Readers Write: From Complacency to Compliance – How Physician Coder Training Systems Evolve in Light of ICD-10

From Complacency to Compliance: How Physician Coder Training Systems Evolve in Light of ICD-10
By Daria Bonner and Philip Miles

 

“You cannot escape the responsibility of tomorrow by evading it today.”

This famous quote by Abraham Lincoln is relevant in our day-to-day experiences, and it’s particularly relevant in healthcare. More specifically, you can’t make ICD-10 go away by simply refusing to learn it. The realities of medical necessity, denied claims, and OIG fines impact all practices and physicians. The days of nonchalant coding in physician practices are gone. Little by little, practices are realizing the importance of accurate and complete coding. They’re also recognizing the need for certified medical coders as part of an integrated professional practice team.

The Tides are Turning
Welcome to a new era of coding where compliance programs, established coding guidelines, and clinical coder certifications are the norm. And these demands for better coding don’t stop at ICD-10. All physician coding practices are prime for improvement, including CPT and E&M. Many practices are under an incorrect assumption that the grace period announced by CMS and the AMA in July 2015 lets them completely off the hook in terms of ICD-10 specificity. In reality, codes submitted from physician practices must still be accurate. The only flexibility is with retrospective audits, denials, and fines — for now.

Effective October 1, 2016, the grace period will end, and all providers will likely see an increase in denials for medical necessity and nonspecific codes. All sites of service, including hospitals, may be affected. Note that pre-payment audits require specificity even during the grace period. Many providers are seeing denials related to these audits now. As a result, coder training and certification within physician practices must evolve and improve. Having certified coders on staff propels coding initiatives and helps drive stronger compliance. Many medical groups have already employed certified medical coders to:

• Navigate the complexities of ICD-10.
• Establish practice-specific coding guidelines and a coding compliance program.
• Support clinical documentation improvement (CDI) efforts.
• Team-up with IT for stronger EHR data integrity and information governance.
• Fine-tune EHR documentation templates for ICD-10.

The first step is to recruit, hire, and retain a certified coder. Keeping your certified coder credentialed and continually educated in a rapidly changing medical practice is next. Quality coder training is an essential operational cost — and one that can’t be ignored.

Technology’s Role in Coder Training
Traditionally, coders travelled to coding conferences for credentialing, updates, and continuing education. However, sending coders offsite has become cost prohibitive for many medical groups and physician practices for three reasons:

• Travel costs sometimes exceed registration for the actual training event.
• Cases pile up and billing stalls when coders are out of the office.
• Backlogged coding disrupts cash flow during a time when practices are particularly vulnerable to ICD-10 denials and payment delays.

Online/virtual coder training systems are rising up to meet this need. That’s because many online learning management systems (LMS) not only offer coders a quality education, but also yield significant cost savings for practices.

A Five-Point Technology Checklist

Aside from the cost of the LMS itself, the only other ongoing cost is effective Internet virus protection. This protection allows coders to access Web browsers and online platforms without the added risk of inadvertently downloading a virus. Most practices have already invested in this software. Another benefit is the pace and format of online coder training. The sky is the limit in terms of online/virtual training developments — particularly in the physician practice market.

Educators continue to explore and enhance virtual options that mirror a live classroom environment, providing a more hands-on experience. Many of these online/virtual options are also self-paced, meaning a coder can move through certain portions of the course more quickly and spend more time focusing on content that seems unfamiliar or challenging.

If you’re going to invest in an LMS, there are key capabilities to include. Consider the following top six characteristics of an effective LMS:

1. Functional and elegant user interface.
2. Efficient and effective back-end (underlying program).
3. No additional software or systems to access the LMS.
4. Simulated “live setting” so students feel as though they’re physically in a classroom setting.
5. Constant feedback mechanisms regarding grades and/or progress.
6. Ability to provide certification.

To maximize effectiveness, practice managers or instructors using the LMS should also be able to complete these tasks:

• Import and segment groups of students.
• Interact with the entire group, a subgroup, or an individual student.
• Update and amend content in real time.
• Allow students to communicate with each other.
• Offer multiple learning modalities.

Credibility Powers Productivity

Beyond the technical and instructor-specific capabilities listed above, training options should be evaluated for their credibility. There is a whole host of online courses for clinical coding in physician practices. It’s important to ensure that each coder obtains high-quality training catered to his or her unique learning style. Use the following checklist to vet coding trainers and find the best solution for your practice:

• Does the instructor hold any credentials? If so, which ones?
• What is the instructor’s educational and professional background? What other courses has he or she taught?
• Is the course backed by an accredited organization? If so, which one?
• Are any prerequisites required?
• What experience do students need before taking the course?
• What type of access will students have to the instructor?
• How much time, on average, will students spend interacting with the LMS daily or weekly?
• What are the goals of the course, and do these goals meet coder expectations?
• Will the course be offered according to a specific schedule?
• What’s the cost of the course, and are payment plans available?

Coding Content is King
When evaluating coder training options, practices also need to focus on content. Today’s physician practice coders require training on a variety of topics, including clinical documentation improvement, coding, auditing, and compliance. Physician practice coders also want to be cross-trained in inpatient and outpatient coding, and they want to learn more about other types of specialized coding. This includes HCC coding and coding for home health and other settings that have become targets for the federal government. Ensure that any LMS you choose includes educational components for each of these areas.

Consult with your coders to ensure the LMS is worthwhile and will ultimately help staff be more productive and compliant. Remember that anyone can create an online training program. Look for a credible source, ask questions, and get references before making a final decision. Now is the time to level-up coder training systems, programs, and coder certification in physician practices — starting with your own.

Daria Bonner is CEO of Xact Healthcare Solutions in Port St. Lucie, FL. Phillip Miles is the owner of The Medical Management Institute in Alpharetta, GA.

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Contacts

Jennifer,  Mr. H, Lorre, Dr. Jayne, Dr. Gregg, Lt. Dan

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