By Scot Nemchik, VP of Coding Education for Ciox
Accurate coding has become more important to Government organizations and more valuable to their budgets than ever before. Government agencies who deliver care are also submitting claims to commercial insurers, which reimburse them for the services rendered, similar to the way it works in the private sector. The largest of these include the VA and DoD health agencies. For these organizations, coding matters.
As a result, it stands to reason that coding accuracy is of growing importance to Government organizations, just as it has become a hot button item in the private sector. Complete and complex clinical pictures are captured within coding encounters. Though medical coding was, at first, used exclusively to facilitate reimbursement, today it is also used throughout the care continuum to facilitate electronic health records and capture important population health intelligence.
Governments Need Coding Intelligence More and More
Increasingly, our Government needs the same intelligence and efficiencies around coding as the private sector. Government health agencies own hospitals, provide services, and have at their fingertips the same data streams and intelligence-gathering opportunities as countless private sector organizations. Like the private sector, Government agencies are using medical data to make more informed predictions about their beneficiaries, to gain efficiencies in care delivery and to target fraud waste and prevention.
Because the impact of accurate coding in the modern era extends beyond reimbursement and into so many other aspects of Healthcare delivery, it is clear that the stakes have been raised in Federal Healthcare. With the added importance of coding accuracy, many of these organizations are today assessing how to drive improved results.
Employee Retention and Smart Hires are Key
As Government agencies look to improve performance within their coding staff, whether through new hires or by strengthening existing teams, the transition to a platform-based training and assessment environment with experiential and measurement capabilities can provide one part of the solution.
Coding is an industry that requires specialized skills, so it’s important for organizations seeking improvement to hire and retain their technical staff using industry best practices and insights. It is far more efficient throughout the private and public sectors for organizations to retain coders than to replace them. The Work Institute’s 2018 Retention Report suggests that when an employee departs an organization, it costs on average 33 percent of that worker’s base salary to replace them, with organizational costs ranging from marketing the open role to the costs of lost productivity, temporary replacement workers and recruiter fees.
The process of ensuring better upfront assessment of candidates starts with deploying better screening measures during the onboarding process. Traditional testing of coding skill is accomplished by simple multiple-choice assessment. However, the private sector has found – and Government agencies should take note – that those assessments are not as predictive of aptitude as modern measures. A better approach has proven to be the use of platform-based assessment techniques, where candidates are tested in an environment that replicates a current EMR, coding real clinical content. By taking a practical approach to how the candidate will code in “live” situations, organizations gain meaningful insight into coding aptitude.
The same testing tools used to improve the quality of new hires can be used to improve the accuracy of existing staff as well. Traditionally, organizations have relied on passive training such as webinars and learning management system (LMS) assignments to teach new and important coding instructions. However, just as with new hire testing, it has become clear that active platform-based training produces far more scalable and effective results for existing staff. By training actively, coders learn by doing. These hands-on methods have been proven to accelerate learning, optimize retention and teach coders to learn from mistakes in real-time.
Coders Become Even More Valuable with Cross Training
Platforms for coding training also offer effective and efficient cross-training, allowing organizations to teach diverse capabilities to coders, or to give specific teams additional support staff for more flexibility. It’s not just the organization that benefits; existing teams benefit from ongoing education too. In addition to cross-training exercises, coders can also learn the latest guidelines. Coding is dynamic, and each year sees new changes. Access to new guidelines and codes is essential, and comprehensive learning platforms offer all of these capabilities, as well as the ability to measure their uptake in real-time.
Beyond education, the latest in Natural Language Processing (NLP) technology offers Government agencies a chance to gain efficiency by automating more of the coding and extraction processes. While few, if any, Government agencies are using NLP technologies in their medical coding efforts today, the technology is currently being used in the private sector with positive results.
Technology has Come a Long Way
The industry has evolved considerably since the time where NLP platforms produced questionable results. Initially, NLP was plagued by its reputation for producing invalid or missing codes, requiring recoding a prohibitive number of charts from scratch. Many who tested NLP platforms in those days found it more expensive than traditional coding. Today, NLP has turned a corner. Clinical rule sets are more refined than they once were, and millions of charts have been fed to AI and machine learning tools to tune the engines and refine extractions. NLP platforms are now operationally viable, and able to drive insights into both corporate and Government entities at lower coding costs per chart.
While advanced screening and training methodologies and new automation technologies are all relative newcomers to the Government’s medical coding efforts, the true value of these practices will only be realized when agencies fully leverage people and technological innovation to support coding and training. For savvy organizations, the data generated by medical coding can translate into more informed clinical decision-making, waste and fraud prevention, and improved efficiency. Down the line, that type of preparation should result in meaningful value for Government agencies and, most importantly, for those Government Healthcare efforts serve.
About the Author
Scot Nemchik CCS, AHIMA Certified ICD-10 Trainer, is Vice President of Compliance and Strategic Planning for Ciox Health. Scot has over a decade of experience in health information management with concentrations in workflow assessment/improvement, revenue cycle optimization, and acute care coding/compliance. In his various roles in education and coding compliance Scot has trained hundreds in areas as diverse as Disease Management, CDI, PPS and, of course, coding. He is currently developing strategies to help hospitals minimize the productivity and financial impact of ICD-10 adoption.