January 2017

Yearning to Learn
By Juliann Schaeffer
For The Record
Vol. 29 No. 1 P. 22

Smart coders won't sit on their laurels. Instead, they'll take advantage of customizable education programs designed to keep them one step ahead of the field.

An increased scrutiny on claims, the ICD-10 transition, and turnaround time expectations have all played a part in helping to transform HIM processes over the past decade—and there are more changes to come. As employees and departments in these subsets of health care do their best to keep up, new workforce development initiatives are popping up to help address the need for ongoing education.

Here's a rundown of a handful of recent educational initiatives and workforce development offerings that seek to ensure a stable of new and current coders who exhibit the nuts and bolts to help health care organizations meet changing regulations while maximizing revenue.

AHIMA Grant Focuses on Apprenticeships
Thanks to a $7.1 million investment from the US Department of Labor's Employment & Training Administration, a newly formed Healthcare Workforce Consortium will be leading an effort to increase apprenticeship opportunities in health care organizations across the country. One of four organizations composing the consortium, the AHIMA Foundation will push issues involving health informatics and HIM.

According to a news release announcing the initiative, "The Healthcare Sector Intermediary initiative will help address the growing gap between academic training and competencies and the skills needed to ensure workforce readiness. Apprenticeship is a way for employers to build the talent they need to compete and grow and for workers to gain the skills and credentials that put them on the path to successful careers."

"Coding is a highly specialized skill that requires in-depth formal training as well as mentoring to ensure success," says Pam Haney, MS, RHIA, CCS, CIC, COC, coding trainer lead for the Department of Labor American Apprenticeship Grant at the AHIMA Foundation. "ICD-10 specificity has demanded greater knowledge in the area of anatomy and physiology, disease process, and pathophysiology in order to correctly classify each patient encounter. Coding professionals who expand their knowledge in these areas should see greater career opportunities into the future. Many roles within the field of health information management depend on this foundational coding knowledge."

According to Haney, the AHIMA Foundation Registered Apprenticeship Program recognizes the current need for well-trained, skilled, and workforce-ready coding professionals to meet industry demands. "Coding knowledge is also essential for various HIM roles such as clinical documentation improvement specialist, data analyst, and revenue cycle positions," she says. "By requiring related instruction and a recognized coding credential, the AHIMA Foundation apprenticeship program helps to bridge the gap to employment for new coding professionals who meet minimum competency requirements."

How does it work? Haney explains that the AHIMA Foundation's grant, Managing the Talent Pipeline in Health Information, has an apprenticeship model to develop an "on ramp" program to assist new graduates seeking their first work experience and to boost career mobility. "The Registered Apprenticeship Program will provide the missing, initial, immersion, and on-the-job training of the apprentices at no cost to the HIM employer or the employee," she says.

The grant works with credentialed apprentice applicants to identify employment opportunities and works with employers to match them with applicants that best suit their needs. "In addition, the grant provides coding immersion training based on the AHIMA Certified Coding Specialist domains that identify apprentices' learning gaps and delivers individualized learning plans for workforce readiness," according to the announcement.

The immersion training and support resources are also offered to apprentices throughout the apprenticeship period as necessary to ensure success, Haney says.

Mentoring Program Addresses In-House Training
Barry Libman, MS, RHIA, CCS, CCS-P, CIC, CDIP, president of Libman Education, believes the ICD-10 transition has been an eye-opener. "What we have learned from the extraordinary effort to prepare for transition to ICD-10 is that coder training must be more than a box that gets checked as completed," he says.

While Libman believes there is currently no consensus on what the future of coding will look like, he expects coder training to be key in keeping new and experienced coders up to speed in an ever-changing industry. "The coder's job is constantly changing to accommodate advances in health information technology and medicine," he explains. "Coders must embrace lifelong learning to keep their skills current. Yearly code set updates and guideline changes are just part of the job."

When looking at the various trainings options available for current employees, Libman encourages health care organizations to consider the key characteristics that matter most to them. "There is a qualitative difference in coder training options, and hospitals should seek the option that is right for them," he says. "Coder training is a continual process, and the more successful training options recognize individual learning styles. Training, when viewed as an investment and not just a line item in expenses, requires a defined path of learning, with measurable goals and objectives clearly identified for both the organization and the individual, and documentation of the return on investment for the coder training dollars to prove its value."

