Medicare Compliance & Reimbursement

Bring in the reimbursement your practice deserves by hiring the right coder.

A solid coder can reduce your denial percentages, increase your revenue, and keep you out of trouble with payers — but how do you find a suitable candidate? Follow this eight step path to hiring success.

1. Why Hire a Coder at All?

Having a coder in your practice helps ensure you are submitting accurate claims that will bring in the reimbursement your providers deserve for the work they have done. The coder will analyze and translate the providers’ notes and then assign codes to those services so the provider’s work can be billed. Coding efficiently and accurately can be challenging and having a dedicated coder can only benefit your practice. That coder or coders, as the case may be, will stay up to date on ever-changing coding requirements and regulations, to not only bring in reimbursement but also keep your practice compliant and off the auditors’ radar.

2. Determine What You Need

Before you even place an ad in the paper or post a job opening to an association website, you first need to determine exactly what your practice needs. You’ll want to create a detailed job description for the coder position that includes general skills you’re looking for and specific skills pertaining to your individual practice.

Keep in mind: Much like physicians who decide what branch of medicine to work in, coders can choose a specialty to focus on. You may want to look for a coder who has experience in your practice’s specialty, as she will be more familiar with the specifics and nuances of that specialty.

If you are a general surgery practice, you may not want to hire a coder who only has primary care coding experience. Or perhaps you want someone with physician practice coding experience, and won’t consider a candidate who only has facility coding knowledge. You should also consider if you need a coder who knows particular payers’ rules.

"I believe physicians prefer a coder with experience in their specialty to ensure accuracy and will capture all of the billable codes," says Becky Boone, CPC, CUC, urology surgery coder for The Coding Network and cardiology coder for the University of Missouri Internal Medicine Department in Columbia.

On the other hand: "On one hand (the more popular hand) a physician would want a coder with a defined stream of knowledge in the specialty of the physician," says Suzan Hauptman CPC, CEMC, CEDC, manager of physician compliance and auditing at West Penn Allegheny Health Systems in Pittsburgh. "However, there is a smaller group of physicians that would like to see the well-rounded coder as s/he may be able to find things that may be missed by a specialty focused coder."

Best bet: Create a written job description that sets out clear expectations for a new hire; this will go a long way toward helping you screen resumes and draft appropriate interview questions.

3. Look in the Best Places

Once you know the exact job you need to fill, you need to decide how you will advertise the position. There are many good options out there from local colleges, to national associations, to free or fee-based online job search websites.

"Word of mouth is the best form of advertising," Hauptman says. "However, more and more I see groups, head hunters, and the like reaching out through LinkedIn, the AAPC, and conferences."

When you’re hiring a coder, one of the best places to start looking is through local chapters of national associations such as the American Association of Professional Coders (AAPC) and American Health Information Management Association (AHIMA). It is a pretty good bet that coders who are active in their local chapters are invested in their careers and have a passion for the medical coding industry. You can contact the local chapter executives or even post on the association’s national job board.

"Most coders will begin searching for positions online," Boone says. "Another option for coders is to look online at their nationally recognized certification organization."

Don’t forget: Look at your existing staff to see if you have someone with coding knowledge that you can build upon. If you have someone in your practice already who could successfully code with a bit of additional training, consider that option before going outside the practice.

4. Don’t Be Afraid of New Coders

Another good place you can look for coders is at local colleges with medical coding and billing courses or degrees. Many practices are worried about hiring brand new, just-graduated students because they lack experience. But candidates who are just out of school are often still eager to learn and have the basics fresh in their minds. Many are even newly certified.

Remember: Every coder started as a new coder once. Mastery of the nuances of coding comes with time and experience, but coding can be taught. Office processes and payer know-how change from practice to practice, so you will have some learning curve with whoever you hire.

Your best bet when looking at brand new coders is to focus on their coding education and on other skills that are important to the job. Keep in mind that there is a big difference between a two-week course and an associate’s degree from a local college that includes a coding certification. What other skills can the person also bring to the table? Consider things such as computer knowledge, organizational skills, and personality and ability to work with providers, other billing staff, and even patients.

