Pulling vs. Pushing: Coding Education for Providers

By Victoria Jennings, RHIA, CCS, CPC-A

Getting providers to pay attention and perhaps make changes in how they document or code their services can be challenging. As a coding educator, I find a combination of different techniques is sometimes necessary.

My husband is a manufacturer’s representative and has been in sales all his life. He shared with me the concept of “pulling” a sale vs. “pushing” a sale.

When you “pull” a sale, the buyer is the one asking for the product by name. An example would be Red Bull. Creating “pulled” sales of Red Bull happens on television when commercials tell you where you can buy it and to “ask for it by name.” Consumers recognize the name from the commercials, “pull” the product off the shelf, and make a purchase.

When you “push” a sale you are incentivizing others, such as a retail salesperson, to push one product over another. The Red Bull representative offers a low cost to retail stores. With the lower cost to them, the stores now make more money on sales of Red Bull. So the store suggests Red Bull at every opportunity. Stores are now “pushing” the sale of Red Bull for the company.

Here is the key: if you can both push and pull a sale you will have better success. You are motivating both the buyer and the influencers of the buyer to move your product.

Let’s look at this concept as it applies to education and training for providers.

Examples of “Pull” provider education include anything that causes the provider to ask for the training. It includes direct “selling” of the benefits of training by your Coding Education team to their assigned providers. As with anything else, the easier you can make the provider’s access to the training information, the more likely they are to “buy.”

  • Phone Access: Provide a “Coding Questions” phone number to call during business hours
  • Email Access: Assign an educator to the provider to address their unique needs and make the educator available by email. The assignment might be made by specialty or territory. Educators can send written email trainings on topics as well.
  • Electronic Coding Tip Sheet Access: Make training materials such as tip sheets available on shared drives. It is critical that the training materials are maintained and kept up-to-date per guideline changes.
  • Laminated Reference Access: Sometimes something printed and in their hand is just what your providers need. Pocket references on common/universal topics can be very helpful.
  • PowerPoint Training Access: Create quick training powerpoints for tricky subjects, new material and commonly asked questions.
  • Face-to-face Coding Educator Access: In-person meetings with Coding Education may be needed to achieve individual clarification.
  • Invitations to request meetings with Coding Education.

Examples of “Push” provider education include any other departments promoting the coding training of providers. Ensure that these other departments know that Coding Education is available to help them by taking coding issues off their plate:

  • Compliance Department: Compliance can suggest in a non-threatening manner that providers accept training and coding assistance by the Coding Team to address issues identified in Compliance reviews.
  • Information Systems: Just because codes appear in the electronic health record, does not turn IT staff into coding experts. Ask IT to refer providers to Coding Education when IT is asked coding questions.
  • Quality Measures Department: When the question does not apply to quality measures, the QM Department should defer to Coding Education.
  • Practice Manager Education: Practice Managers can help create a link to the Coding Education Team when their providers are not getting the desired results.
  • Finance Department:
    • Provider contracts will help with financial incentives for better documentation; disincentives for failure to improve documentation.
    • Sharing performance metrics with service area leads so they can identify the providers that need to receive additional training.

A note about Peer-Reviews and Non-Compliant Providers
Working to change the habits of non-compliant providers is challenging. While involving the Compliance team can be very incentivizing, it is important to keep Coding Education separate from Compliance, otherwise the education culture becomes stressed and difficult. I recommend keeping a non-threatening learning environment for optimal results.

The following tactics may be effective for redirection of non-compliant providers:

  • Enlist peer pressure by benchmarking providers’ coding statistics to identify outliers.
  • Share aggregate audit results in such a way that the provider asks for training on the problem areas.
  • Create training based on negative external audit results.

When you combine both Push and Pull techniques in your provider education programs it can create synergy within your company culture. With synergistic results you can create a winning Coding Education program and a winning organization.


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About the Author
Victoria Jennings, RHIA, CCS, CPC-A
Victoria is the new acquisitions/new provider Coding Educator with Millennium Physician Group, a large multispecialty physician group with over 500 providers throughout the state of Florida. She has worked in the Education field as a Program Director for an RHIT and Coding Diploma program and was responsible for their accreditation with CAHIIM. Vicki enjoyed a role within compliance with Lee Health as a compliance investigator and external Audit Coordinator. She has also worked as an outpatient and inpatient coder for the hospital side as well as a Profee coder and educator for physician groups. She has also been a presenter for the local AAPC chapter on several occasions.

About the Author

Libman Education
Libman Education Inc. is a leading provider of training for the health care workforce offering self-paced and instructor-led online courses designed and developed by leading industry experts in Health Information Management (HIM) and Medical Record Coding. Our courses are specifically designed to improve individual skills and increase the efficiencies and competencies of health care providers and institutions. At Libman Education, we understand the needs and challenges of a well-trained workforce and offer the right-mix of online education to ensure that the health care professionals are prepared to meet the challenges of the changing workplace.

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