Coding, Classification and Reimbursement

New Coder Training

  • 1.  New Coder Training

    Posted 01-07-2019 11:08
    ​Good morning.

    Would anyone be willing to share your internal process for onboarding new coders?

    Do you have a designated trainer?
    Do you have a test system you allow coders to practice or are you coding discharged patients with someone reviewing?
    What is the accuracy rate set before releasing from training?
    Is there a certain amount of time they have to be in training?
    What resources outside of Coding Guidelines and Coding Clinics do you use for training?

    I appreciate any responses in advance!

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    Jamey McGowen, MBA, RHIA, CCS
    Him Coding Manager
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  • 2.  RE: New Coder Training

    Posted 01-08-2019 04:19
    Hi Jamey,

    Good morning,

    We have designated trainers for individual speciality (ex IP DRG, ED, E/M,Ancillary, SDS etc).

    We wil be giving coders to practice charts which were already coded by the experience coders then will evaluate coders on all the  aspects such as coding accuracy, DD,POA,Modifiers etc,

    All new coders should clear final assessment test which will be conducted by the trainer with 95% or more. Those who are not upto the 95%  mark then they will be trained again.If still coders are not upto the mark then we will be changing their department.

    Mostly for IP-DRG it will be 45 Days for remaing all departments it will be less than a month.

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    Naresh Dhodle CCS,CIC,COC,LSSGB
    Quality Lead








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    Naresh Dhodle
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  • 3.  RE: New Coder Training

    Posted 01-08-2019 08:06
    ​Thank you!

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    Jamey McGowen, MBA, RHIA, CCS
    Him Coding Manager
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  • 4.  RE: New Coder Training

    Posted 01-08-2019 12:05
    Hello Jamey,
    I have worked in several different venues over the years and have seen onboarding/training new coders completed in a variety of ways.
    Designated trainer - my first coding job in a university setting did have a designated trainer/educator.  We were a very large department and had two trainer/educators plus DRG coordinators, outpatient coordinators and compliance auditors.  Every chart was reviewed for code assignment (dx and px), discharge status, all abstracting fields and many fields that were specifically for core measures and data collection for residents, fellows, etc.
    My work with clients across the nation has also afforded me the opportunity to set this up for facilities who do not have the talent internally.  They simply do not have coders/managers skilled enough or with time to train up current coders or new employees.  We have either located trainers/educators to work with these facilities on a permanent basis or contractually.  We have set a curriculum, hands on training and feedback to train coders up (or cross train coders) within a set period of time with milestones agreed upon by the trainer, facility and contracting company.  This can be extremely helpful if the facility does not have the talent internally, cannot locate a resource or is wanting to do this remotely.  Great options and you can be creative in the milestones and steps to the program.
    Test system/Mirror System - Some facilities have the ability to put the records in the test system or "suspend" the record and then the trainer/educator reviews the code assignment, various status and any abstraction collection that is required.  This is ideal and really alleviates duplication of effort for the coder/student and trainer.  The "downside" is that many facilities do not have the IT capabilities to support these test systems.
    Accuracy rate - Generally, I have seen a 95-98% accuracy over a set period of time before the coder is released to code without every chart being reviewed.  Many times this is by "service line" or chart type as well to expedite the process (e.g. simple surgeries, OB charts, rehab, psych, etc.).  Also, this provides the coder with a sense of accomplishment if they can start releasing charts rather than having each chart reviewed - this depends on the accumen of the coding student and the ability of the coding student/new coder to grasp your internal systems and code accurately.
    Time frame - The time frame can vary depending on the case mix, complexity of charts and student comprehension.  Three months to six months seem to demonstrate the best indicator of how the coder is progressing.  If you are looking for budget and milestones much of this depends on the coder/students background - are you cross training, training from an accredited school or taking someone from the floor to teach coding?  Most coders that I have trained are quite competent after 3 months but they will continue to learn depending on how the program is designed (this may be by product line, or a Coder I, Coder II designation, etc.)
    Resources used - OCG, Coding Clinics, Coding Handbook and real time charts are all good sources.  Also, we now have YouTube for surgery demonstration and education sessions with local AHIMA, AAPC chapters.  Coding updates, departmental meetings and guest speakers (preferably some of your physician champions) all are helpful in educating your coders.  Many physicians are wonderful teacher and enjoy sharing their knowledge as well as working with coders to expand their knowledge of our challenges too.
    Good luck with your training - I know it will be worthwhile for you and your facility!!




