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August 2017

Editor's Note: Coders Under the Gun
By Lee DeOrio
For The Record
Vol. 29 No. 8 P. 3

Have you ever made a huge purchase—a car, a kitchen, a deck—and then been disappointed with the item's performance? Not enough to return it or request a refund but just enough to regret your choice?

In those instances, I find myself trying to justify my thinking, spotlighting the item's strong points and minimizing its drawbacks.

Recently I received a letter from a reader that reminded me of such a situation. The reader works at a level 2 trauma cardiac teaching hospital where the coders tackle difficult charts and easier ones are handled by overseas coding vendors whose accuracy rate hovers around the 70% mark. Why does the hospital employ an outfit with such low marks? The attractive price tag softens the blow.

Meanwhile, the in-house coders struggle to meet productivity requirements. The coders use computer-assisted coding (CAC) software, which the reader claims is of little help because the coders must review the complete EMR regardless and the codes provided are incomplete (the CAC reads only dictated items).

Why continue spending money on ineffective software? The reader claims the department manager may have buyer's remorse but rather than admitting the mistake, misinforms management about the number of records inpatient coders can complete.

This results in coders being expected to code 16 complicated cherry-picked accounts per day, most of which are surgical. Coders average seven to 10 inpatient charts per day, falling short of the requirement. As a result, coders with 20 years' experience and a long track record of success are being told they're failing to meet standards.

When I posited these circumstances to an industry veteran, she said vendors often receive self-pay and indigent patients in order to avoid a diagnosis-related group error affecting payment. She acknowledges that assigning complex patients to trusted in-house coders is a sound strategy. However, productivity expectations should be adjusted accordingly.

The source also could relate to the hospital's CAC plight, noting that management can feel the need to validate the purchase of a product despite its general ineffectiveness.

"I don't at all doubt that her complaints may be 100% accurate," the industry veteran says. "Finding a new employer might be the only viable option if the current environment is that toxic and unreasonable, and management is not approachable."

In these days of evolving payment methodologies, coders have a huge target on their chests. The pressure to deliver satisfactory charts is enormous. At times, it seems as though they are pawns in a high-stakes financial game. Is revenue not meeting expectations? Blame the coders. Did management make poor software decisions? Shift the onus on the coders to produce more.

It may reach a point where the best in the business will decide it's not worth the headache. Then where will the health care industry be?