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Elimination of “A” Designation: The Apprentice designation is not needed anymore

  1. Default C Shaffer, CPC-A
    Medical Coding Books
    I'm a CPC-A and I am quite unsure of what I now may need to do to get the"A" lifted from my credential. I have a particular concern with this change because I actually did sign up and work through, all but about 100 of the 800, doctor notes for the Online Apprentice Removal Program this past summer when the site went down and I was not able to complete it. I am sure there are some of you who have read some of my posts since this all went down, and you are probably tired of hearing about it, but let me just share my story once more...

    I decided last summer to take some time off from a job I had as a Medical Assistant, which I had worked for 14 months. I thought this was going to be my "foot-in-the-door", but it was clear it was not going to happen with this practice due to nature of it being a small practice( one doctor), no room to move up. Anyway, I decided to leave the practice-due to other unfortunate reasons as well, to per sue the Online Apprentice Program. I dedicated my ENTIRE summer to try and finish this with the hopes of finishing by fall, so I could get back to work with this experience behind me. I literally worked all day, and night, every single day this past summer (from 8:00 am to at least 10:00 pm). Unfortunately, the site went down when I had about 100 to do in order to finish. This was in Aug/Sept, and I have been patiently waiting for the site to come back up so I could finish. I even participated in helping with providing feedback to the AAPC during this time. I want to say that having nearly finished this program, it was very exhausting and every bit as grueling as the CPC exam. I feel I have worked extremely hard, and dedicated a large amount of time working on this progam, only to possibly have it no longer be available as an option for removing my "A" status. I signed up for this program because it allowed me to do it on my own time, at my own pace, and from home. I think the idea of this program was a good one in that it teaches you not just what to code, but if you submit incorrectly, to do some research to find the correct codes, and understand why you may have an incorrect code. I think a coder gets a better understanding of the process as a whole. If you sit for a test consisting of only 20 notes, and have a time limit how is this considered an apprentice program where a new coder is being prepared for real world? Everyone needs to be trained for any job, and there aren't many employers willing to train a coder, so I think an apprentice program should be an option to train and further teach a new coder to prepare them for the real world. New coders still need experience to get a job, they cannot get a job and then sit for the test, because they won't be hired without the credential either. And it is another, additional expense.

    All this being said, there definately needs to be a change on how new coders can obtain the experience, and the credential, to help them gain the employment. But from my point of view, I am very upset about how this is potentially going to affect me. I have spent a large amount of time, AND money persuing this credential/education. I am beginning to feel I have wasted alot of my time, money, AND energy trying to obtain this credential. Maybe I should go back to Accounting, where I DO have the experience, in addition to a degree from a state college. I love the medical feild and I have the compassion for this line of work, and I thought I had found where I belonged, but I have to say this has been a dissapointing experience. I hope those at the AAPC will read my post and try to help me understand what exactly MY options are now....?

  2. Default Apprentice
    This is quite a surprise.

    Basically, AAPC is moving the goal post so that rather than allow you to sit for the exam and THEN get one year of work experience on your own before getting the full credential, now you will be required to already have a year of experience before you can even sit for the exam - unless, of course, you're willing to take not one, but TWO five hour and forty minute exams, and, of course, pay AAPC for this priviledge. (The orginal post didn't specify the cost of this new exam, but I can only assume that if the same time limit is alloted for it, the cost will probably be the same as the first exam - $295 for members, including the $35 price increase - a total of $590 for two exams, which according the president's announcement, must be paid for up front at the same time.)

    It appears AAPC has painted itself into a corner and found itself with a LOT of newly certified (CPC-A) coders and is trying to find a way to still collect money for membership dues, online courses, books, practice exams, study guides, and exam fees without diluting the integrity of the certification by having too many certified coders flooding the market.

    As it stands, it looks pretty grim for those of us struggling to break into this field. If employers were reluctant (at best) to take a chance on a coder with an Apprentice designation, they certainly aren't going to jump at the chance to hire a candidate with NO certification and NO work experience.

    I challenge any senior coders and hiring managers to take the chance on that eager, enthusiastic new graduate and/or newly certified coder and reap the benefits of establishing a relationship of trust and loyalty that will pay big dividends.

    Just my two cents.

  3. #13
    Default
    I really hope the AAPC puts some more extensive thought into this before they rush forward. I like that they give an opportunity for students with no experience to get certified. Students come to school and work really hard to learn this stuff, and then pursue a career. There is no reason they should be required to have the career first, before they can get certified. If you think it is difficult to get a job with the CPC-A credential, try getting your foot in the door with nothing.

    I see nothing wrong with the apprentice title. I would be fine with it going away too, but what I don't want to see is students not be able to pursue certification at all because they don't have experience. That seems backwards to me.

