Experience Is the Best Teacher

PMCC instructor offers coding and billing students a taste of the real world.

By Ken Camilleis, CPC, CPC-I

I was very impressed by Beverly Haynes’ article in the June issue entitled “Become a Successful Coder in the Classroom.” As an educational consultant and billing/coding instructor, I share many of Ms. Haynes’ sentiments. I bring to the table more than 20 years’ experience in medical practice management, and, before I became a professional coder, my primary focus had been on billing and reimbursement.

Like Ms. Haynes, I have never actually worked as a coder in a physician’s office; however, I did observe firsthand the types of issues with which an “in-the-trenches” coder may be faced, especially regarding quality of physician documentation and proper communication of information that impacts the cash flow cycle. Authorizations for surgeries, primary care physician (PCP) referrals, Health Insurance Portability and Accountability Act (HIPAA) compliance and up-to-date demographic data were often an issue. Being the senior manager of an off-site billing company made my staff and I further removed from information sources because the medical records were not readily accessible to us to determine whether an encounter form was coded properly.

Although we were familiar with the structure of ICD-9-CM and CPT® manuals in terms of what services practitioners and specialists were likely to perform for conditions, the function of our business was essentially reduced to being a processing house based on the “garbage in, garbage out” (GIGO) principle. We had access to Medicare bulletins and other periodic payer publications, and we would inform the providers as we learned of new coding regulations, deleted or changed CPT® codes, or new reporting guidelines, and we managed our clients’ ongoing accounts receivable. Beyond that, our job, plain and simple, was to process piles of superbills every day for a multitude of specialties, most of which were prepared by hand and delivered by postal mail or courier. Although we submitted the bulk of our claims electronically through a clearinghouse, it was too much bother and expense for most of our clients to hook up with us for electronic charge capture.

Start at the Bottom

My career took a major twist in May 2006 when a “golden opportunity” fell right in my lap. I received an unsolicited call from the regional director of a career school chain. She was looking for a billing and coding instructor. After 18 years as a billing manager, I was getting more and more frustrated dealing with countless denials, delays, and underpayments because of poor practitioner documentation and communication. I welcomed this opportunity to bring my knowledge into the classroom. I subsequently shut down the billing business to become a spinoff coder and educational coding consultant. Four years ago I didn’t know how to read a chart note, but I went through intense training, took online courses running the gamut from medical terminology, anatomy (hearing terms I hadn’t studied since my eighth-grade biology class), HIPAA, coding guidelines, and other subjects germane to coding. I joined AAPC in the summer of 2008 and took a Professional Medical Coding Curriculum (PMCC) course that fall. I passed my Certified Professional Coder (CPC®) exam on Dec. 13, 2008, and I haven’t looked back.

Work Your Way Up

In the past four years, I’ve taught coding to individuals of all ages, from numerous walks of life, with diverse careers, and with different learning capacity. I especially enjoy teaching new students who have no prior knowledge of medical coding, such as a typical audience where the PMCC program begins with the Step-By-Step book.

To grab the attention of students and make learning enjoyable, I start the first class by:

  • —  Breaking the ice with a ‘tell us about yourself and your career goals’ to help students feel comfortable in the classroom.
  • —  Illustrating a ‘bird’s eye view of the life cycle of a medical claim’ with an interactive demonstration involving four to six multicolored markers, where each student plays an integral role in the cycle, explaining the process of the life cycle from the time the patient schedules the appointment to when the claim gets paid and posted into the practice management system.
  • —  Explaining how lay words like “office visit” and “low back pain” are translated into codes like 99212 Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A problem focused history; A problem focused examination; Straightforward decision making and 724.2 Lumbago.

Bask in the Glory

It really gives me a great feeling when one of my students in this capacity says she wants to move on and pursue a career as a coder. My mentoring has given her that impetus to move forward. While I won’t reach everyone, I feel that each new AAPC member especially every new CPC® or other credentialed member I’ve helped and encouraged to continue in the coding field is a feather in my cap.

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John Verhovshek

John Verhovshek

John Verhovshek, MA, CPC, is Managing Editor at AAPC. He has covered medical coding and billing, healthcare policy, and the business of medicine since 1999. He is an alumnus of York College of Pennsylvania and Clemson University, and a member of the Asheville-Hendersonville AAPC Local Chapter.
John Verhovshek

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John Verhovshek, MA, CPC, is Managing Editor at AAPC. He has covered medical coding and billing, healthcare policy, and the business of medicine since 1999. He is an alumnus of York College of Pennsylvania and Clemson University, and a member of the Asheville-Hendersonville AAPC Local Chapter.

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