Legalities of coding different than MT work

The feds see it like this - you (the coder) are in the business of getting payment for yourself, your facility, and the doctor.  Anyone in the "getting it paid" chain is suspect.  The MT is normally not in the "getting it paid" chain, they are in the "creating the report" chain.  MTs feel safe that the doctor will be blamed for mistakes, and they have no control over whether money is coming in when they simply type the report.  When you are coding, your liability is equal to the doctor's.  When someone is creating the report as well as coding it, because they are aware that what they type needs to be payable, their incentive for and ability to pad a report to make it more payable will be much more suspect by the feds.  Many doctors offer bonuses to their coders based directly on the percentage of paid claims they produce, and the feds know this. It could certainly be construed as a conflict of interest, and it is very bad business practice to say the least.

IMO, this entire thread should actually be on the Billers & Coders forum.  If you want to argue the legalities, please go there for current coder's advice.  I no longer do coding, but I am certain a coder's personal legal liabilities are vastly greater than that of an MT.

• Need your opinion please.... - Jennifer
  • Greedy Ins. Compaines - doggielover
  • Be careful - there can be legal liabilities
    • But like MT, isnt the dr the final say on report? - If doesnt read or if does sgn off, liability is hi
      • Legalities of coding different than MT work - legal liabilities
      • Oops, liability is his. - nm
  • Can't think why you would think it is not - AJ
  • Sounds like facility is trying to save money by - not using coders, but MTs to act as coders SM
    • If they wish to do this, then it's really their own - problem because won't get $$. sm

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background and anatomy and physiology knowledge, a transition into coding wouldn't be hard at all.  From what I can tell by looking through my husband's books, an MT would have to learn insurance regulations and legalities.  We've basically got all the medical background down or we should be if we're worth our salt as an MT.

I even contacted AHIMA and found that the qualifications for taking the CCS or CCP coding exams are completion of the a coding program, RHIT program, or RHIA or related work experience.  Transcription is part of HIM, albeit the red-headed stepchild of the HIM department, but a part nonetheless and so satisfies the qualification of having work experience.

The test is tough though.  My husband didn't pass it his first time out and I think I read something like only 20% or so pass it the first time.  So it would probably be best to take some sort of formal coding class, in my opinion.

I have been thinking for quite a while about getting into coding.  Are there any MTs here who are also coders?  Are there any reputable "on-line" coding schools?  I really would like to do this.  27 years is enough.  If anybody knows about this, feel free to e-mail me.

Thanks

I used to work in a Doctor's office and do coding, electronic insurance billing, statements.  I loved it, but I had to quit because of my kids.  If my kids were older, I would still be doing it now.  I fell into coding when I was a Medical Assistant and it lasted 16 years.  Maybe I will get into it again when the kids get older. 

As far as any online schools that good, I don't know.  But what I can tell you is from my experience, working from an office or hospital is the best place to be for coding!!

I will try to be brief (please don't think me curt but there is much more I could say that I just don't have time to go into).

First to be a professional coder, you will need to be nationally certified.  There are 2 national organizations that provide proctored certification.  The first was AAPC and has an excellent program for both office-based and hospital-based coding certifications.  You can do the home program or find a company who provides classroom instruction and testing.  Either route will cost you about $1500 and about 3-4 months investment.  The other national is AHIMA.  You would need to look at their website to find the details for them, as I did not utilize them.  They cater more to people who are already in the field and need certification.

Because AHIMA's umbrella covers more than just coding, hospitals tend to give more credibility to their credentialling, but since AAPC set the standard and has the largest number of members, they have to be doing something right.  Both companies require prior coding experience, personal recommendations and membership in their organization.  If you have no previous experience, they have apprenticeship programs.  The CEUs to maintain your certification is about 20 per year with each organization.

Your investment in resources to perform your job is greater than in MT.  You will probably need a lap top and several programs to perform your job if it is not provided by an employer.  You can be a consultant if you can't get a job as a coder.  You could get additional certification and become an instructor and teach.

The next issue is home versus on-site work.  Some MT companies are beginning to combined MT and coding into their at-home programs; however, if you have no experience and no liability insurance and no support network, you could find yourself out of a job if you cannot produce quantity and quality quickly.  Finding a on-site coding position is difficult without experience unless you get lucky and find an office to give you a chance.  Many, many times your best bet to find a job is by networking through your local national's chapter or showing exceptional talent in the classroom setting and getting a referral from the instructor.

