Should your facility move your coding department?

Coders benefit from reimbursement knowledge

Many coders know the stress that can occur while they are working in the medical records department. They feel pressure to improve the quality of their coding, while noncoding personnel grumble that the coders should also help with the phones and filing. This leads some coders to wonder — would the grass be greener under the direction of the billing department?

Having coding personnel in the financial department rather than medical records is logical, says Colleen Albert, RHIT, CCS, a contract coder from California. "It is always useful to expand your knowledge [and career potential], and familiarity with insurance/reimbursement issues. And the role coding plays may best be accomplished by more direct exposure to such. Medical record offices are often noisy and cramped, and coding requires a high level of concentration to work not only accurately but quickly."

Some billing and financial managers also may see a good match, thinking that if they had control of coding, then accounts receivable (A/R) would decrease, says Allan P. DeKaye, MBA, FHFMA, president and CEO of DeKaye Consulting in Oceanside, NY. Since medical records’ coding is both an art and a science, however, placing it in the financial department could have the opposite effect.

"Billing, and for that matter, the A/R functions, certainly have enough open accounts of their own to devote their attention to lowering their investment in A/R, without the added worry of all the clinical and physician interaction that would likely occur with coding in the billing department," he says.

DeKaye says the coding function appropriately belongs in the medical records department, but should be staffed with qualified credentialed staff. "The biggest challenge is, of course, overcoming the inadequate numbers of available skilled personnel. This becomes especially difficult with increasing outpatient volumes."

Most medical record departments will, of necessity, use their most qualified coders for inpatient accounts, he says. This often leaves less experienced personnel taking on the most voluminous activity. "Private ambulatory services have increased vulnerability given Medicare’s requirement that a relevant diagnosis be provided when ordering laboratory and X-ray serrvices.

"With APCs [ambulatory payment classifications] looming on the horizon, coding will take on even more significance," he continues. "If hospitals are prepared to invest in coding infrastructure, therefore, let the investment be in medical records."

[DeKaye also offers the Patient Accounts Manage-ment Listserver (PAMLIST). For more information, visit the Web site:www.dekaye.com.]