  4. Default
    Although I think gaining experience is the key to successful coding, I have to disagree with parts of this proposal. Take the people who just passed the rigorous CPC exam for instance, like myself. We went into this process knowing that passing the exam would give you the CPC-A status, like all of the CPCs before us. To remove this status, one has to prove on-the-job training. This is great. You pass the exam and get the training needed to code "in the real world" without time limits. Now the AAPC proposes to put a time limit on when the apprentice can submit this letter (December 2013, I believe). But did anyone think about the fact that the AAPC are favoring those who are already in the medical field. I have decided to change careers like many people out there. We are stuck in a horrible economy (not to mention I am living in the state with the worst unemployment rating) and not able to find jobs. It disgusts me that I studied hard and passed the exam, only now the AAPC is saying that it is not good enough. Not to mention some of my fellow test takers will only have to have their employer write them a letter, when I will have to sit through another rigorous exam. This is absolutely not fair! I feel you are not doing me any favors by taking off the -A designation (and making me sit for another exam), because as the proposal reads, it only tells the employer that you do not have experience. But with or without the -A, my resume shows that I do not have on-the-job experience...that I only have educational training. What harm is it to leave this -A for the people who already have it until they have the opportunity to get the on-the-job training needed (with no time limits)? This way they can phase out the -A designation without changing the process altogether. The people who are getting ready to take the CPC exam understand what will be needed of them (2 exams totaling almost 11 hours--ouch), and not take the exam and find out (only a few days later in my instance) that because you do not have have a job in the industry, you have to sit through another gut wrenching exam. I am not asking for a free pass (being grandfathered into CPC status), only that I have the same opportunity as those who are in the medical field and were sitting for the exam at the same time as I. I feel that the AAPC should just revamp the old test if they feel that straight coding is needed and remove the -A designation for current test takers. For those who already have the CPC-A, let them follow the protocol the AAPC laid out for them and gain the on-the-job experience in there own time (since there are no jobs out there right now). I ask that the AAPC please re-evaluate their proposal before rushing forward.
    Last edited by marver; 01-04-2012 at 08:29 AM.

  5. #15
    Location
    Columbia, MO
    Posts
    12,965
    Default
    As I stated earlier I think this is fantastic. I have no problem with expecting newly certified coders to also sit for a 20 question non multiple choice exam. I am also good with revamping the existing exam to be all fill in the blank with op notes to code. The idea is with no experience you have to show that you can take the ball and run with it. I have run into many new coders that cannot code without someone first giving them the suggestion of what the code might be. You have to be able to think independently. The provider is selecting the codes in todays world with the way the EMR is set up, but many times they are incorrect, a coder needs to know how to read the note and to be able to extract the correct codes. I worked with a billing service not long ago. they had many newly certified coders and those wanting to become certified. They allowed them to work to get the experience and then sit for the exam so as not to have an A. I suggested an exam to determine the level of expertise for each coder, a test was administered that was fill in and used the op notes and office notes from their clients. Easy right? there were only twelve questions and only 3 were op notes. It took everyone a full 8 hours to answer the questions, and the highest percentage achieved was 35%! They were all angry because the test was not multiple choice. This told me then why there were so many rejected claims and why so many denials were not being appealed. They were using the codes "suggested" by the physicians without ever considering they could be incorrect.
    So to take a part of a test or even an entire test that is not multiple choice is a good thing, it is a true measure of your abilities to code. I am not sure why you would not welcome the opportunity. As far as the AAPC goes I think it is good for them to elevate the credential. I also think they are really working in the best interest of the coder by making it more apparent to the future employer that AAPC coders really do know how to code.

    Debra A. Mitchell, MSPH, CPC-H

  6. #16
    Default
    Quote Originally Posted by marver View Post
    Although I think gaining experience is the key to successful coding, I have to disagree with parts of this proposal. Take the people who just passed the rigorous CPC exam for instance, like myself. We went into this process knowing that passing the exam would give you the CPC-A status, like all of the CPCs before us. To remove this status, one has to prove on-the-job training. This is great. You pass the exam and get the training needed to code "in the real world" without time limits. Now the AAPC proposes to put a time limit on when the apprentice can submit this letter (December 2013, I believe). But did anyone think about the fact that the AAPC are favoring those who are already in the medical field. I have decided to change careers like many people out there. We are stuck in a horrible economy (not to mention I am living in the state with the worst unemployment rating) and not able to find jobs. It disgusts me that I studied hard and passed the exam, only now the AAPC is saying that it is not good enough. Not to mention some of my fellow test takers will only have to have their employer write them a letter, when I will have to sit through another rigorous exam. This is absolutely not fair! I feel you are not doing me any favors by taking off the -A designation (and making me sit for another exam), because as the proposal reads, it only tells the employer that you do not have experience. But with or without the -A, my resume shows that I do not have on-the-job experience...that I only have educational training. What harm is it to leave this -A for the people who already have it until they have the opportunity to get the on-the-job training needed (with no time limits)? This way they can phase out the -A designation without changing the process altogether. The people who are getting ready to take the CPC exam understand what will be needed of them (2 exams totaling almost 11 hours--ouch), and not take the exam and find out (only a few days later in my instance) that because you do not have have a job in the industry, you have to sit through another gut wrenching exam. I am not asking for a free pass (being grandfathered into CPC status), only that I have the same opportunity as those who are in the medical field and were sitting for the exam at the same time as I. I feel that the AAPC should just revamp the old test if they feel that straight coding is needed and remove the -A designation for current test takers. For those who already have the CPC-A, let them follow the protocol the AAPC laid out for them and gain the on-the-job experience in there own time (since there are no jobs out there right now). I ask that the AAPC please re-evaluate their proposal before rushing forward.
    No one is forcing existing CPC-A's to take the additional exam. Yes, taking the exam would allow your A to drop off sooner. If you don't take the exam, your experience requirement will have been cut in half from 2 years to 1 year.