Libman says many clients, primarily hospitals and organizations that provide coders and coding-related services, believe accurate coding—and the importance of skilled coders—to be at the forefront of revenue cycle management. "Health care administrators know the value of accurate, complete, and defensible medical coding, and that it is a critical advantage for their enterprise," he says.

To address this need, Libman Education recently introduced a Medical Coder Mentoring Program, which provides in-house coder training. The program, which can be tailored to meet a hospital's specific needs, assesses coder skills, develops customized learning paths, and offers optional one-on-one mentoring to help staff develop and then practice new skills.

The training solution uses a model of progressive learning to ensure coders develop the knowledge and real-world experience necessary to perform their jobs, Libman says. "The program, called Grow Your Own Coder, allows organizations to keep their coding staff in production while developing their own credentialed coders in-house," he says. "Using our progressive model of training for coding skills, employees advance from simpler to more complex coding assignments in accordance with the organization's need and the individual's progress."

Libman says some organizations prefer to hire coding staff with baseline skills and knowledge (anatomy and physiology, medical terminology, and pharmacology as well as basic CPT and ICD-10 knowledge) and then offer training that fits their specific needs. "These employers may prefer to identify those with aptitude and potential to grow and then mentor the most promising," he says.

Either way, training new coders to handle complex inpatient and outpatient cases requires an investment in time and energy, Libman says, noting that hospitals are increasingly seeing the value of in-house mentoring and training services.

Portal Offers On-Demand Coding Content
In the past, coding may have been a remote function known and understood only by coders. However, Karna W. Morrow, CDP, RCC, CCS-P, an AHIMA-approved ICD-10 trainer and manager of consulting services at Coding Strategies, expects to see an increased emphasis on medical necessity, comorbidities, and coding the "case" even in the physician coding world. Like many others, she believes the coding world is "drastically changing," largely due to ICD-10, noting how difficult it is for facilities to find subspecialty coders.

"The subspecialty, procedure-oriented coders are impossible to find," she says. "Some positions—for example, for an interventional radiology coder—can go unfilled for a year—and not because of pay or benefits, but because the résumés aren't available.

"Health care is changing at the federal level financially and at the ground level in the delivery of care," she continues, noting that today's coders need to understand more than coding. "They need to know enough about the new reimbursement models to understand how coding plays a vital role in the data capture."

Education efforts that focus on training the skills needed today—not last year or even last month—will best meet the needs of new coders and those looking to further their careers, she says.

To meet those needs, Coding Strategies recently partnered with the Healthcare Billing and Management Association (HBMA) to provide the organization's nearly 50,000 revenue cycle professionals with access to specialty curricula and webinars via HBMA eUniversity.

A new portal tied to Coding Strategies' education content, the Online Learning Center "includes more than 80 web-based courses and hot-topic on-demand webinars that teach accurate and compliant coding for optimal reimbursement," according to a news release on the partnership. Each course offers coding instruction and exercises to help users gain a complete understanding of a range of coding topics. Certain courses are approved for CEUs, whether from AAPC, AHIMA, or the Radiology Coding Certification Board.

Morrow says such on-demand learning opportunities allow users to stay current on the latest trends and changes in the coding industry at their own convenience. Fine-tuned topics also allow for a single defined subject to be explored and/or revisited in a short amount of time, she says.

Targeted Credentials
While subspecialty coders require a certain subset of coding skills, they're not the only ones who might benefit from a customized learning path. According to Gary Lucas, CPC, CPC-I, AHIMA ICD-10 ambassador and vice president of education operations for the Association for Rural Health Professional Coding, coders working in rural health care or community health centers face a unique set of challenges.

"For people who are working in highly urban or rural areas, that means that they largely have to learn a lot of things to get certified that they will never do," Lucas explains. "For example, in order to get a more traditional certification, many coders need to learn the CPT book, printed by the AMA [American Medical Association] every year, cover to cover. However, many rural health and community health centers will never be performing a wide swath of services related to surgeries, radiation oncology, or anesthesia. So one of the challenges in our particular area is that people would sometimes have to spend a good chunk of change to learn a lot of material that they may never use."

