testing. Then develop a productivity protocol within those standards. You will have some coders who are going to function “above” the norm, but you should also have coders who “meet” the norm, and you will invariably have those that are “below” the norm. It is only then that you can determine what is the “correct” productivity standard.

When developing a productivity standard, you should also elicit productivity information from other coding departments who are similar to yours. (ie other practices within your market, state, etc) Don’t be afraid to contact specialty coding societies such as AHIMA, AAPC, MGMA, AMA, or even medical specialty societies for their input as to what they feel is a good productivity standard, and how they implement into their practices or facilities.

It is very hard to quantify a specific “number” but with the variables within coding, you will have to be flexible, when stating “you need to code 20 surgeries per day”. Those 20 surgeries, could be 20 easy, quickly coded operative reports, or they could be 20 “very difficult” surgeries. So again, you may have to do your productivity research over a period of time, just to get a “baseline” idea of what the productivity standard should be.

Another area of productivity that you should consider, is the area of “errors”. Each area needs to develop a standard percentage of error (i.e. 1% error rate, 2% error rate etc) and determine what factors will be considered “errors” (i.e. missed diagnosis codes, non-specific diagnosis codes, missed procedures, etc)

Once you have developed a specific set of norms for your productivity standards, then you have to put into place ongoing review and observation that these standards are being met. You should always meet with your coders 1-1 to evaluate their own progress within the productivity process, but you should also quantify the productivity goals for the entire department. Each coder should see how they stack up against the “department” as a whole.

Evaluation of productivity should be done on a “regular” basis, but probably not daily. You really need to allow for off-days, high volume days, low-volume days, and even personal or professional inefficiencies that may come up. Again, be sure you are comparing “apples to apples” and get a good mix of charts/records to ensure that your data is standardized to a certain degree. Assign the coding of records in as “random” a basis as possible, to eliminate some coders getting all the “easy” charts, and other get left with the “hard” charts. Don’t forget to factor in the non-coding duties that crop up during the day. These non-coding responsibilities such as filing, sorting charts, abstracting, telephone calls, locating documentation, you may want to rotate these between your staff so no one person is “stuck” with these functions more often than another.

Coder productivity has a direct correlation between revenue that comes back into the practice. You will want to manage the “error rate” percentages of your coding department (based upon the same set of error’s identified in your productivity matrix). If you have a 5% error rate as a norm, you may want to consider a goal of reducing that error rate. Even in the simplest of mathematical terms a 5% error rate, means that you are potentially losing 5 cents on every dollar. In a small practice 5% may not look like much, but if you regularly have $20,000 in gross charges per month, that is $1,000 potential dollars that you’ve let go untapped. If you’re a big practice that has 2 million in gross charges per month, that’s $100,000 dollars that have slipped through, so by shear numbers a 5% error rate in your productivity analysis is probably too high. A 0.5% error rate may not be attainable, but I think it should always be something to shoot for!

Other issues to address for optimal coder productivity, is to create as stress-free an environment as possible for your coders. Utilize standard “break times” and “lunch times”, be sure to allow your coders to have “voice mail” to eliminate telephone interruptions. Rotate the “non-coding” duties. You want to have as many coders “coding” productively with few being interrupted with ancillary duties. Move coding staff away from high-traffic areas and provide good lighting, tools to perform their jobs (i.e. encoders, books, PC’s, printers, )
Incentivizing your coders:

Now that your department is tops in productivity, and your error rates are down, now you have to keep the momentum going. Is it time to consider incentives for your coders? Do you need an incentive program to retain good staff, or attract new employees? There are pro’s and con’s to every incentive plan. The pro’s to having a good incentive plan in place is the potential to improve morale, coding timeliness, reduce coding errors, reduce “non-productive” time wasted on talking, breaks, and consistency of coder production. However, the “cons’ to an incentive plan, is that they are never “long-lasting” and usually have to be re-worked quite frequently. The other con to incentive plans, is that all staff may not respond to the incentives the same way. It is often thought that monetary incentive is the best way to motivate staff. However, with some employees, money is not what “motivates” them. For others it may be gaining more responsibility, or stature within the department, others it may be a pat on the back and recognition by peers or ancillary departments. So with incentives you really have to know how to motivate each individual employee to really bring out the best in each one of them.