Bonus: Hiring a coder with a nationally recognized certification such as Certified Professional Coder (CPC^®) from the AAPC or Certified Coding Specialist (CCS) from AHIMA is often advisable. While certification is not a necessity and not being certified does not necessarily mean a person is not a solid coder, you know that a credentialed coder carries a mastery of at least the basics of coding.

"It helps to have a solid background in coding, but knowing that you have a certified coder that has taken the extra classes and training and continues to keep educated each year for their certification is a bonus for any practice," Boone stresses.

"Being a certified coder for many years, I would initially say that having the credential tells me your basic knowledge level; however, I also take into account the person and their personality as it would fit with the culture and personality of the current work force," Hauptman explains. "I can always make an offer about a position contingent on someone passing a particular test, but I can’t teach someone how to adapt to a particular culture. Having a certification does solidify a few points of training that wouldn’t have to take an extended period of time. But, I am all for giving someone an opportunity if s/he can prove they have the drive to succeed and ambition to make the position their own."

5. Ask the Right Questions

The interview process is key when hiring for any position, and hiring a coder is no different. You want to ask a variety of questions to gauge the candidate’s coding knowledge and experience, evaluate other skills the person may have, and get a feel for whether she will fit in with your practice.

Here are a few sample questions you may want to include in your interview:

Are you familiar with Medicare and private payer regulations? If so, which payers?

How do you stay updated on policy and code changes?

Which procedures have you most often coded in your current and prior positions?

Do you have EMR experience? If so, did the EMR select the code for you or did you use the data in the chart to select the code yourself?

How many charts/cases do you typically code in one day?

What is your average coding accuracy percentage?

Tell me about a claim that was denied due to your coding. What happened and how did you fix it?

Do you have medical coding certification? If so, which one(s)? If not, are you planning to get certified?

"Most of the skills tests are designed to test the knowledge of coding for that position and doesn’t need to be complicated," Boone says. "An easy way to test is by taking several sample operative notes or E/M notes and having the coder you’re testing code them. [That] is always a good way to check that they are able to handle the job you are looking to hire them for."

6. Give a Test

A good measure of a potential coder’s actual ability to code real-life scenarios is a coding test. Consider having job candidates complete a short coding quiz that focuses on the type of cases they will see in your practice. You’ll be able to see where the person excels and where you may need to provide additional training if you go ahead with the hire.

Suggestion: Create a 10- or 15-question quiz that incorporates CPT^®, ICD-9, and HCPCS coding. Put in a few scenarios that are common in your practice. You should also include a few more challenging questions that involve more in-depth knowledge of topics such as modifier use, global periods, or Correct Coding Initiative (CCI) bundling rules.

Pointer: Medical terminology is also important. Coders have to be able to translate provider documentation that includes complicated terms and sometimes confusing abbreviations. A solid medical terminology knowledgebase will help ensure proper coding, efficient production, and successful job performance. Some employers incorporate a quick quiz on terminology along with the coding test.

7. Verify Credentials

As mentioned before, coding certifications are typically a big positive when you are looking to hire a new coder. When a candidate says she has a coding certification, make sure you verify that statement. Ask prospective employees for their membership or certification number. Then, go to the certifying entity’s website or call their membership department. You should easily be able to verify that the candidate’s certification is legitimate and current by providing the person’s name and member ID.

For example, "if you have the person’s name and certification number (member number) you can verify on the AAPC website if the certification is current," Hauptman says.

8. Guard Against Risky Hires

Along with checking credentials, you’ll want to do a bit more sleuthing before hiring a new coder (or anyone, for that matter). First, perform a reference check on any potential employee. Good practice is to contact at least two work-related references to verify the person’s previous employment information, including job performance and reason for leaving.

Then, since a coder will be involved with both personal health information and financial aspects of your practice, consider performing an actual background check that includes credit history and any criminal activity. But remember that you have to provide the job applicant with a written disclosure explaining that you plan to obtain this sort of information.

Don’t miss: One thing specific to the healthcare industry is the need to check the HHS Office of Inspector General’s (OIG) Exclusions Database to make sure the applicant isn’t on the exclusion list for unethical or illegal dealings with Medicare or Medicaid.

For more on this visit: exclusions.oig.hhs.gov to search the database.