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Code Green

Healthcare organizations increasingly are discovering that nurses make top-notch billing coders. 

By Joanie M. Wexler

When trained and credentialed in the billing codes representing medical services and diagnoses, RNs increase their earning potential and augment their job security.

For example, Lisa Foster, RNC, CRN-C, estimates she earns 10-15 percent more per hour as an independent contractor in the coding field than she did working in a hospital as a caregiver.

The Sacramento, CA-based nurse holds both the Certified RN-Coder (CRN-C) coding credential for RNs from the American Association of Clinical Coders and Auditors (AACCA) and the Certified Professional Coder-Hospital (CPC-H) certification from the American Academy of Professional Coders (AAPC).

Foster currently works part-time for insurance-company clients doing coding - mostly from home - and also teaches at the University of California-Riverside.

"I choose my hours," she says, and estimates she spends about 1 week per month working away from home on coding business.

Demand for Skilled Clinical Coders

RNs intimately know their way around a patient chart, making them among the best qualified individuals to choose accurate diagnosis and procedure codes for billing purposes.

Correct Coding is what maximizes Medicare and other insurance reimbursements and, ultimately, is what determines the financial health of a hospital or other medical group, experts say. 

"Bad coding is responsible for what ails our healthcare system," says Joyce Thomas, MHA, CPC, CCC, executive director, AACCA. The association was founded in 2003 to bring clinical experience into coding for reimbursement and compliance.

"If a coder doesn't select the appropriate procedure or diagnosis code for services rendered [during billing], the healthcare institution will not be reimbursed," Thomas explains.  Sondra Strand, BSN, RN, PHN, CPC, CPC-H, CRN-C, owner of healthcare consulting firm, Veracity Consulting, Glendale, CA, describes nurses as "master coders." 

"Traditionally nurse managers have looked to cutting budgets and personnel rather than enhancing revenue," Strand says. "As nurses, the more we understand the financials, the better managers we can be. And you can't understand the financials unless you understand the codes."

This situation leads to lost revenues and even hospital closures, Strand says.

"It's the coders who determine how much money a hospital makes," adds John Durst, MD, an internist for 29 years who now owns Medical Compliance Analysts, Wall, NJ, and teaches coding to physicians.  Dr. Durst further pinpoints the role that coding and billing play in the healthcare financial crisis. He estimates hospitals under-bill payers two- to three-times more often than they over-bill simply because of coding errors.

"There's no statute of limitations on when Medicare can ask a hospital to pay back overcharges," Durst explains. "But if the hospital under-bills, it has only 60 days to find the mistake and collect for it."

RN Career Opportunities

Any organization that touches medical billing or medical charts hires coders, Foster says. She cites hospital emergency departments, tumor registries, organ transplant registries, nursing homes, insurance companies and even law firms as a few examples.

"If you become an independent contractor, your overall salary is limited only by how much you want to work," she says.

The AACCA provides continuing education credit for RN-Coder "boot camps" taught by RNs to other RNs wishing to become certified as coders. 
Its CRN-C credential qualifies nurses to code outpatient, physician, and inpatient charts, and to also become better qualified to handle the fiscal responsibilities of nurse management.

Strand, for example, sought out the RN-Coder boot camp when she was manager of ambulatory patient care services at Childrens Hospital Los Angeles. 

"My job was charge-capture and revenue enhancement. Yet my authority as a nurse carried no weight in billing," she explains. "I had to defer to coders in the medical records department without clinical backgrounds," she says. "I felt we had to streamline the process within the organization to ensure accuracy."

Strand has since become an AACCA board member. In addition to her CRN-C, she also holds the widely recognized Certified Professional Coder (CPC) and Certified Professional Coder-Hospital (CPC-H) coding certifications from the AAPC.

The American American Association of Professional Coders (AAPC) and the American Health Information Management Association (AHIMA) also offers training and certification for non-clinical coders.

Strand believes other certifications are valuable, particularly for inpatient billing. In outpatient billing, however, virtually every service rendered is billable. So proper coding for every single one holds the greatest revenue potential and is where nurses and other clinicians can have the greatest impact, she says.

CRN-C Certification and Continuing Education

The CRN-C represents the first clinical coding exam in the nation, Thomas says. The eight-person board of directors, comprising master's-prepared nurses and other clinicians, wrote the RN-Coders certification exam.

Pearson VUE, a testing company that provides highly secure, electronic testing for RN licensure in all 50 states, originally administerec the CRN-C tests.  They are now hosted by www.WizIQ.com.

"The security and timed proctoring are the AACCA board's main concerns and why we contracted with Pearson Testing," states AACCA Board Secretary, Hilary Falconer, RN, MSN, MPA, CRN-C.

AACCA's certification examination is the first to provide computer-based testing of clinical coders nationwide. Candidates leave the exam with their score reports, rather than having to wait weeks for the results.

The AACCA is a member of the National Organization for Competency Assurance (NOCA) and will be applying for NOCA accreditation this year. The Washington, DC-based organization sets quality standards for credentialing organizations across multiple industries.

The AACCA requires 40 contact hours of continuing education every 2 years after initial CRN-C certification. The requirement can be met by AACCA programs or other continuing education programs specific to coding that qualify.

Further information on RN-Coder training and certification is available at www.RN-Coder.com and www.aacca.net  Joanie M. Wexler is a freelance writer and editor based in northern California.