Wiki The Future and Healthcare Reform

[Denise0728]

Good morning; I would love to hear some thoughts and opinions if someone is willing to share.

I am currently employed; love me job. I work with providers/practices on behalf of a Healthplan. Due to conflict of interest I am limited to what (if anything) I can do beyond for additional professional opportunities.

I am closer to retirement than I really want to admit

Withall that being said; I am starting to explore my retirement options. I do not plan on retiring and not working; I would just like to retire and work for myself or work part time.

I am considering the opportunities that maybe be available with a CEMC or a CPCO. (I currently hold a CPC, CPPM, CPC-I)

Seeing where healthcare is going with Health Population Management, MRA (HCC coding), and now CRA (commercial risk adjustment is at the doorstep) and even PQRS and PPS..... I think the days of a "transactonal system" is limited or short term thinking. This leads me to believe a CEMC may have a shelf life.

On the other hand; with all that is coming at us down the pike... the CPCO really is intriguing me. CEMC is where my comfort level is; like I said - old school girl here LOL. I am thinking now may be a good time to stretch a little inteliectually and work toward the CPCO. I am thinking I will have more options 5 years, ten years down the road.......

It all seems a gamble right now. Would anyone be willing to share their thoughts and opinions?

Looking foward to hearing from you.

 

[Pam Warren]

Good question. Let me dust off my crystal ball.

From what I've seen in the industry, E&M coders and front-end diagnosis coders may head in the way of the dinosaur. Sophisticated CAC (computer assisted coding) is eliminating these jobs already (I'm north of Boston), and with an eye on efficiency and cost-effective care, organizations are not willing to do things the old fashioned way with lots of manual work. What I am seeing, however is a focus on auditing and documentation improvement. Consider a national certification in either area. Although surgical coders are a bit safer from CAC, there are software packages that can code based on natural-language processing, and I've even seen software that can successfully code endoscopies and interventional procedures. We actually do some of that.

As software companies become more sophisticated and provide a better analysis of coding/documentation, they're doing a better job of dropping claims right after the patient encounter. Auditors review the claims, make recommendations for either provider training or software change, and focus on documentation improvement. In the inpatient setting, clinical documentation improvement specialists are assisting providers with better dictation reporting (which is also starting to fade into the background), in order to more carefully support solid DRG abstracting and ICD-10-PCS coding. Still, EHRs are doing a pretty darned good job.....but CDIS will need to continue to coach providers on quality documentation.

HCC Coding is relatively new, but I'm convinced that any and all diagnosis coding is going to eventually be handled through CAC. And those that don't use CAC are hiring coders in India and the Phillipenes, because they will work for much less than we do. It's a business, after all.

Pay-for-Performance is huge, but again, computers are going to assist providers with producing reports to capitalize on this. They won't need coders to abstract information. Consulting for providers who aren't already on the bandwagon is something that is currently in demand, but once everyone's done Meaningful Use, the information systems are going to already be in place.

Compliance is a great direction in which to move, because you already have experience that gives you a head start, but a lot of compliance requires clinical expertise (think risk management). Larger organizations may hire compliance auditors to monitor their EHR systems for critical times such as upgrades and when new providers join.

Whatever you decide, do some research. Check with strategic planners to see where organizations are heading. There will be work out there, but it's going to require so much more than just a coding certification. Make it your business to place yourself where you need to be so you don't find yourself phased out of the workplace.