Coding is different from MT in that you are held liable by the federal government if you make a mistake.  Yes, the doctor is ultimately responsible, but the wording in the law states that the person who submits the bill is as guilty as the provider.  There are monetary and jail time penalties - and how much of each depends on how well you can prove it was accidental because the government assumes the fraud was intentional unless proven otherwise.  Better have insurance.  Because of this law, that is why you are seeing a greater need for certified coders...hospitals in particular do not want to expose themselves to the liability of the Office of Inspector General with unqualified personnel.

I got a coding auditor position on the outpatient side of a hospital.  I went to the clinics and performed audits of the previous quarter for every doctor at each clinic.  I scored everything, compiled reports, provided education to the doctors who failed the audits, provided monthly ongoing education and a coding hotline for daily unusual circumstances.  I was paid about $20/hr which was the low end of the spectrum for a hospital employee.  Physician offices tend to pay $12-15.  When I relocated to a different part of the country, I could not immediately find a coding position, so I went back into MT.  It took another year before I found a management company where I could code, but by then I needed to return back across the country due to family issues...and I let my certification lapse and continued with MT.

what is the best way to get into coding?  I have thought about an online course. 

I have experience in medical billing for 12 years and transcription for four years and I am also going back to school to pursue coding and take the national exam to get my CPC.  Coding is the new future as this transcription business is falling apart everyday.  It is so hard to make a decent wage.  These National companies are indeed a sweat shop taking advantage of the DR’s and paying us a pathetic price.  I make 12 cents a line working for a local physician, but I have lost 4 doctors already due to outsourcing.  I am running fast back to school because I think in the next couple years there will be VR everywhere.  What a shame to such a good profession.  This is just because someone was a little bit too greedy.

Good luck with coding. 

I am taking a continuing education class through my college for 8 months with medical terminology, which I really do not need as I have enough of that, but I am sure it will not hurt, and anatomy and physiology plus the coding.  I have also heard of the Carol J. Buck books and I am also going to purchase them once they come out in the first of January.  I heard these are good books.  I am one of those persons that needs someone to teach me and do better than trying to read out of the book and doing it on my own, but the Carol Buck book would not hurt as an addition.  This is the way to go for me as I have been burned too many times in this transcription industry in the last four years.  It is a shame it is like this way.  There is too much negativity.

I've actually thought about coding as well.  I was an ART/RHIT so I've done a bit of it and liked it, but I liked transcription better.  That was then; this is now.  If HHS would ever stop messing about, the US would start using ICD-10 like the rest of the civilized world.  This is very different from the current ICD-9-CM, so even experienced coders will have to take classes.  Some of my coder friends say they would consider retirement at that time.  Perhaps it would be our opportunity to make a switch. 

Airline job, huh?  I hope he means Southwest because the old major carriers aren't doing well.  I do wonder about Sir Richard Branson's new Virgin America, though.  Of course, maybe you'd get free/reduced fare miles and the paid vacation time to spend them on as part of the benefit package.  Got anywhere you'd like to go?  Taking son along is optional. (she smiles)

Coding is similar to MT.  It can be sent out to a service (Medquist does coding, too) which means it can be sent overseas.  There are computer programs for coding whose developers think will eventually be able to be used by clerks with no training in coding at all.  There are interesting benchmarks for productivity in coding:  Number of charts per day, inches of chart per day, money amount cleared from AR.  There's a lot of pressure in this line of work, too. Still, it might be around longer than MT, and from an administrative standpoint, it is a money-maker since how soon and how much the provider is paid depends on the speed and accuracy of the coding.  You do have to watch out for bosses who want you to illegally *upcode* to increase reimbursement. 

To get hired and move up, you really need to have one of AHIMA's many coding credentials behind your name, and their tests are tough!  I wouldn't mess with on-line classes.  Look for a junior college or college that has an RHIT/RHIA program.  They may have a coding certificate as well.  If the US ever gets around to adopting ICD-10, it may be a good opportunity to get into coding because this version is quite different from the current ICD-9-CM.  Even established coders are going to have to learn a lot of  new stuff. 

I was an inpatient coder.  I liked it, but I'm sure it's changed a low now. Back when I did it we had to read through the charts and try to decipher the physician's handwriting when no reports were available and it ruined my vision.  We also had the stress of the hospital chain I worked for trying to get us to code up to a more expensive diagnosis, whether the patient had it or not.

My husband went to school for it a couple of years ago and aced the course, but nobody would hire him because he had no experience actually doing it, so the course was an absolute waste of money.  Most placed want credentials too.  Unless you are willing to donate your time for free at a local hospital to get some experience, it's hard to break into now for new people.