I have never been a really big fan of incentive programs over the long-term. I think if you have a short-term project, an incentive based motivator works really well. Incentives for the short-term projects can be things such as a paid day off, or a $50.00 dollar gift certificate to a favorite restaurant or store, or maybe even Lunch with executive staff.

I know that for some of the more experienced long-term employees, the company has dangled the “coding at home” carrot in front of the coding staff as a type of incentive. Of course, coding from home brings another set of issues to the forefront. Yet, I still feel that for most staff, incentives should be a short-term and “fun” activity. In the long run, department staff should know what the productivity mark is set for, as the benchmarks have been set as an integral part of their job description and job function, and they will have a formal evaluation regarding these goals throughout the year. If your employee is meeting these goals yearly, they would be rewarded with an annual merit raise rather than just a cost of living type salary increase.

Now that you’ve decided to implement an incentive based program for your coding department, here’s a list of information for you to think about as you design your incentive based plan(s).

1. The fundamental make up of the program should be fairly simple and straightforward
2. It should recognize and compensate the employee for superior performance fairly across the board.
3. It should direct the individual employee’s behavior toward achieving the common goal(s)
4. It should be designed to effect change (positive and permanent) within the department or organization
5. It should allow a substantial portion of compensation to be a variable cost.(i.e. the plan should reward results rather than actions!)

6. The program should have some built in flexibility to meet the needs of the employee and the department.

Quality Monitoring tools for Inpatient and Outpatient Use

The term Quality monitoring “tools” may be misleading. Inpatient quality monitoring tools usually consists of a Data Quality Manager, who functions in concert with the Information Technology team. These individuals are charged with mining data and overseeing data quality that is consistently input into the system from the medical record. In addition to quality, the Data Quality Manager ensures that the data analysis of that information upholds the integrity of the record, and the processes surrounding the gathering of such data for reporting and analysis measures.

Data mining software has really come into its own on the medical market. Many types of data mining applications function with Electronic Medical Records, Patient Management and medical billing systems. For inpatient hospital facilities and stand alone ambulatory care centers and surgical care suites, they also utilize data mining for many different types of applications. he ongoing goal in regard to data management, is to
 Improve the accuracy, integrity and quality of patient data.
 Improve the quality of physician documentation within the medical record to support code assignment
 Utilize only standardized coding data sets in the such as ICD-9-CM, CPT, HCPCS,and DSM-IV,
ICD-9-CM, UHDDS, and DSM-IV are the norms used for inpatient reporting of procedures
CPT4, and HCPCS are the norms used for outpatient reporting of procedures

To achieve consistency of inpatient and outpatient coding of diagnoses and procedures coders should always
1. Thoroughly review the entire medical record as part of the coding process in order to report the most appropriates codes

2. Adhere to all standard coding conventions outlined in ICD-9-CM, CPT HCPCS, and DSM IV

3. Assign and report diagnosis codes, without physician consultation/query, for diagnoses and procedures that are not listed in the physician’s final diagnostic statement only if those diagnoses and procedures are specifically documented in the body of the medical record by a physician directly participating in the care of the patient, and this documentation is clear and consistent

4. Assign and report diagnosis codes within areas of the medical record which contain acceptable physician documentation to support code assignment include the discharge summary, history and physical, emergency room record, physician progress notes, physician orders, physician consultations, operative reports, anesthesia notes, and physician notations of intra-operative occurrences

5. Assign and report diagnosis codes if they are stated in other medical record documentation such as nurses’ notes, pathology report, radiology reports, laboratory reports, EKGs, nutritional evaluation and other ancillary reports. If these diagnoses are not documented by the physician directly participating in the care of the patient, the attending physician must be queried for confirmation of the condition or diagnosis.

6. Utilize medical record documentation to provide specificity in coding physicians’ diagnoses and procedures,within the radiology report to confirm the fracture site or referring to the EKG to identify the location of a Myocardial Infarction etc..

