The challenge of finding and keeping medical record coders has spawned at least one new approach that enables coders to work from computers at home instead of ones housed in the hospital basement.
An Internet-based coding system enables 656-bed Inova Fairfax Hospital of Falls Church, Va., to offer employees more flexible work schedules while getting more coding done in less time.
Medical record coders -- who assign billing codes to medical services and procedures -- are in great demand at a time when they are increasingly difficult to come by, says Dave Bahr, executive vice president of development for eWebCoding, an Atlanta-based company offering an Internet-based alternative to coding by hand.
To recruit coders, Inova Fairfax tried offering a number of financial incentives, but they weren't enough to attract and retain the number of coders needed, says Jennifer Shearer, Inova Fairfax's director of health information management at the hospital, part of Falls Church-based Inova Health System.
In January the medical center decided to try the system available through eWebCoding, a division of InterTech Information Management. Inova Fairfax employs 19 coders, 14 of whom work from home and visit the hospital only occasionally, Shearer says.
"Home coders are more productive because they don't have interruptions during the day, they can concentrate more on clinical coding, there are no long commutes in rush-hour traffic and they don't waste time getting ready for work," she says.
Inova Fairfax's four full-time outpatient record coders have each added 10 charts per day to the number they historically handled manually, an increase of 10% to 15%.
Hard-copy medical charts are scanned into the computer to create an electronic twin. Each chart is assigned to a coder and securely uploaded to the Internet.
Once the coder has applied appropriate codes, a bill is created and sent electronically to the appropriate payer for reimbursement.
The increase in productivity for inpatient charts has not been as substantial as for outpatient charts, Shearer says. That's because the inpatient charts are typically more detailed, with more pages for the 12.5 full-time inpatient coders to review. The inpatient coders work at home most of the time, but they do have to work from the hospital one or two times a week because completing the more complicated charts requires more use of the Inova Fairfax's abstracting system, which can move very slowly over the Internet.
Inova Fairfax bills more than 220,000 patient encounters per year, and Shearer anticipates eventually coding about half of those encounters using the Internet application.
They don't do that now because of the need to use the abstracting system, which includes supporting demographic and clinical data on each patient, she says. The hospital is upgrading its network to provide quicker remote access and faster data transmission.