To address that reality, Lucas says the Association for Rural Health Professional Coding has created its own coursework and credentialing, trimming the more generalized coding material offered in more recognized coding credentials. Instead, it focuses on information relevant to the daily activities of rural coders.

"We think tailoring your education and certification to what you see day to day is paramount," he says, noting that the organization's coding credential also addresses billing aspects—something other coding credentialing programs traditionally do not.

There's a danger of the overall credentialing market becoming "too full," Lucas says. "The danger is that people may have a hard time navigating it to find what's most relevant for them." There's more benefit to tailoring certification into little pieces where it makes sense, he says.

Because not all organizations pay their employees to receive ongoing training, Lucas says affordability can be another benefit of a more-targeted credential. However, he never dissuades someone from seeking one of the traditional, more recognizable coding credentials first and then supplementing it with a targeted credential, especially if he or she has intentions of someday changing facilities.

Distance vs in-person learning is also a factor in determining the right learning opportunity, Lucas says. "By nature, our community doesn't have the same budget that a lot of other people do, and they're geographically spread out," he explains. "A lot of times one of the challenges people have, whatever training or credentialing they're after, is the ability to physically get that training."

While the traditional learning pyramid has been in-person learning supplemented by some distance learning, Lucas says that model is slowly but surely flipping to include mostly on-demand learning supplemented by in-person training.

AHIMA Reevaluates HIM Curriculum
As changing times create new roles for coders, many of those same factors are driving change in HIM education as well.

"The scope of the HIM profession has broadened with every new opportunity captured by HIM professionals," says Desla Mancilla, DHA, RHIA, senior director of academic affairs at AHIMA. "The many successes of program graduates and practitioners feed back into the education cycle. New competencies are frequently developed to ensure that all HIM students are prepared to take on new and emerging roles similar to those that have been enjoyed by their predecessors."

This approach may have worked successfully for decades, but Mancilla says it is time now to reevaluate that process. "It is unsustainable to continue to add content to the curriculum in the way we have in the past," she explains. "We are at the point now of making some difficult decisions on how to revise future curricula to ensure the HIM profession enjoys the same level of success in the future that it has in the past—particularly in light of advancing technology that we know is disruptive in every industry."

Working toward that end, AHIMA has developed HIM Reimagined, a framework that has been circulated for member comment and which Mancilla says is generating some great discussions around the best way to meet future needs. Whatever lies ahead for HIM education, Mancilla is confident it won't look the same as the coursework of previous decades—and that's a positive.

"While all the details are not known or finalized, it is accurate to say that significant change in educational programming must take place to ensure there is time enough to appropriately educate students at a significant depth level to make a meaningful impact as new employees and to set the stage for their continued success throughout their careers," she says.

It may be too early for specifics, but Mancilla says HIM professionals can expect to hear some news by August 2017, when a set of new academic competencies for all academic levels in HIM is expected to be implemented.

Mancilla says other specific advancements in education focus on content related to master's-level health informatics. "Many HIM professionals are working in informatics-related positions throughout the country. AHIMA's Council for Excellence in Education has supported the efforts of a recent taskforce composed of health informatics practitioners and educators around the development of curriculum competencies. These competencies are specifically targeted to be meaningful to employers that recognize the value of applied or operational informatics in the workplace," she says.

These ongoing efforts are meant to provide opportunities for both HIM professionals and others to further their education and understanding of key informatics content areas as outlined in the current draft competencies document. "As these competencies are adopted throughout the academic community, master's-prepared program graduates will be at the ready to fill applied or operational informatics positions," Mancilla says.

Choosing the Right Learning Path
Lucas encourages HIM and coding professionals exploring education options to consider their relevance to their current position as well as any future opportunity. "If I'm a hiring manager, what I want to know is do you know what we do in this facility on a day-to-day basis," he says.

"But if there's one certainty about this industry, it's that once you get something down, it's about to change," he continues. "So I encourage all coders, particularly, to create and maintain an ongoing education plan that mixes in various types of learning that work for them."

— Juliann Schaeffer is a freelance writer and editor based in Alburtis, Pennsylvania.