7. All POA (Present on Admission) indicators are subject to reporting and collection of information involving inpatient admissions as per federal law, and the POA indicators are assigned to principal and/or secondary diagnoses as defined as “present” at the time of the inpatient admission.

8. Coders must use a formalized query process when a diagnosis or procedure meets reporting guidelines, but is not clearly stated within the medical record, or conflicting documentation is contained within the medical record.

9. All inpatient records much have a coding summary attached and also must note the ICD-9-CM diagnosis and procedure codes in addition to the narrative description, the POA indicators, patient identification/demographics and admit and discharges dates.

10. The coding summary may also contain the discharge disposition (i.e. patient to home, to skilled nursing facility etcc) This summary may also contain the DRG assignments and descriptors. Once approved, the coding summary will become a permanent part of the medical record (and data information systems)

11. In addition to the coding summary, a physician attestation should also be included. It validates the physician agreement to what is contained within the coding summary. Verbiage for attestations need to state that the physician aggress and approves of the diagnosis and procedure codes listed and that the accurately reflect the episode of care.

12. Coders should not add any diagnosis based solely upon test results.

13. Coders should not misprepresent the patients episode of care by adding or deliberately omitting diagnoses.

14. Each record and episode of care should reflect the medical necessity of such.

15. Coders should comply with all standard coding conventions and guidelines. They should have a firm commitment to the ethics and morals of quality data integrity and perform their job functions as such.


What is benchmarking? Why does it matter? How do I start? In the medical industry, benchmarking is known as a process of measuring internal processes, then identifying, understanding and adapting the optimal processes and functions from other peers, companies or organizations that are considered to be best in class. You are basically seeing how you measure up against those considered to be the best of the best. Depending upon what you want to compare yourself against, you could benchmark your requirements for hiring a marketing director in healthcare against the processes for hiring a marketing director in the banking sector. Even though the industries are different, chances are the hiring processes are similar.

When benchmarking for coders, and coding departments, you will want to decide upon a standardized set of criteria, that is universal within your peer group. The first area that comes to mind is benchmarking coder productivity and coder salaries. The experts to look to within the coding industry would be American Health Information Management Association (AHIMA) and the American Academy of Professional Coders. These two businesses routinely compile data and statistics from their members in regard to coding salaries. Of course, both businesses have different outcomes with the salary surveys, but it certainly gives you the opportunity to see where your department or employer measures up in relation to others within your peer group. The surveys also present salary information based upon locality, state, region and national averages. In addition to the salary surveys, they also bench mark salaries for full time coders delineated by length of time (years) in the industry and part time coder’s by a set number of hours worked within the workweek delineated by length of time (years) in the industry. Another area that may be able to provide you with good benchmarking criteria is the MGMA (Medical Group Management association) and also your local or state employment offices and job data bank warehouses.

Most companies want to remain very competitive with salary, so they do try and keep abreast of what are the starting salaries for non-certified new and experienced coders, newly certified coders, and certified experienced coders. Comparisons to benchmark should be very similar to the comparisons and analysis that you do for data quality management. You want to make sure that you are comparing “apples to apples” not “apples to ice-cream”.

Areas of confusion for coder benchmarking is determining “who is the very best” and how do we position ourselves to meet or exceed these benchmarks? If you don’t know what the standard is, it makes it difficult to analyze where you or your organization fits in against the other organizations. Of course, it really helps if your peers contribute to the benchmarking standards, or if there is a designated independent pool or databank where this information could be stored then disseminated out anonymously. The AAPC and AHIMA do a very good job of these type of reports. One of the best things about benchmarking a specific set of criteria, is that it is a system that enables you to improve yourself, your department or organization from a very positive aspect.

There are 3 types of “benchmarking”
1. 1. Internal Benchmarking – most often used as the first place to start. Performing an internal benchmark of your coders productivity (against each other) can be very helpful. Especially if you have coders who perform the same or similar jobs but in different locations. You could benchmark productivity based upon the type of coding( E&M) , the experience level amongst the coders (long-term vs/newbies) , and even the location to location coded volume vs/dollars per day.

