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Competence

Core Values

AAPC's commitment to core values includes competence. This commitment is reflected in adopted principles for AAPC members to adhere to including, but not limited to:

  • Developing and achieving a skill set that fosters high quality, effective work product, and work process;
  • Maintaining credentials and coding expertise through ongoing continuing education, networking, and professional development; and
  • Maintaining a strong knowledgebase of key principles, including an awareness and understanding of applicable laws and regulations surrounding ethical and competent, professional coding.

Competence, as defined by Business Dictionary, is "A cluster of related abilities, commitments, knowledge, and skills that enable a person (or an organization) to act effectively in a job or situation.” In medical coding, competence requires more than memorizing codes or physician office habits. Rather, it requires coders to understand the premise of professional coding, to quantify (on behalf of a provider) the cognitive interaction between a provider and patient so as to describe sufficiently the encounter to the payer for reimbursement purposes.

Coding is the last link in the chain of the physician/patient interaction. It’s the last step that tells the payer why the patient presented for care, what happened, and when. Such a step requires a high level of trust by the physician that the coder comprehends his or her note describing the patient’s problems and treatment; and by the payer that the codes submitted for payment correlate with the provider’s documentation and the patient’s condition.

Competency cannot be emphasized enough. AAPC’s Ethics Committee occasionally encounters disputes involving competency. Surprisingly, such issues rarely involve actual knowledge and skill, but instead involve member conduct, where a coder knew or should have known his or her actions deviated from generally accepted standards and practices.

Taking shortcuts, not engaging in due diligence, failing to adhere to the “rules of the road,” and engaging in inappropriate behavior can lead to review before the AAPC Ethics Committee panel. For example, coders should question circumstances where quantity of claims processed is more important than ensuring the codes on the claims are correct.

If elected to represent a local chapter, it is necessary to become acquainted with AAPC's Local Chapter Handbook, which covers roles, expectations, and general guidance regarding chapter finances. If designated to proctor an AAPC certification exam, it is important to remember that AAPC credentials (your credentials) are highly regarded in the healthcare industry. As such, they must be earned based on merit. Test-takers must achieve their credential(s) on their own, without the help of others. No one would seek care from a physician or advanced practice professional who cuts corners. Similarly, no one would want to leave accurate coding and reimbursement to someone who is unprincipled.

The coding profession’s role in healthcare will assume increasing importance with the transition to ICD-10 and shift from fee-for-service to value-based compensation. Such importance is reflected by the increased discussion surrounding these transformative changes.

AAPC seeks to ensure that its membership reflects the very best of competent and trustworthy professionals who can be relied on to help physicians and other providers be properly compensated for their services. The AAPC Code of Ethics should serve as a road map to all who help navigate the business of healthcare.