Remote Coding Management Report Medical

Remote Coding Management Report

Medical coding involves using a pre-determined code -- usually developed by insurance companies for billing purposes although they also collaterally serve as a diagnostic tool for doctors and the injured party's loved ones -- and its preciseness, or lack thereof, in correctly coding the medical condition, ailment, or cause of death can have dramatic consequences for the hospital, the insured, the insured's family, and the insurance carrier. One wrong letter or numeral, for example, can have the injured party going from suffering a concussion to a contusion. Worse, an incorrect code can misidentify a cause of death, causing pain the deceased's family, or even causing the deceased's insurance carrier to refuse to pay for any medical treatment rendered.

JM Taylor (2008) found that emergency department managers benefit most by using certified coders, and by providing incentives for their coders to make few, if any, mistakes (2). Continuing education is imperative as the healthcare industry is dynamic in general. Taking the time to invest in their education ultimately saves on the hospital's bottom line. Though most of us don't prefer to think of hospitals as for-profit businesses, that is precisely what the majority of hospitals are: businesses. And the treatment they provide is most profitable when paid by insured patients.

Certified coders almost always have to spend at least a couple of years working on-site at a healthcare facility before being allowed to work as remote coders, and specializing in a particular area -- such as emergency medicine in our example above -- paves the way for the experienced remote coder to make few, if any, coding mistakes. This allows the hospital to collect cleanly on its treatment bill from the insurance carriers.

This paper will examine what qualifications are necessary for a successful -- and lucrative -- remote medical coding career. Certifications and coding scales will be examined. Finally, suggestions will be made based upon the findings in order that the hospital may implement the most advantageous plan to employ its remote coders.

9; disease classification; medical coder certification.

Medical coding is essentially transforming a healthcare professional's work or diagnoses into a pre-determined number according to a stringent chart of varying ailments, diseases, and causes of death. Remote medical coding carries that trade one step further in that the medical coder often works at home, and is considered an independent contractor rather than an employee. Thus, the benefits package to the remote coder will likely be very different than that of the employee as will the federal income tax consequences (independent contractors are responsible for figuring and paying their own taxes whereas an employer would automatically deduct federal taxes from the employee's paycheck). Still, it can provide a rewarding and lucrative career for those who need to work from home for whatever reason, and for those with enough self-discipline to successfully carry out their important and oftentimes complicated job duties.

Rodecker (2010) avers that medical coding serves several purposes, chief amongst them is the correct corresponding diagnosis necessary to provide to insurance carriers to enable the insurance companies to determine whether or not to pay a portion or all of a hospital's bill. Other uses include data accumulation for statistical purposes, triage, assisting the administrative staff of a healthcare facility, keeping track of possible epidemics, and for future planning of healthcare needs and services.

Job advertisements appear to be common and one can find them easily with a simple Google search. These ads, however, do not typically paint a complete picture of the skills necessary to succeed as a remote coder. For one thing, most successful coders will need to have served on-site for at least a couple of years. For example, in the case of persons injured in vehicular accidents, Kramer, Barancik, and Thode, Jr. (1990) found that some external injuries lacked a specific code, and therefore a particular categorical code could not be ascertained by conventional methods. It would then become incumbent on the experienced coder to be able to read through the injuries and determine the accurate code to use. Another issue Kramer, Barancik, and Thode, Jr. (1990) found was that certain areas of the body lacked a code when injured to a very specific area of the body.

The training and education one needs to be a successful medical coder, and in particular a remote medical coder, is extensive. If we examine Figure 1 below, we can understand why this is so:

AAT (alpha-1 antitrypsin) deficiency 273.4

AAV (disease) (illness) (infection) - see Human immunodeficiency virus (disease) (illness) (infection)

Abactio - see Abortion, induced

Abactus venter - see Abortion, induced

Abarognosis 781.99

Abasia (-astasia) 307.9

[7 subitems]

Abderhalden-Kaufmann-Lignac syndrome (cystinosis) 270.0

Abdomen, abdominal - see also condition

Kramer, Barancik, and Thode, Jr. (1990) found

Abdominalgia 789.0

[1 subitems]

Abduction contracture, hip or other joint - see Contraction, joint

Abercrombie's syndrome (amyloid degeneration) 277.39

Aberrant (congenital) - see also Malposition, congenital [26 subitems]

Aberratio

[2 subitems]

Aberration - see also Anomaly

[3 subitems]

Abetalipoproteinemia 272.5

Abionarce 780.79

Abiotrophy 799.89

Figure 1-Example of medical coding chart

Who amongst the untrained can make sense of this medical gobbledygook? Obviously, it would require a great deal of instruction and education to be able to decipher which symptoms applied to which condition. An even greater level of skill would be required should one work remotely, where one would be unlikely to have help in ascertaining the correct medical code.

JM Taylor (2010) recommends extensive, supervised on-site training, followed by annual continuing education, as the healthcare industry does not remain static but is overwhelmingly dynamic. The American Health Information Management Association goes a step further to suggest mandatory certification (2011). This credentialing would, at minimum, prove the coder had the sufficient medical knowledge to pass a rigorous examination. Once earned, the continuing education requirement would ensure the coder was kept abreast of new medical advances and technologies.