AAPC Survey Reveals Coders Can Be Enforcers or Rescuers

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  • June 1, 2008
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by Sheri Poe Bernard, CPC, CPC-H, CPC-P
Sorting through the thousands of responses to AAPC’s The Work of a Coder survey, it is clear that coders love coding.
But for coders working in physician offices or clinics, a strong division arises between those who love coding and love their jobs, and those who love coding but are downright miserable in the workplace. How do we account for the difference?
It may boil down to something as simple as perception. Consider this analogy: We all, intellectually, appreciate the fact that our neighborhoods and our families are kept safe by police and firefighters, either of whom would risk their life to protect you from harm’s way. Emotionally, however, each creates a very different response in us.
When we think about an encounter with a police officer, what images do we conjure? We think of someone who demands that we slow down, or someone who waits to give us a ticket. The police officer is seen as an obstacle between us and our goals. He may have public safety as his goal, but to us, he’s an unwelcome enforcer.
When we think about an encounter with a firefighter, what images do we conjure? We think of someone saving a cat in a tree, or rescuing a sleeping family from a house fire. The firefighter is seen as someone who makes himself an obstacle between us and certain danger. His goal is public safety, and we look upon him as our lifesaver.
When your physician sees you heading his way, who does he see: the police officer or the firefighter? An obstacle and enforcer or a welcome lifesaver? The answer will correlate directly to your own job satisfaction.
If you are a firefighter, bravo! You’re part of a team with common goals and mutual respect. Your physician may see you as a firefighter because of your own communication skills and team-building activities, or you may be benefitting from groundwork laid by your predecessor. It’s also possible that you work for a provider who independently figured out your role. Count yourself lucky, as this survey respondent does:
“The relationship between coders and physicians is collaborative, and communication is essential to compliance and reimbursement. We are the “business side” to the medical office and we are valued as “equal partners” in the success of our practice. My employer generously provides resources and training (including conferences) for the coders in equal measure to other members of the practice (medical staff & providers).”
If you are a seen by your providers as a police officer, work to change your hat. Consider new communication tactics and work approaches. The fact that you are perceived as an enforcer is not necessarily your fault. It could be that your physician doesn’t appreciate impediments to his clinical calendar, even when they lead to higher reimbursements. Or it could be that a previous coder employee warped the physician’s view on the value of coders. What can you do to help your physician see you differently? We may find some answers if we look at the activities of firefighters:
Prevent and educate. The best fire is the one that is prevented. Work with your physician to reduce future errors by ensuring he or she understands the problem. Bring documentation or examples to illustrate your case, and keep your explanation as concise as possible.
Remember: Don’t fan the flames. Keep your voice level and unemotional. Don’t use “hot button” words like “always,” “never,” or “wrong.” Once a physician is put on the defensive, communication suffers.
Speak in positive tones. Many people only point out what is wrong; be sure to praise what is right. Outline steps to improve the rest. Put dollar amounts to your suggestions to move your image from “enforcer” to “money-maker.”
Size up the problem. Before firefighters enter a building or climb their ladders, they assess the situation to determine which approach will be most effective. Coders seeking information from their providers should do the same. Ask neutral, introductory questions, and agree where you can. An emphatic nod accompanied by “Absolutely!” or “So true!” can get frank answers to your follow-up questions. Follow-up questions can help you sort feelings from facts. Wear down resistance with good humor and an earnest desire to fix the problem. Leave your ego at the door.
Preserve and control. Do what you can to diffuse the heat. The best way is to remain emotionally neutral yourself, even when faced with a confrontational doctor. Don’t respond to aggressive or angry questions with an answer. When you answer an angry question, it sends a message that the question’s tone is appropriate and you are the rightful recipient of anger. Instead, ask another question, or make a comment acknowledging the physician’s concern: “I know exactly how you feel—this is so frustrating!” Not only will this help to cool the situation, but it also results in you gaining a reputation as an even-tempered professional.
Search and rescue. Successful search and rescue is dependent upon devising a plan and following it through. Do your homework before each encounter with the physician team. Have copies of coding or compliance rules you plan to cite. Be organized in your written and verbal communications, and link your concerns to the “vital signs” ($$$) of the business. How is this going to safeguard the practice and increase revenues?
Foster teamwork. Never forget you and your physician are on the same team. Firefighters work in large teams and each player has a critical role. In teamwork, there is no right or wrong. Instead, everyone is committed to mutual success. If your language and attitude communicate self-righteousness, teamwork is doomed. A team culture in which everyone is chasing mutual goals is what you seek. Look at how everyone suffers in this survey respondent’s office:
“I have been met with resistance and outright anger when I have asked the physicians to correct, complete or comply with whatever would be necessary to warrant the code they wish to be sent on to the insurance company. Now I just down-code the fee ticket if it is not documented it was not done.”
Many times, we make the mistake of thinking our coding abilities are enough. But it is human nature to value trust more than competence. Earn your providers’ trust, and they will see your competence. Use facts, data, and coding and compliance rules to allow your physicians to make their own analyses.  Don’t feel their need to validate. The facts are a reflection of your abilities. Trust is developed over time, and they will eventually be comfortable with your presentation of the facts without having to investigate the issue themselves. When that happens, you’ll know you’ve changed hats and are a bona fide coding firefighter.

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