2. Competitor or Peer Benchmarking – with this type of benchmarking you are looking to set your business standard and practice next to how your competitor or peers are performing under the same standard and practice. With this type of benchmarking, it is helpful to know and work in conjunction with your competitors and peers to make the standard itself better. (i.e. in customer services)

3. Best in Class Benchmarking – it focuses outside your specific organization’s specific industry, and you compare yourself against national “norms” or “values”. This best in class benchmarking is usually only concerned with one specific function, and can cross many different industries. This type of benchmarking is oftentimes summed up in a report from an independent evaluator, crossing many different types of industries… i.e. Hospital XYZ wins the award for the best in customer service for 2009, but in 2008 Big Box Bank won the award for best in customer service.

So within these 3 separate types of benchmarking you can easily determine which type you want to pursue, and how it will best function for you as a coding manager. I personally liked being able to put the coder productivity to the test for the coders in the different locations. In looking at the data for these benchmarking activities. I determined that it was very useful for my staff to see how they stacked up against each other within the locations. Especially when they could see that the Internal Medicine office has xxx amount of coded encounters (E&M visit, procedure, injection) per month, and has generated xxx amount of dollars. The other area of benchmarking that really gets things lively is by benchmarking the amount of co-pay dollars that are brought in each month by each location. We disclosed this out to each location and let them see how they stacked up against each other, then we implemented an incentive for a 3 month period of time. The location with the most amount of co-pay dollars collected over the 3 month period won a “pizza party” catered luncheon, that included salad, drinks and dessert.

Interestingly enough, the location that won the “pizza party” was one of the “lowest” performers initially, but seized the opportunity and has consistently been one of our best performers since that initial benchmarking process. We still provide the feedback to each location every month as to where they stacked up against each other with the co-pay dollars. We haven’t done the “incentive” yet this year, but we will again within the next few months. This time…we’ve changed the criteria a bit. We will be having an incentive to see which location can collect the most amount of self-pay dollars within the 3 month timeframe. The incentive for the winners is a 15 minute chair massage for all the employees in that location. We have been fortunate to partner with the local technical college, and their massage therapy students will be performing the chair massages. This really is a win-win for both of us, as our employees get the massages free of charge, and the students get valuable experience during school hours.

Possible pitfalls to benchmarking is beginning the process before you are truly ready. You need to make sure that you have clearly outlined what it is you want to compare yourself to, and how you want to make this happen. The other consideration is the fallout (e.g. financial, employee turnover etc) if the data is skewed, or is not properly validated. Just doing 1-1 comparisons is not enough to truly elicit any type of change of process or focus. Poor preparation just leads to frustration and wasted time. To have a truly successful coding benchmarking program you as the manager need to be able to identify your internal departmental strengths and weaknesses, then recognize which of these processes need special attention. It is then you will be able to begin the critical processes for comparison and analysis. Again, communication is the crux of the process and when successful those changes become an accepted part of the routine, day to day processes.

Good coding benchmarks have the potential to increase your revenue stream, reduce your monetary days in AR, incentivize and increase productivity of your coding and billing staff, and reduce staff turn-over. Once you get started and see the successes, you will want to continue the process, finding many ways to utilize this often overlooked management tool.

Remote coding – Outsource coding: Do I? Don’t I?
As a new coding manager there may be times when you need to seriously consider whether or not you should take advantage of remote or off-site coding.. There are a number of ways that a remote coding situation can benefit both you and the department. There are also many different scenarios to consider when deciding to implement a remote coding situation, or utilizing your current staff in a coding from home employment option.

An inpatient coding manager, may want to consider utilizing outsource coding resources for monitoring and reviewing codes in the Charge Description Master (CDM) or utilizing them for clinical coding compliance audits and some facilities utilize outsource coders for help with department backlog and JCAHO preparation for the department. If you decide upon using an outsource coding firm, be sure to get references from previous clients as to how they performed for them. You will want to research the company to ensure that their employees are bonded, and also have them sign confidentiality and privacy agreements for your specific facility. You will want to determine the turn-around time on the coding of records that they are contracted to do, and oversee that these timeframes are being met. Perform due diligence, and have each of their coders take your own “coding test” that you’ve designed for your own employees. If possible, review these tests for accuracy before the outsource company begins working for you. Also determine if you will be charged separately for each type of record audited/coded/billed, or if all will be billed in one invoice as a combined fee.

