"You miss all of the shots you don't take" - Wayne Gretzky (a quote given to me by my former boss about a year ago, which I then taped on my book):
I have one of those jobs where people get this glazed look in their eyes after I tell them what I do for a living.
I assist in the coordination of all of the Government audits that we receive at our healthcare facility.
What does this entail exactly? Here’s the process: We receive an audit, with anywhere from 1 – 400 accounts on it. We read the audit letter carefully, identify what they are auditing for (either medical necessity inpatient stays, correct coding, drug related issues, etc.), identify the accounts, gather the information, retrieve any other information, and send it off (electronically, thank goodness).
Then we wait. And wait. And wait. When we get the results, we determine how many were favorable (we keep our money), and how many were unfavorable (they take our money back). We go through them and decide which ones are worth appealing (we can appeal anything that’s been denied). Then we send them off again to a company we work with that handles our appeals. They write the appeal and send it off.
And we wait. And wait. And wait. Then we get the result from that letter – favorable or unfavorable. Then we decide if we appeal to the next level. Do you see a pattern here? There are 5 levels of appeal. From the time we receive the first audit request to the time it gets to the last level of appeal (if it goes that far) can take 3-4 years. I am not joking.
So there is tons of waiting, tracking, follow up, reports, pouring over clinical documents, etc.
And that is what I do. I am pleased to say that in my 4 years of working with this company, I have never missed any audit deadline. It’s a lot of work, but it’s surprisingly low-stress, which is nice.
However, there has always been one portion of my job that I’ve been a little bit more interested in – coding. I found myself really looking at the coding denials we were receiving more so than the others. So last year, my former boss started sitting with me and teaching me how to code. Mostly inpatient (that was her specialty) and some outpatient. I really liked it. I’m not sure why. It’s kind of like detective work. And you have to have great attention to detail. For those of you that don’t understand coding, here’s a little breakdown:
When you go see the doctor or have a visit to the hospital, everything the doctor does with and/or to you ends up in your medical record. Your physical exam, tests, diagnoses, procedures, etc. Same thing at the hospital. Everything is charted. A coder than takes that chart (usually within a day or two of discharge), and reviews the history and physical, discharge summary, progress notes, labs, pathology reports, etc.. they then assign a code to every single procedure, diagnosis, secondary diagnosis, condition, etc. There is a code for everything. From something as simple as a basic immunization to open heart surgery.
It’s not as easy as it sounds though. There are rules. Guidelines. Sequencing issues. Exclusions. Certain codes cannot be paired together. You can’t overcode and you can’t undercode. You have to pay attention to body sites, suture lengths, unspecified conditions, acute conditions, chronic conditions, present on admission conditions, hospital acquired conditions, complications, comorbidities, v-codes, e-codes, etc. I could go on and on and on. You have to dissect the medical record to make sure everything is captured.
Once all of the codes are in place, the computer analyzes them (instantly) and assigns them as an MS-DRG (Diagnosis Related Group).
Usually the DRG ends up being the principal diagnosis, but not always. Each DRG is assigned a ‘weight’, and each weight is assigned a dollar amount. The higher the weight, the higher the dollar amount. The hospital is then reimbursed according to the DRG. Sometimes it ends up being more than if each item were billed separately, sometimes it’s less. When coding is complete, it gets sent to billing. And from there, well, honestly I’m not sure what happens. I’m not a biller.
So I was doing pretty good studying with my boss with the eventual goal of becoming a certified coder. But then she left. And I stopped studying. And then I seen something on the AHIMA website (the organization that accredits inpatient coders) that stated that as of March 31st, the CCA exam will be on ICD-10 coding (not ICD-9 coding). I FREAKED out. For real. ICD-10 is a just a bear. It is complicated. I don’t know it. And I had been studying (well kind of) for ICD-9. There is no way I wanted to test in ICD-10.
So in a matter of eight days, I registered and paid for my exam, got authorized to take the test (you have to have some experience and be a member of AHIMA, which thankfully I already was), scheduled my exam, and took and passed it Thursday night.
It was 8 days that felt like two months!
And honestly, the test was awful. I was convinced that I failed. I didn’t feel sure on probably 75% of the answers. It was multiple choice, thank goodness, but there was a TON of coding on it and a two hour time limit. Yes, I know it’s a coding exam. But it also included a lot of Health Information Management stuff as well. I’ve taken other certification tests in the past (Medical Assistant, General Insurance) and this was by far the hardest. I was convinced I was going to run out of time. Most of the actual coding questions were all at the beginning, which ate up a lot of my time. At my 1 hour mark, I was only on question 39 (you have two hours to take a 100 question test). I wanted to be on question 50 at that point! But it all worked out, I even had 8 minutes to spare to review my answers.
So what does this all mean? It means I have a certification now (CCA). It will help with my current job (reviewing coding denials, possibly writing appeals myself). It will open further doors for me if I decide to become a coder. I will have to keep up my certification with a certain number of CEU’s each year (which I can get all at work thankfully). My job will pay for my test since I passed and they will now pay my membership dues each year, which is nice.
And....it's done! I did it. Here's the flowers my husband sent me on Friday at work:
It made my already great day even better!
