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Regional Medical Center Doubles the Number of Skilled Coders to Lower the DNFB

“There is no denying the need for new coder training, and a mentoring program
enables this invaluable type of one-to-one instruction.”

BEDFORD, MASSACHUSETTSAugust 22, 2018This case study presents the solution one Hospital found to the challenge of finding skilled and up-to-date coders. The solution was already in their department (with a little help from Libman Education!).

Lack of well-trained coders can lead to delays in reimbursement and increased risk of coding errors. Finding and retaining experienced and skilled coding staff can be difficult.

Accuracy in clinical documentation, error-free coding, quality reporting, and performance monitoring are all extremely important when working to strengthen the revenue cycle management of a hospital. These tasks are possible only when well-trained coders are on staff.

Regional Medical Center shared some of the common challenges faced by other hospitals:

  • Lack of skilled and experienced coding staff
  • Lack of up-to-date and facility-specific resources to support in-house staff training
  • Need to control the metrics of coding performance such as DNFB
  • Aggressive auditing and claw-backs by third-party payors


The Goal

Regional Medical Center wanted to ensure it could recruit and retain highly-educated medical coders while maintaining a low discharge-not-final-billed (DNFB), a frequent measure of productivity. This required a proactive approach to ensure that all coders would be cross-trained to handle a variety of ancillary, outpatient, and inpatient cases. “We wanted to have a program where people could move around and not be slotted into one particular patient type,” said the Director of Health Information Management (HIM) and Privacy Officer. “With cross-training, you have more flexibility, and it allows you to have greater productivity.”

Weighing the options
Regional Medical Center already worked with an outside staffing vendor to assist with coding backlogs; however, Regional Medical Center didn’t want to rely on the vendor to fill basic staffing needs in the long-term. “It’s better if you have your own coders,” said the Director. “When people belong to your organization, there is a greater loyalty.” The Director, like other HIM professionals, had matriculated through the HIM ranks, advancing from less complicated cases to more involved inpatient coding responsibilities. Her training had relied heavily on the senior coder, the go-to person for mentoring. Unfortunately today, that person is no longer there in most HIM departments.

Regional Medical Center was interested in the idea of establishing an internal training program that would not only attract and train new HIM graduates but also expand current coders’ skillsets. However, as a busy HIM director, she wasn’t sure whether she—or her staff—could take this on. “No one has time to be able to focus on the mentoring—especially when you have a brand-new coder,” she says.

Regional Medical Center knew they couldn’t create an entire mentorship program by themselves. Libman Education was brought in to help transform new and existing staff into certified coders who would be well-versed in coding all chart types.

Staffing limitations often are the biggest barrier to creating and maintaining a successful coder mentor program, says Angela Lehoux, CCS, an instructor and coder mentor at Libman Education. “Coding managers have so much more to do than educate their staff. It takes a lot of time to review someone’s charts and teach them,” she says, adding that a nine-month training period per coder is not uncommon.

Libman Education’s “Grow-Your-Own Coder” program
Libman Education was a good fit for Regional Medical Center because of its “Grow Your Own Coder” program that provides online training combined with hands-on mentoring. As part of the collaboration, mentors worked closely with Regional Medical Center and other department managers to assess coders’ strengths and weaknesses and jointly define mentoring goals.

“Mentoring is not a new concept,” says Lehoux. “Many experienced coders, myself included, can look back to a mentor in their career who helped them become the coder they are today. However, HIM staffing is much leaner now, and finding an in-house person to handle the training is becoming more and more difficult. There is no denying the need for new coder training, and a mentoring program enables this invaluable type of one-to-one instruction.”

To date, eight coders have completed the mentorship program, and most have also sat for and received their coding credential. Three of these individuals were recent HIM graduates hired by the hospital to expand the coding department. The remaining five were already employed as ancillary coders who needed to be able to code outpatient and inpatient records as well. In total, Regional Medical Center doubled the number of skilled coders in the department and lowered the DNFB from four days to 24 hours.

Individualized coder feedback
Unlike an audit, a mentorship program is all about ensuring each coder’s success, says Lehoux. “An auditor is usually focused on CCs and MCCs. They’ll give you some guidelines, and then they’re gone. But a mentor is there for you—to ‘hold your hand’ and go through the whole explanation of the chart,” she adds.

Lehoux says she works hard to make coders-in-training feel comfortable right from the start. “I tell them, ‘We’re working alongside you. We’re coders just like you, but we have more experience. We’re here to help you,’” she adds.

Consistent coding using your facility’s own cases and guidelines
In the case of Regional Medical Center, Libman Education was able to use the hospital’s own cases which allowed the coders to become accustomed to their facility-specific physician documentation patterns, electronic health record, and other details. “Even the best courses cannot prepare you for the actual cases you’ll code in a facility,” says Lehoux. “So if you want your coders to learn how to code the cases that you have, you should train them using the cases that you have.”

Increased coding accuracy and retention
With mentoring, coders gain confidence and improve accuracy. “What I love about mentoring is that you can really see the students learn and progress,” says Lehoux. “They don’t often make the same mistake twice because we’re teaching and guiding them.”

Coder mentor programs also enhance employee retention and satisfaction. “It lets the coder know that the company they work for values them,” says Lehoux.

About Libman Education, Inc.
Libman Education, Inc. is a leading provider of training for the healthcare workforce. Its Grow Your Own Coder Program allows you to keep your coding staff in production while developing your own credentialed coders in-house. Hospitals can use their own cases for training purposes or follow Libman Education’s Medical Coding Career Program (MCCP) with Mentoring to address their specific training needs. Contact Libman Education at [email protected] or 978-369-7180 to discuss how Libman Education can be of service to you.

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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