From a departmental or facility standpoint, an outside coding/billing company can be a good use of your financial dollar. These outsource functions can help control budgetary costs by reducing your backlog of uncoded/unbilled charts, you don’t have to provide any sort of employee benefit package such as paid time off, medical insurance, overtime, holiday or vacation pay. Another perk that an outsource coding company brings to the table, is an increase of productivity in regard to your claims schedule and revenue stream, since you do not have to plan for unscheduled time off, or unplanned absences by your immediate staff.

Most coders will tell you that this is the "nirvana" that they are hoping for. If you talk to newly credentialed coders they want to know how they can start "coding from home". I hear this from coders in all aspects of the medical field. It bothers me to some degree that schools seem to be really emphasizing this "perk" for newly credentialed coders. I feel it is extremely important for a new coder to work side by side with a more experienced coder to develop the mentor/mentee relationship. My other feeling is that just because you've gotten your coding certification, it does not automatically make you a good coder. In my years of experience, I have seen many non-credentialed coders who were as good if not better coders than some of the credentialed coders.

However, remote coding, or coding from home is unique in the fact that you have to be very self disciplined to get the work completed accurately, and in a timely manner. I have seen many remote transcriptionists transition to the coding/billing from home workforce very successfully, as transcription deadlines are so very similar to the deadlines that coders face.

If you are a coder that is currently employed by a facility, and wishes to code from home, there are a number of issues to consider.

• The coding manager and the coder need to determine the amount of time that will be spent in remote coding. (i.e. part time, full time) and total hours per day.

• You will need to have a HIPAA compliant area for privacy and security within your home office

• You will need a PC with internet connectivity to your workplace, and possibly even a fax machine, scanner, and encryption software, OR the ability to dial into a VPN and access the facility or office's EMR directly.

• As the manager, you will need to have an accounting system or timekeeping system to oversee if the coder is truly "working" during the hours stated, or has completed the amount of work sent to them within the prescribed timeframes and is accurate. The coder must be able to work with little or no supervision, and have a great deal of self discipline to get the job(s) completed within timeframes.

• Human Resources will also need to be notified, as some states have laws governing employees that work from home and are considered telecommuters. This may affect how the employee's pay is determined and taxes are deducted or applied. This may also affect how the employee accrues vacation and sick pay.

• Also, the coder and the manager need to have regular communication regarding how things are going – I suggest weekly phone meetings or web-cam meetings. Then the usage of e-mail should be highly encouraged. Working from home is very isolating, so keeping in touch with peers and supervisors/managers is essential.

• Your remote coders should still be held accountable for keeping their licensure current, and maintaining their educational requirements for certification and per your coding department policies.

• The remote coder should also continue to participate (i.e. come into the office) for departmental meetings, educational updates, and for mentor/mentee participation.

• Usually the most rewarding of all, is that coder job satisfaction goes up, and you have less departmental turnover.

After evaluating the above, discuss with your upper management, human resources and financial officers and see if this is a good fit for enabling your facility or practice to create a “coding from home” program for your employees. This is probably not a good fit for all, but in some situations it can be a win-win.

Before committing to having “work from home” coders be a permanent part of your practice or facility, have each employee who wishes to pursue the “work from home” option, that you enact it on a “temporary” basis. the “work from home” program should undergo a 30,60,90 and 180 day evaluation of the success or failure of the program, and of each employee participating in it. Inform the employee (and have them sign a work from home agreement that states the same) that this program is temporary, and will be subject to being terminated at any time. If you elect to terminate the program itself, or terminate the employee’s work from home agreement, they will be required to work in-office from the practice or facility, as per the requirements and or needs of the facility or office. .

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