There is a definite advantage to being an MT and switching to coding.  I found a course through an adult education course (excellent course and virtually free except for the books) and it was great.  It is difficult and very technical, more than just assigning numbers to diagnoses but I liked it.  The thing is, at least from where I am (So Cal), I would have had to take a huge cut in pay to take an entry level position, work into coding, apprentice, and then once certified, then the potential for earnings is there.  Also, I think you really need to have a lot of experience before you can do it from home.  I can't take any kind of step backwards in pay or I'd be pursuing it.  Who knows, maybe I still will.  I just want to alert everyone to check their adult education programs, ROP, and local colleges first before paying a lot for this education.  Good luck!

I don't know if the course is good or bad but personally I would not recommend that anyone take any of the training for medical "work-at-home" jobs.  I expect that shortly all coding will be done electronically and it should be easier to implement than VR.  I think people are going to have to get used to paying a babysitter and commuting to a workplace if they expect a paycheck.  There are jobs that will allow at least some flexibility, even some that are family friendly.

Use the link below that I wrote a few months ago.  It is a very honest review of today's coding needs and environment.  Good luck!

http://forum.mtstars.com/company/v/1/13589.html

Admnistrator, What happened to the coding board?

The growth opportunities are so much more than with transcription and the need for coders is tremendous.  Please don't be put off by people saying that it is so hard to get into.  While you may incur some stumbling blocks depending upon where you live, they are very easy to get over if you volunteer during your clinical process.  That is usually all it takes.  I'm not understanding why individuals seem to want to dissuade career seekers with such negative advice, such as you will never get a job or you will be sued if you make a mistake because you are liable.  Hogwash!!!  The only time you may be individually pursued is if you are an INDEPENDENT, working for yourself and no other company, hospital, or physician's office.  Otherwise, there are compliance programs in place in organizations that make the facility the reponsible party, although it's possible you could lose your job.  But all facilities should have good Quality Assurance programs in place, and therefore the quality of your work is being constantly evaluated, as it is with transcription.  This places the reponsibility for correct coding with the facility.

If you are seeking training on an independent study basis, AHIMA (American Health Information Management Association) and the AAPC (American Academy of Professional Coders) both offer great programs.  AHIMA's program is $2000 not including books.  They award the CCS (hospital-based) and CCS-P (physican-based) credentials.  The AAPC program costs are based on the type of certification you are seeking...$1105 for the CPC (physician-based) and $1540 for CPC-H (hospital-based).  As a previous poster stated, you DO NOT at this time have to have previous experience, personal references, or membership in order to obtain AHIMA certification.  Although, credentialing requirements are swiftly changing in health information (so don't delay if you are considering this field).  You do have to have at least 2 years experience and membership to obtain the CPC or CPC-H.  However, if you take their program, they will waive one year and award you a CPC-A (apprentice) until you finish your first year.  Then after verification they will automatically award you the full CPC or CPC-H.

I, personally, am taking the CPC program at the AAPC.  I have been transcribing for 8 years and am ready to change for good.  I do, however, have previous experience as a coder.  I was a coder with a major insurance/healthcare provider on the east coast.  I was employed right out of school with no experience ($17/hr, 6 years ago).  I am currently a member of AHIMA and have been for 6 years.  I graduated with an A.A.S. in Health Information and am an RHIT.  I am mainly taking a course to brush up, get a coding-specific credential, and jump right in.  The job opportunities and pay are outrageous here in my area.  I truly believe they can be the same for any new coder in this area, as I have seen many of my colleagues and previous classmates do extremely well, all coming from different backgrounds, some with no experience and some with much experience.

I see many people asking about coding so I thought I would just try and help a little and give accurate, upbeat, and truthful information to the best of my ability.  However, I can't type this all again so I hope it goes along way

Please excuse any typos as I am too tired to edit.  I work four 10-hour days and today is one of them!

Hope this helps!

Hi, I am currently a transcriber.  (leaving the field because as you all know this field is getting too ridiculous).  I am planning to attend a billing and coding school locally.  I was wondering if the hours vary for coding/billing or are the working hours typical 9-5 or 8-4, etc.    TIA

Not to sound like a dunce but what is coding?  I know that a coder takes reports and pulls ICD codes, etc and does something with them, but what precisely? How does coding work?  In transcription, I use a program to play the audio file, controlled with the foot pedal, while I type it in Word.  I've been curious about coding but cannot find out exactly what it entails.  I love transcribing but let's be realistic, it is looking scary out there.  Love the company I am with but what with VRE, EMR and India looming, I am thinking now would be the time to train for something else just in case. 

Thanks for any information. 

Hc

I am currently a Transcriptionist at a hospital and I am really interested in getting into the coding business.  I was just wondering if there are any of you out there who have made this transition and if you have any tips or warnings for me.  Any advice is appreciated.