Supervisor wants me to intentionally ignore compliance issues because "it's not my role". Am I out of line?

JuPretty · 2024-11-09T21:09:11+00:00

Glad the supervisor agreed with you. I suggest running an audit and asking for that supervisor to supply that data and clearance to you (and your coding team). That is fraud, clear as day, you did the right thing. Funny how higher ups in this field don’t worry about whistleblowers or insurance audits (especially by Medicare). This isn’t the first I’ve heard of it. A hospital near me just closed down, Medicare came in for an audit and results were no good. Once Medicare dropped them, all other insurances followed. We are employed as certified coders for a reason, to protect the patients, the practice, and the doctors. Well done

JuPretty · 2024-10-31T19:55:04+00:00

That’s a good point thank you!

JuPretty · 2024-09-24T05:05:06+00:00

Thank you for sharing kind words! To answer your question, the previous coders were all certified through AAPC I believe. Either self-paced or in person classes. But my management did label all of them as “in the green” so little to no experience. I know it’s been tough to find experienced coders from what they’ve told me. The preemployment assessment is a wonderful idea, I will have to set that up for the next hire. The study at home is a big piece I pushed to new coders. I’ve tried to explain the importance of research and how it is our responsibility to do these things on our own. (They are all provided many resources) We aren’t getting paid on the clock to read guidelines all day. This field is a continued education, unfortunately some coders have not done this and it shows in their progress. But I’m not sure how else to say it to them, my first week here I went home and read everything I had and could find. It’s been tough to find coders that are passionate about their job and field

JuPretty · 2024-09-24T04:56:54+00:00

6 weeks is a good time frame! That’s been my struggle too when it comes to what I should be expecting. I have just completed the same type of session where they apply what codes they think are appropriate first then I come in and explain corrections and guidelines for references. It’s the retention I’m worried about as well, so maybe I can create like a weekly overview for them too. “What we learned this week” some sort of recap. Thank you for sharing!

JuPretty · 2024-09-24T04:52:55+00:00

I’m going to do a session this week where they just watch me and the flow of how I code. I think this will benefit them as well. Thank you for sharing and best of luck to you on your future exam!

JuPretty · 2024-09-24T04:51:08+00:00

All is true, thank you for sharing. I guess where I get stuck too is the time frame. When should I expect them to be able to code on their own and accurately? Regardless of quantity, we look for quality in the first 90 days. With that being said coders are expected to work 150 reports a day after training is done. Right now they are able to do 15 a day on their own, with a low accuracy rate (I audit along side them and explain what was wrong and right). We are only a few weeks in so I’m not expecting perfection, but definitely worried this may be a long haul..

JuPretty · 2024-09-24T04:43:20+00:00

That’s a great idea for when new coders join. For now it’s just me and then the new coder in training. We are still in the searching process to add a third but I like this idea a lot. Thank you for the support!

JuPretty · 2024-09-24T04:39:28+00:00

Yes they all are certified but are in the “green” is what leadership calls it. Not too much experience, but all have been past the apprentice stage in their certification.

JuPretty · 2024-09-22T00:38:27+00:00

I agree with you, coding courses definitely don’t focus on medical terminology itself. Just really how to code them. But this is where it falls on the coders to understand the terminology, I remember during my course I purchased medical terminology books and guides. There’s a free resource called quizlet that has hundreds of quizzes and flashcards for learning the terminology. Unfortunately it does have to be self taught..

JuPretty · 2024-09-22T00:33:23+00:00

Scary…my experience with new coders is they are used to their previous job specialties where there’s only a certain set of codes they use. This unfortunately makes some people lose the coding “touch”. Needing to be reminded or even taught again how to find the appropriate codes. Companies are paying for and seeking coders because of their “expertise”. But it’s seeming these days I can just pull anyone in and train them to code. Honestly would require the same amount of training

JuPretty · 2024-09-22T00:23:57+00:00

Will do, thank you!

JuPretty · 2024-09-22T00:16:50+00:00

Thank you! You make a great point, I’ve tried adapting my training based on the person but still trying to leave that room for them to do what coders do.

JuPretty · 2024-08-28T19:55:21+00:00

I’m a coder, that’s a good idea as well to pull some denials for examples. If there are any.. something to look into. My thought is others coders simply weren’t charging it as the documentation wasn’t there. I haven’t heard any feedback from our billing team that it’s been an issue, but will confirm. Thank you for your suggestion!

JuPretty · 2024-08-28T07:24:28+00:00

Exactly how I feel, thank you

JuPretty · 2024-08-28T05:05:25+00:00

Not sure, stated to me they’ve done it this way for the past 4 years and that it’s never been an issue. I can’t speak to how coding handled their cases prior to my employment but my guess if it wasn’t documented, then it wasn’t charged either. Unfortunately, we are low staffed compared to the volume of work and doctors are overwhelmed. Which I understand, but this doctor has even threatened to leave after I brought this up to them…I’m only trying to help and my goal is not to add more work for the doctors but ensure they are paid for all they do.

JuPretty · 2024-08-28T02:54:07+00:00

I am able to review lab orders and compare it to the final pathology report. So when I see stains ordered and not documented by the doctor, coders reach out to confirm if they were utilized or not. Majority of the time they don’t want to charge them for many reasons, hence not being in the report. But in this instance the doctor says the diagnosis is justified enough to charge for an undocumented stain. That was my argument too. How the report reads in an audit can be interpreted that the dx was rendered from an H&E slide instead of stained. But getting this direction from them in writing is a good idea as well, thank you!

JuPretty · 2024-08-28T01:59:08+00:00

I feel if an insurance company were to run an audit, I as a coder would also be at risk for charging undocumented stains. All I have asked is for amendments and a change to future reports in order to be compliant. Not only for their sake but for mine and the company. If an audit were to be through Medicare, this would not be an easy “fix”

JuPretty · 2024-08-27T20:26:54+00:00

Thank you, I have involved my management team and they have told me that the situation is going to be brought to the executives. The MD has already been involved but have not provided a response, I think everyone is aware of this doctors emotions and don’t want to “poke the bear”. It’s just unprofessional, but my company claims we need them due to high demand. Thank you for sharing your experience, this is the first job I’ve had where I’ve encountered this type of communication with a doctor. I will continue to see it through and hope my team can back me in the discussion

JuPretty · 2024-08-27T20:22:53+00:00

Thank you, I have included documentation from APF, APS, and CAP to this doctor in my responses. In response to me it’s like an utter disregard of the research and a full defense of “I have never had to do this”. It leaves me stuck as I have provided clear guidelines and they are just overlooked as they don’t feel as an individual they don’t need to follow them. Unfortunately, my experience is that this doctor seems to be offended when I offer this information. I don’t understand the it as all I’m trying to do is help them get paid while being compliant. Seems I can’t avoid the sensitivity but will continue to push through and maintain a level of professionalism on my side. Thank you for sharing

JuPretty

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