Spotlight on Medical Coding

Our Healthcare clients are steadily and continually engaging with us to support them with consultants in key areas of revenue cycle management, including coding and auditing. This demand is well documented. According to the Bureau of Labor Statistics, employment in the medical coding and health information sector will see a 13% growth through 2026. Compare that to the average 7% growth rate for all other occupations, and the importance these professionals play in healthcare and specifically to the projects they are placed on is clearly seen.

Medical coding and billing is a technical and specialized skill that requires these professionals to stay on top of trends, technology, and continued education in order to keep up with new regulations, compliance, and the latest medical coding updates.

At Oxford, we partner with several talented HIM professionals on a regular basis to meet the demands of our clients. These experts have their finger on the pulse of the healthcare industry, and their unique perspective warrants further exploration. To that end, we surveyed a group of Oxford’s HIM consultants to gain deeper insight into the people behind this profession. Below is a summary of our findings.

The Top Three Trends on the Horizon

While there are a handful of macro trends in the industry that everyone from software integrators to medical coding schools are tracking, we wanted to hear from the operators and technicians themselves to understand what they see in terms of anticipated trends and the ways it affects how they do business. According to the consultants surveyed, the top three trends on the horizon for Health Information Management in 2021 are:

1. Clinical Documentation Improvement (CDI): According to AHIMA, it is vital for HIM professionals to understand all aspects of “documentation requirements, code assignment, coding guidelines, and quality reporting.” With the recent move in the U.S. to the ICD-10 coding system, there are now 71,924 procedure codes and 69,823 diagnosis codes. The ICD-10 coding system is just one of the many factors involved in ensuring the accuracy of clinical documentation. To really maximize the revenue cycle and improve the quality of care, it all starts with good medical data.
2. Revenue Cycle Management: The healthcare and insurance systems in the U.S. create one of the most complex revenue cycles compared to any other industry. TechTarget defines revenue cycle as “all the administrative and clinical functions that contribute to the capture, management and collection of patient service revenue.” This includes but is not limited to: “charge capture, claim submission, coding, patient collections, preregistration, registration, remittance processing, follow up, and utilization review.” From the patient’s initial appointment with the healthcare system to their final payment completion or insurance reimbursement, the revenue cycle can also be looked at as the total patient experience. As medical coding and billing professionals, the patient experience is highly dependent on how accurately and efficiently they can do their jobs. Therefore, the roles HIM professionals play are more than just coding for revenue, it’s playing an integral part in patient care. This is sure to be a topic we will continue to hear about as the industry evolves.
3. Compliance: With the advancement of big data and the digitization of healthcare information, patient data and privacy have come to the forefront in the discussion of ethics and protecting the interests of individuals. A key aspect of an HIM professional’s role is understanding and working within the rules and regulations set forth by HIPAA, and ensuring their colleagues do as well. Privacy and security are of the utmost importance in the healthcare sector. The consequences of compromising that privacy could be an erosion of trust between patients and healthcare providers, and that can be detrimental to all parties involved. If a lack of trust exists between patient and provider, crucial information could be withheld that would lead to less effective treatment. As EHR and other data security issues continue to be a concern for patients, compliance will certainly remain an important topic among HIM professionals.

Technology’s Impact on HIM

Technology and digital transformation are impacting many large enterprises and industries, and HIM is no exception. Each one of the HIM professionals surveyed said they had been impacted by technology in some way. One audit and compliance manager pointed out that one way technology has affected her job is “being able to work remotely when not so long ago [she] had to be onsite.” She also brought up the use of computer assisted coding (CAC) saying, “while many coding professionals fear this tool and think it will replace them it is merely a tool. I enjoy using it and notice that while it does pick up a lot of codes which saves time, it lacks critical thinking abilities humans have. Also, it sometimes identifies something I may have overlooked.”

This brings up a real, although some say an overblown, concern about how AI and CAC will affect their jobs. Many experts agree that CAC is a tool for efficiency and accuracy, but will not likely replace human coders. Much like many other industries, real people in medical coding are better at certain tasks while artificial intelligence and machine learning are better at other tasks, such as helping the person reduce or eliminate mistakes and error.

Thanks to the advancement of technology, many consultants echoed that “Education and training is easily accessible and resources are readily obtainable.”

Other coders stated additional positive effects such as improved productivity, increased efficiency, and easier and faster access to knowledge and records.

Challenges within a Project

HIM projects come in many sizes and vary in scope. Depending on the staff, the systems the client uses, and the process by which information is collected, the challenges coders face can range tremendously. We took a handful of common challenges we often hear and asked them about those. When asked to rank aspects of a project from most challenging to least challenging, disclosure management and safeguarding protected health information was reported as the most challenging, followed by accuracy with document scanning, conversion to and implementation of new EHRs, education and training of staff, and finally coding and billing compliance based upon regulations. All of these challenges are typical to HIM projects, which makes working with experienced consultants that have the right expertise critical to project success.

Why HIM?

Of the consultants surveyed, a large percentage were seasoned professionals who have 10+ years of experience. These medical coding professionals were inspired to get into the HIM field for several reasons, from continued education and interest in the medical industry, to job flexibility and security. In order to keep their skills up-to-date, approximately 65% of consultants surveyed said that they prefer to use continued education and certifications as their primary method, while others referenced online resources, professional development courses, and professional events.

For those interested in getting into this competitive field, the overwhelming advice from these professionals is to continue to learn and educate yourself throughout your career. One of the coders we spoke to summed it up by injecting a dose of reality with some perseverance:

“Gather information, talk to coding professionals, and make sure it’s something that you are truly interested in. It’s not meant for everyone. If you decide to do it and have a hard time getting into the field — be persistent! Take the ‘nos’ in stride… keep pushing for that ‘yes.’”

Another HIM professional we interviewed captured the nature of the ever evolving field by reminding:

“[Don’t] be afraid of change, and learn to adapt to new skills and growth.”

With a future of inevitable technological change and adoption of tech such as AI and CAC, we couldn’t agree more. Being accepting of change and having the willingness to learn how to use these tools, while at the same time becoming an expert at proficiencies such as ICD-10, can make you an extremely valuable HIM professional.

The last topic that our consultants weighed in on was the importance of having a partnership with a staffing agency and working with a recruiter that you can rely on. Oxford consultants work with us for several reasons.  Here’s what they had to say:

“Oxford pursued me for many years before I finally came on board. As a former coding manager, I used Oxford consultants for coding supplementation and was always very pleased with the results of their work. When I decided to move on, I decided why not be associated with that caliber of company?”

“I have been with Oxford for almost 2 years… The support from my recruiter, auditors and manager is why I choose to work at Oxford.”

“My recruiter is great to work with. [She] is always just an email or phone call away. She made the hiring process very easy. I never felt like I was having to jump through any kind of hoops.”

“I have had an overall friendly experience with the recruiters, very good communication if [I need] a question answered, and great at job placement based on my skills.”

“Oxford provides a wide variety of remote coding opportunities, and a great coding team to work with.”

“I started working as a part-time last year, it has been a very rewarding experience from day one. I was given a very good client, steady job, and a very good recruiter and support.”

Medical coding consultants like these are leading the way in health information management — keeping an eye on trends to constantly learn and develop new skills that meet the demands in healthcare. As the industry continues to change and evolve, Oxford is proud to support the professional growth of our coder community and all of the talented professionals in our network. We look forward to empowering the future of healthcare technology.