That leads to another part of the puz­zle. Because hos­pi­tals are so short-staffed with cod­ing per­son­nel, many lack the man­power to pro­vide essen­tial train­ing for new coders. Even those peo­ple with an edu­ca­tion in med­ical infor­ma­tion man­age­ment need direct over­sight and train­ing for six months to a year to get up to speed on the com­plex­i­ties of the job, Leon-Chisen says.

In the rush to fill med­ical cod­ing vacan­cies, hos­pi­tals need to be scrupu­lous about hir­ing qual­i­fied peo­ple. After all, a hospital’s rep­u­ta­tion is on the line, says Bill Robert­son, pres­i­dent and trustee of Adven­tist Health­Care Inc., Rockville, Md. “Hos­pi­tals have a lot to lose if they don’t use qual­i­fied peo­ple,” he says. “Cod­ing essen­tially cre­ates the win­dow [through] which oth­ers judge the com­plex­ity of care you’re pro­vid­ing. Out­comes are adjusted by sever­ity. If your cod­ing is not com­plete and up-to-date, it will affect how out­side com­pa­nies judge your level of care.”

Rita Sci­chilone, AHIMA’s direc­tor of cod­ing prod­ucts and ser­vices, agrees: “Coders are an inte­gral part of a health care sys­tem. Not only are they key in reim­burse­ment and pro­cess­ing claims but they are crit­i­cal in deci­sion sup­port, index­ing of dis­ease and over­all clin­i­cal man­age­ment. They are respon­si­ble for mak­ing sure the hos­pi­tal fol­lows the appro­pri­ate gov­ern­ment rules and reg­u­la­tions. Inac­cu­rate and inap­pro­pri­ate codes are what get a hos­pi­tal into com­pli­ance prob­lems with fraud and abuse.”

Con­tract cod­ing com­pa­nies pick up the slack for many hos­pi­tals, and have become a $5 bil­lion busi­ness, says Cronin.

It is not uncom­mon to see more than $1 mil­lion to $2 mil­lion worth of charts that have been untouched for weeks or months, accord­ing to Cronin. He’s even seen the num­ber rise above $20 mil­lion because of missed dead­lines. The result is a sig­nif­i­cant loss of revenues.

A tell­tale sign that your hos­pi­tal may be short of coders is an increase in accounts receiv­able or out­stand­ing days to col­lect pay­ment, Incar­nati says. Adven­tist strives for a three– to four-day turnover, Robert­son says.

For McLaren Health Care Corp., which has annual rev­enues of approx­i­mately $2 bil­lion, a day lost in accounts receiv­able trans­lates into approx­i­mately $5.5 mil­lion in lost reim­burse­ment, Incar­nati says.


Many hos­pi­tals, such as Adven­tist, are begin­ning to imple­ment inter­nal mea­sures to ease the short­age: upgraded pay scales, sign­ing bonuses, flex-time and over­time oppor­tu­ni­ties, schol­ar­ship pro­grams for cod­ing edu­ca­tion, online train­ing pro­grams, in-house train­ing for inter­nal employ­ees and increased use of free­lance coders.

Hos­pi­tals also should con­cen­trate on employee reten­tion. “Coders need to know that they are respected and rec­og­nized for the impor­tant con­tri­bu­tions they make,” Sci­chilone says. “Cur­rent coders need to be sup­ported by oppor­tu­ni­ties for con­tin­u­ing edu­ca­tion and pro­fes­sional development.”

Adds Incar­nati: “Our indus­try receives a lot of crit­i­cism that we are not proac­tive enough [with] rev­enue. There are some good lessons to learn from the pain of oth­ers. This is one issue that hos­pi­tals can’t afford to sit on.”

Writ­ten By: Susan Meyers