Coping with the Coder Shortage

Healthcare is suffering from a shortage of medical coders, who affect an organization's bottom line with almost every action. Kathy M. Johnson, RHIA, in her article "The Massive Medical Coder Shortage," in the February issue of HFMA's Revenue Cycle Strategist, writes that revenue cycle leaders, patient financial services managers, and CFOs of hospitals and health systems are embracing alternative solutions to the problem. One such solution is a dedicated revenue integrity department.

Johnson writes that implementing a revenue integrity department lessens the impact of the coder shortage by complementing the efforts of the health information management department, reducing the recurrence of errors, and lessening the work load for coders. Although revenue integrity departments have existed since the late 1990s, few U.S. hospitals and health systems have these departments in place today. However, this dynamic is beginning to change. Hospitals are implementing these departments to correct the disconnect that occurs during interdepartmental claims data handoffs; provide a holistic, accountable approach to payment and the claims flow process; and reap numerous financial and organizational benefits.

These departments centralize responsibility for securing entitled payment of all claims, ensuring an efficient claim flow process, correcting any processes leading to denied claims and significantly improving revenue flow and compliance. Revenue integrity departments reduce claim denials, and fewer claim denials result in less work for a hospital's coding team, minimizing the impact of the coder shortage. Although revenue integrity departments provide many other benefits to the hospitals and health systems that implement them, reducing claim denials and infusing greater efficiency into the claims flow process are among the most substantial. Proactively addressing problems with claim denials reduces the demands placed on the coding team and alleviates some pressure caused by the shortage of qualified medical coders.

You can read about other actions to cope with the coder shortage in the February issue of Revenue Cycle Strategist.

Enhancing revenue integrity is one part of comprehensive revenue cycle improvement, which requires comparing your performance against benchmarks, identifying opportunities for cost-effective changes, identifying the team you need to implement your ideal process, and developing a strategy to overcome internal and external obstacles. You can learn how to put this improvement process into action from "Implementing the Ultimate Revenue Cycle Model," one session in an intensive revenue-cycle track at HFMA seminars being held March 3-4 in New Orleans and May 7-8 in Seattle.

As you embark on revenue cycle improvement, you quickly recognize that skilled staff are your most valuable resources. Yet traditional off-site staff training can be challenging because of the cost and difficulty of having staff out of the office. HFMA provides you with a comprehensive on-site staff-training program that you can implement on your own, or with an HFMA-supplied facilitator. Module 1 of the program is Excellence in Customer Service; Module 2 is Mastering the Revenue Cycle from Key Practices to Clean Claims to Denials Management. HFMA also offers convenient e-learning courses in patient financial services, billing, and avoiding and managing claims denials.

Visit the HFMA web site for more business resources that will help you make a difference in your organization.

HFMA Wants You to Know  ISSN: 1540-0697.  Volume VII, Issue 4. Copyright 2008, Healthcare Financial Management Association. All rights reserved.