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    Cheryl Bowling, RHIT, CCS, CHC, C-CDI
    Client Compliance Partner
    samstaff
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  • 5.  RE: New Coder Training

    Posted 01-08-2019 15:16
    Hi, Jamey -
    Our onboarding new coders depends on their background and experience.
    If they are experienced and have experience in our applications (Epic and 360 Encompass), we have Learning Management Systems modules for them to complete to be familiar with some of our facility-specific processes.  The Coding Supervisor reviews our query process with them.
    I am the lead designated trainer.

    We use actual cases for them to train on, with myself or members of our HIM Auditing Team reviewing prior to account completion.
    We require 95% accuracy before they are released.  We usually give 2 weeks, evaluate and then give another week or two depending on the evaluation and accuracy.
    We have an abstracting guide, coding workflow and facility-specific guidelines documents we provide other than the "official" Guidelines and Coding Clinics.

    For beginning coders, it is similar, but we have specific service lines for training.  We retrieve cases already coded and assign to them to re-code and then I review their results.  Once they have grasped concepts, then they move to actual cases with pre-bill review by myself.  They are also expected to reach 95% accuracy before being released on a service line, and then they start the process again for another service line, and repeat the process until they have completed our major service lines and gained experience that can be applied to other types of cases.  Sometimes this may take some months.  We don't have a set timeframe for beginners to learn.
    After being released from Training both new and beginning coders then enter the retro review auditing process.

    Hope this is what you were interested in.

    Janice

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    [Janice] [Noller, RHIA, CDIP, CCS]
    [Inpatient Coding Educator][University of Utah Health Care][Salt Lake City][Utah]
    [Janice.noller@hsc.utah.edu]
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  • 6.  RE: New Coder Training

    Posted 01-10-2019 09:20
    Jamey,

    I would agree with the other comments with this post.    Additionally, it is important to have your own facility guidelines so that the new coders are trained based on your expectations.    These guidelines should include the productivity and quality expectations and how these key performance indicators are calculated.    Having facility guidelines, which is encouraged by Coding Clinic, helps to eliminate the gray areas regarding coding.

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    Laurie Johnson, MS, RHIA, FAHIMA
    AHIMA Approved ICD-10-CM/PCS Trainer
    Healthcare Consultant
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  • 7.  RE: New Coder Training

    Posted 25 days ago
    Hi everyone, you all have given out some great information on onboarding/training that you each do for your facilities.  It is nice to know that there is several weeks of training and that a 95% rate is to be achieved before you actually start actual coding.  I am taking classes right now through Bryan University for Codning and Billing, but am finding that the coding is harder than I thought, but I am working hard to understand and learn each code set.  I look forward to the day that I graduate and will be able to start working in a facility as a coder/biller.  Thank you all for sharing your information, I found it to be very helpful and beneficial.

    Nanette

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    Nanette Mauth
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  • 8.  RE: New Coder Training

    Posted 22 days ago
    As a first year student who is interested in coding, I am very pleased to see all the help that is given and can't to start coding.

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    Cara Mcdaniel
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  • 9.  RE: New Coder Training

    Posted 23 days ago
    ​Yes I have a coding trainer/Quality analyst that onboards coders and audits for quality throughout the year

    They code live cases however they are in a held status until the trainer reviews

    95% accuracy must be met to be considered proficient in a service type

    We do not have a minimum time frame as individuals learn and progress at different stages. We do provide an agenda to show all things to be covered and to get through before you are cleared of a service type

    We use our internal policy and procedures and NCCI edits in edition to Coding guidelines. We cover coding clinic, CPT assist and CDR. We also touch on revenue codes and modifiers because my team codes professional and facility charges.

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    Leticia Selmon
    Ambulatory Coding Manager
    Children's Minnesota
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  • 10.  RE: New Coder Training

    Posted 22 days ago
    As a new HIT student it is nice to see that Forums like this exist. I also was glad to get to see some of the training I would receive and who would possibly be training me.

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    Kristina Jordan
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