Insurance Q & A

Financial Management

By: Lolita Jones

Published: 6/9/2008

Share:

How to Hire a Coder - Part II


Last month, we addressed a number of issues regarding hiring and orienting new coding professionals. This month, we continue with screening, testing and orientation issues.




Background Checks
Some facilities only perform background checks on your applicants who will directly interact with patients, such as physicians and nurses. However, there are now so many legal and regulatory compliance issues surrounding coding and reimbursement of procedures that more and more facilities are including their coders in their pre-hiring background check process. It is good practice to do so. Before you proceed with the background check, have the potential coder sign a release form authorizing the check.

What will the background check focus on? Obviously, the primary red flag to watch out for is a candidate with a criminal record and/or a history of substance abuse. However, there are some other issues that may be less obvious hindrances to the candidate's ability to be a successful coder. You may also want to consider the following:
  • Driving violations. This is a reflection of the candidate's judgement. Some may consider a person with a history of reckless driving to also be likely to make rash, ill-conceived decisions that could cause your facility to be audited.
  • Financial/credit status. How has the candidate managed his/ her own financial issues? A coding candidate with a poor personal credit rating may not able to handle coding and reimbursement responsibilities efficiently.
  • Employment references. If the candidate has only provided limited information about his or her previous employment history and not cited references, you may want to consider asking for copies of annual evaluations from previous employers. You may also want to require candidates to provide direct contact references.


Even before you start interviewing candidates, you should create in your facility bylaws a disclosure policy as to whether the details of background checks- especially negative findings- are to be shared with employment candidate. Consult with legal counsel on the policy. The main issue is that the policy is applied equitably. If the information is to be shared, your facility policies should also specify by whom (for example, a designated member of the corporate office staff, the administrator, the business manager, etc).

Finally, if you hire the candidate, before he or she begins work, the facility administrator should make certain the personnel file of the new coder contains copies of the following:
  • any educational degrees/certificates;
  • the AHIMA and/or American Academy of Procedural Coders (AAPC) coding credential certificate(s);
  • the current AHIMA and/or AAPC continuing education maintenance/validation form(s)/certificate(s); and
  • certificates of attendance/ achievement for any health information management (HIM)-related educational programs coding, reimbursement, for example).

Coding Resources

Your coder should have access to the following coding resources (when applicable, the publisher is listed in parentheses):

  • ICD-9-CM code book (Government Printing Office, Washington, DC)

  • CPT code book (American Medical Association/AMA, Chicago, IL)

  • HCPCS (Healthcare Common Procedure Coding System) Level II code listing/book/electronic file

  • Medicare Outpatient Code Editor (OCE) edits for outpatient claims

  • CPT Assistant newsletter (AMA, Chicago, IL)

  • Coding Clinic for ICD-9-CM (AHA, Chicago, IL)

  • Code Write (Society for Clinical Coding, AHIMA, Chicago, IL)

  • American Health Information Management Association (AHIMA) Communities of Practice (www.ahima.org)

  • Complete Global Service Data for Orthopaedic Surgery (American Academy of Orthopaedic Surgeons, Skokie, IL)

  • Global Service Information for Hand Surgery (American Society for Surgery for the Hand, Englewood, CO)

  • ICD-9-CM Coding Handbook with Answers (AHA, Chicago, IL)

  • "Coding Note" column (published in the Journal of the American Health Information Management Association, AHIMA, Chicago, IL)

  • ICD-9-CM Coordination and Maintenance Committee meeting minutes (See the Summary of Procedure Code Presentation Minutes at: http://www.hcfa.gov/medicare/icd9cm.htm and See the Summary of the Diagnosis Code Presentation Minutes at: http://www.cdc.gov/nchswww/about/ otheract/icd9/maint/maint.htm )

  • AHIMA Practice Briefs and Position Statements (egs, "Data Quality," "National Coding Quality")

  • Annual November "CPT Symposium" handout (AMA, Chicago, IL)

  • The Office of Inspector General's Compliance Program Guidelines and Special Fraud Alerts

  • Copies of letters received by any facility staff in response to coding and/or regulatory questions submitted to American Hospital Association (AHA), AMA, Centers for Medicare and Medicaid Services (CMS), and/or the National Center for Health Statistics (NCHS)

  • Copies of Medicaid coding, billing, and reimbursement regulations and guidelines published in the: Federal Register, fiscal intermediary or carrier hardcopy or electronic newsletters/bulletins, local medical review policies (LMRPs), Medicare Program Memorandum, Medicare or Medicaid Manuals,

  • Medical Dictionary

  • Drug/Pharmaceuticals Reference

  • Clinical Anatomy book/chart/software


    • Skills Assessment Testing
    Adopt a systematic approach to testing to ensure that the skills you are testing for match the work that the candidate will actually need to code. Start by generating a report to identify the ICD-9-CM/CPT/HCPCS codes and modifiers that you used most frequently during the last calendar year. Structure the assessment so that it encompasses scenarios or charts that reflect your facility's actual case-mix. If you do cases for the eyes, bones, digestive tract, the assessment should cover these specific areas more thoroughly.

    Here are some other related pre-testing issues to consider:
    • Consider creating a two-part assessment. For example, part one can be comprised of multiple- choice questions to cover general knowledge (for instance, 20 questions about ICD-9-CM and/or CPT coding conventions), and part two can test the candidate's aptitude with actual medical record documents or charts.
    • Assign point values to the test ? will each question or code assignment have the same value or be on a scale weighted to its overall importance?
    • Pre-establish a "passing" score for the test(s) ? e.g. 95 percent accuracy rate.
    • Determine if there should be a time limit for completion of the test.
    • Will the potential hire use only a code book(s) (and not a computerized encoder) to complete the test? I recommend testing potential coders using code books only to ensure that the individual understands how to use the book and coding guidelines within the book.


    If you need help in creating an assessment test, the following ASC-specific publications contain numerous exercises (and an Answer Key) that can be used as resources for testing potential coders: ASC Clinic: Dermatology

    Related Articles