Kristen Niedermeyer
Central Arizona Student
In the high stakes world of health information, is there really anything that a student can do to affect coding and billing accuracy rates? I believe there is, so please read on to hear more about it.
According to the last CMS Comprehensive Error Rate Testing (CERT) report the estimated accuracy rate of Medicare FFS payments for fiscal year 2014 was only 87.3 percent. This leaves an overall error rate of 12.7 percent or $45.8 billion to providers. Inpatient hospitals had an improper payment rate of 9.2%, while the combined physicians, labs and ambulance error rate was 12.1% and non-inpatient hospital facilities had an improper payment rate of 13.1%. Statistics like these are the reason for the rise in federal programs and audits to recover overpayments.
Some common reasons for these overpayments, per the Medicare Learning Network, include duplicate charges, services that are not medically necessary, billing for an inappropriate place of service, and billing for excessive charges.
The truth is, health information professionals do have an important role to play in reducing these improper payments. These high stakes can be overwhelming to students and new health information graduates. The good news is that there are now plenty of resources available to coders to ensure proper coding in the future and thereby reduce coding error rates. From day one, the American Health Information Management Association’s Code of Ethics and the Standards of Ethical Coding offer a foundation for accurate and ethical coding practices. These are both listed on the AHIMA website, ahima.org. Ethics are such an important part of health information management. Medicare fraud, abuse and false claims are totally avoidable and should never happen.
I personally decided to get into health information because I have always been fascinated with healthcare. After serving four years in the US Navy, I completed a program for medical assisting and entered the workforce. I found I was more interested in working on authorizations and administrative tasks than calling patients with their test results and checking vitals.
After a decade with the same company, I decided I needed to branch out and continue progressing in my career. I am currently working on my associates in health information at Central Arizona College in Pinal County. Being married and no longer in my carefree twenties made it a tough decision to go back to school.
As a student, the changing landscape of health information technology can seem wrought with risks. Challenges such as new technologies, recovery auditing programs and data security (to name just a few!) are here to stay. Support from the wider health information community is imperative to staying on top.
AHIMA offers a student membership to those enrolled in a health information related degree or certificate program for a fraction of the cost of active membership. This membership has been invaluable to me. As a student member of AHIMA I have made a life-long commitment to continuing my education in health information.
Some of the numerous resources available for AHIMA members are: a digital subscription to the Journal of AHIMA, educational tools, eligibility to merit scholarships, and access to volunteer opportunities, free career preparation webinars and a career assist job bank. The Engage Online Community (formerly Communities of Practices, or CoP) provides members an opportunity to network with health information professionals and find mentors or mentees.
Coders can continue the learning process by attending workshops, seminars and coding roundtables to stay sharp on their coding skills and learn new things. Coders can stay informed through HIM journals, and submitting their coding questions to online forums such as the American Hospital Association’s Coding Clinic at http://www.codingclinicadvisor.com/. Nothing can take the place of on-the-job training, however, since the intricacies of coding can only truly be learned through working with actual source documents.
Seminars are another opportunity for learning. In September, I attended the AHIMA Fall Meeting at Banner Desert Medical Center in Mesa, AZ. As a student, I found the information presented informative and interesting. It is helpful to students to hear advice and guidance from experts in the field on specific and diverse areas of concern such as cutting and pasting in an EHR (don’t do it!), documentation- based coding, and the Joint Commission Initiatives.
In summary, I would highly recommend to other students that they take advantage of the resources that are available through the AHIMA website and network with professionals in health information careers.
Coding Tips for Students
As Aristotle once said, “Quality is not an act, it is a habit.” Since habits are created by repetition and practice, the best advice I have ever been given is to practice coding – repeatedly. The following are tips for success in coding to prevent errors and instill confidence in your work:
- Continue the learning process by attending workshops, seminars and coding roundtables to stay sharp on coding skills and learn new things
- Stay informed through HIM journals
- Submit coding questions to online forums such as the American Hospital Association’s Coding Clinic: http://www.codingclinicadvisor.com
- Search deeply into the medical records rather than briefly scanning to ensure coding to the highest level of specificity, therefore reducing billing accuracy
- Avoid over-reliance on coding software or cheat sheets (coding software may not be specific enough and cheat sheets can become outdated or may be oversimplified)
- Practice, practice, practice . . . and, of course, study!
References:
- https://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Medicare-FFS-Compliance-Programs/CERT/index.html?redirect=/cert
- https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/MCRP_Booklet.pdf
- SusanChapman: http://www.fortherecordmag.com/archives/0114p20.shtml. Jan 2014 Edition.