concurrent coding MAKES A COMEBACK
Is it right for your facility?
By Gretchen Berry
Kim Weller, RHIT, fondly recalls the day she found out her job no longer existed. It was 1993, and she had reported for work at Liberty (MO) Hospital only to be told that she was no longer a coder in the health information management (HIM) department. From that day on, she was to be a “clinical reviewer” working on the patient floors and functioning under the auspices of the review services department. Liberty Hospital had implemented a concurrent coding program–and Weller has never enjoyed her job more.
“I love coming to work,” Weller admitted. “Every day brings something new.”
Part of the reason her job offers so much variety is because her range of duties has been increased. “Our title, clinical reviewer, reflects that we do more than just coding,” explained Weller’s colleague, Bonnie Lindsay, RHIT. “We do a combination job–coding concurrently and doing utilization review (UR).” In addition, Liberty’s coding system allows coders to enter quality assurance, infection control and other important data as needed.
The program was the brainchild of Joyce Massa, MBA, RN, current manager of review services. At the time, she was looking for a thesis project for her master of business administration (MBA) degree. “We had a terrible lapse in our billing procedure,” Massa noticed. “It was sometimes three months before the coders even saw the charts. So, I went to the CEO and proposed that we take the coders out of the HIM department and put them in the different nursing units so they were right there coding on a daily basis.”
Massa was granted permission to do a pilot program in the emergency room (ER). “The ER was running about three to four months behind in billing,” Massa recalled. “We placed a coder in the department to code as the patients came in. I estimated that it would take her about 60 days to get the ER caught up–instead, it only took her three weeks.”
Shortly thereafter, the program went facility-wide, and Weller got the news about her change of position. In the years that followed, Liberty Hospital has seen a drastic reduction in its accounts receivable (AR) and an average turnaround time of less than five days. “Our program has been hugely successful,” Massa enthused. “Administration is more than pleased with the results, and our coders love being such an integral part of the health care team.”
Benefis Healthcare in Great Falls, MT, has had similar success with its concurrent coding program. At Benefis (the largest hospital in Montana), coders do their desk work in the HIM department, but spend the majority of their time on the floors using sophisticated laptops to assign codes as care is provided.
“Our facility is completely satisfied with our concurrent coding program,” asserted Janet Minnerly, RHIT, coding supervisor. “We complete 90 percent of our charts within four days of discharge and 80 percent within 24 hours. The finance people are thrilled with it, but we’ve found so many other benefits. With concurrent coding, we help to ensure proper documentation while the patient is still in-house. Our coders are more confident about the codes they are assigning. We’re being told to do so many things for compliance, and concurrent coding dovetails with all of this so nicely.”
According to Karen Schmidt, BSN, practice manager with St. Anthony’s Consulting, success stories like these are becoming more common. “A few years ago, when the Health Care Financing Administration (HCFA) dropped its requirement for the physician attestation, people started to think that concurrent coding was no longer necessary,” she explained. “But those hospitals that dropped it began having problems with their AR. Also around this time, hospitals became more concerned with compliance and data integrity. So just as the door was beginning to shut on concurrent coding, new requirements and old concerns made it relevant again. We are seeing a renewed interest.”
Despite the benefits touted by Benefis and Liberty, many facilities and coders are still resistant to the idea. Perhaps the biggest reason being that many coders are intimidated by the idea of working so closely with the clinical staff–and with a shortage of skilled HIM professionals, many facilities are reluctant to risk losing any of their precious staff.
Indeed, Massa admits that she did lose a couple of staff members when Liberty made the change, and Minnerly reports that there was a certain period of adjustment at Benefis. But both insist that these growing pains were worth it and that their employees would never want to go back to coding retrospectively.
“It does take a special breed of person to be a concurrent coder,” Minnerly admitted. “It is very interactive. But once our coders got over their hesitation, they quickly became part of the clinical team. They have become very well respected and they enjoy that.”
At Liberty, the coders have become such an integral part of the care team that clinicians routinely draw on their specialized expertise. “The nursing staff in particular has really come to view the coders as a valuable resource,” reported Massa. “They ask them questions. And because the coders have access to so many reference materials, the nurses regularly ask them to look things up. They are clearly part of the team. They even go to the nursing meetings. In fact, I don’t think that nursing would initiate any new program without including them.”
Another reason some facilities are resistant to implementing concurrent coding is cost. But Schmidt insists that, with proper planning, start-up costs are minimal. “It takes about six to nine months to do this well,” she said. “So, there are some lost-time costs associated with planning and training. Liberty Hospital implemented “permanent” computer workstations, while Benefis choose to use laptops. Both had that initial expenditure. If you put together a work plan and do a feasibility study, you should have a good idea of the costs. In the end, the return you get should more than make up for the investment.”
Faster turnaround; decreased AR; cleaner and more-timely data; better documentation; more accurate coding; increased respect from medical staff–with results like this, interest in concurrent coding will surely continue to grow. So, is it right for your facility? “I don’t think there is any facility that can’t benefit from concurrent coding,” stated Schmidt. “But it’s certainly not something you should just jump into. Speak to people who have done it. Go visit their facility and watch their staff in action. And be sure to bring one of your coders with you so they can see what it is really like. Implementing concurrent coding is a major initiative and a huge life change–but done correctly, it’s definitely a change for the better.” *
Gretchen Berry is an assistant editor at ADVANCE.
Secrets to Successful Concurrent Coding
As a practice manager for St. Anthony’s Consulting, Karen Schmidt, BSN, has more than a decade of experience implementing concurrent coding. Over the years, she has observed that successful programs all have the following in common:
* Good advance planning. “Some facilities think that talking about concurrent coding for a long time is the same as planning. It’s not,” said Schmidt. “Every aspect of the program should be decided on and written down. What is the start date? Who is in charge? All of this needs to be noted.”
* Multi-disciplinary participation and buy-in. “Lack of buy-in is a major pitfall to successful concurrent coding,” she cautioned. “The workflow is going to change, and you need to discuss that not only with all of your coders, but with every department that will be affected. Do some “one-on-one” with those who seem skeptical. Explain the functions and importance of coding to those who may not understand. For the program to work, you need to support other departments and you need them to support you.”
* Effective communication. Advised Schmidt, “The first time you tell someone about the move to concurrent coding, it will probably go in one ear and out the other. The second time, they’ll kind of listen. The third time, they’ll start asking questions. You need to find three different ways of getting your message across: hospital newsletters, posters in the cafeteria, etc.”
* Proper education and training. “You don’t want your coders to hit the floor and bombard the physicians with a million notes,” she revealed. “If you do some training up front–gently explaining to clinicians how to document properly and showing coders the most effective way to approach medical staff–everyone will have a better idea of what is expected of them.”
* Measurement and feedback. “Measuring and monitoring your progress is crucial,” said Schmidt. “Otherwise, you don’t know where you are or where you’re going. And once you’ve established your metrics, don’t just keep the results to yourself. Post a notice on the bulletin board, place flyers on the cafeteria tables–find a way to let people know what their investment of time and effort has yielded.”