letters to the editor
Concurrent Coding Can Be Successful
TO THE EDITOR:
I read the article titled “Concurrent Coders: On the Floor and Maintaining Contact” in the April 6, 1998, issue with much interest. However, I feel the article came across without enthusiasm for this practice. The article did say that “…some institutions are still using concurrent coding programs and achieving excellent results,” and Liberty (MO) Hospital is one of those hospitals.
In this rural, 200-bed hospital, we have been utilizing “clinical reviewers” for six years. The staff members are assigned to a nursing unit and have deskspace at the nursing station. These are accredited record technicians (ARTs) and registered record administrators (RRAs) who, in addition to coding each record concurrently, complete the utilization review and are involved in discharge planning.
Their interaction with medical staff and nursing staff takes place constantly. They also communicate with the admitting office, social services, the billing office, occupational and physical therapy, and any other disciplines required to either obtain or give information regarding patient plan of care or discharge.
The article claimed that “…nursing tends to resent having non-clinicians in their nursing unit…and coders may be viewed by nurses as in the way…” This has not been the case at our hospital. In fact, we considered having portable desks so that coders could move out of the way if necessary, but opted for permanent desk settings so that everyone would visualize the coders as permanent fixtures.
The article also stated that there is “…a lot of downtime.” I can tell you that we have no downtime. Coders have coding resources and equipment to do their work, and if charts are not available, they can work on coding unbilled charts. An unbilled list is always available for coders. With quick turnaround for patients, some do come and go before the entire chart is coded and billed, so there is always something to work on–with no downtime.
Other hospitals in our area still use coders only to code the medical record. However, we feel that we get tremendous “bang for our buck” by utilizing these people in the concurrent-coding model.
The coders are also very happy with this job responsibility. It’s not for all medical record professionals, but for the outgoing ones it is ideal. They love the recognition and are proud of the acceptance that has been obtained by them with the doctors and nurses. They are considered an essential part of the team on each unit and have stated that they would not be happy going back to the old division of responsibility.
Our program has been extremely successful in reducing the accounts receivable and in shortening the length of stay. While I do realize that each hospital and each team is unique, I feel that if Liberty Hospital could successfully implement this type of program, most other institutions would be able to as well.
Director Review Services
Liberty (MO) Hospital