    Based on my massive 3 months experience as a coder (), I feel as though coding 20 op/clinical notes is a much better indicator of whether one understands coding or not. While the current exam is long and difficult, it really isn't coding. You are already given the correct answer among 4 choices. On the job, who is going to give you the answer?

    This doesn't really effect me since I'll have 1 year experience with 80 hours of classroom (current rules) or 1 year experience (proposed rule) in October. I would feel no need to take the exam in July just so that my A will drop off 3 months earlier.
    L. Mark Kozu, COC, CPC, CCC

  7. #17
    Location
    Dover Seacoast New Hampshire
    Posts
    2,030
    Default
    Quote Originally Posted by mitchellde View Post
    As I stated earlier I think this is fantastic. I have no problem with expecting newly certified coders to also sit for a 20 question non multiple choice exam. I am also good with revamping the existing exam to be all fill in the blank with op notes to code. The idea is with no experience you have to show that you can take the ball and run with it. I have run into many new coders that cannot code without someone first giving them the suggestion of what the code might be. You have to be able to think independently. The provider is selecting the codes in todays world with the way the EMR is set up, but many times they are incorrect, a coder needs to know how to read the note and to be able to extract the correct codes. I worked with a billing service not long ago. they had many newly certified coders and those wanting to become certified. They allowed them to work to get the experience and then sit for the exam so as not to have an A. I suggested an exam to determine the level of expertise for each coder, a test was administered that was fill in and used the op notes and office notes from their clients. Easy right? there were only twelve questions and only 3 were op notes. It took everyone a full 8 hours to answer the questions, and the highest percentage achieved was 35%! They were all angry because the test was not multiple choice. This told me then why there were so many rejected claims and why so many denials were not being appealed. They were using the codes "suggested" by the physicians without ever considering they could be incorrect.
    So to take a part of a test or even an entire test that is not multiple choice is a good thing, it is a true measure of your abilities to code. I am not sure why you would not welcome the opportunity. As far as the AAPC goes I think it is good for them to elevate the credential. I also think they are really working in the best interest of the coder by making it more apparent to the future employer that AAPC coders really do know how to code.

    Bravo!

    Although the CPC exam is challenging, it's not an absolute indicator of coding competency, and elevating the difficulty of the CPC examination will only improve the integrity of the certification. The apprentice certification, in my mind, was well-intentioned, but generated a huge glut of inexperienced (and unemployed) would-be coders, regardless of their abilities and willingness to work. I'm glad that the AAPC has recognized this, and is moving towards re-recognizing that we are setting a higher standard.

    I'll never forget the words of one of my staff members, who was struggling early on to grasp the coding concepts in my department. He said, "I passed the CPC examination, but I had no idea that it would mean that I wouldn't just be able to sit down and do this work. There's a h$ll of a lot more to this coding stuff than just passing an exam".
    Pam Brooks, MHA, COC, PCS, CPC, AAPC Fellow
    Coding Manager
    Wentworth-Douglass Hospital
    Dover, NH 03820

    If you can dream it, you can do it. Walt Disney

  8. Default Cshaffer, CPC-A
    Although I am an apprentice, I am well aware of the fact that the CPC exam is multiple choice, and in the real world there are no multiple choices. A coder DOES need to be able to read a note and pull the appropriate codes for the procedures and/or diagnoses, and that truely IS a good measure of the ability the coder has. That is why I strongly suggest that the AAPC really take a look at continuing to offer the Apprentice Program, wether it be an online or on site program, I feel that is a great way to get the "new" coders the experience and/or education that is needed in order to be a successful coder. Since there are not many providers that have the time, or the finances to train "on the job", it seems to me that someone appointed by the AAPC should lead an apprentice program (like the online program), to work with the new coders, and mentor them on the issues in a real world situation. I would rather pay for an apprentice program that's going to give me the "real world" information needed to be a certified coder, than pay for yet another test that is timed, and does NOT offer any feedback on why a code would NOT be correct, and WOULD get denied in an actual coding setting.

    I am speaking from actually having attempted the on-line prgram. Although it had some bugs that needed worked out, I feel it was quite challenging and offered a very real picture of what it is truely like to be in a coding position. The program consisted of 800 doctor's notes, from EVERY specialty. It is alot of hard work, but I felt that it really showed how the real world looks and what is expected of the coder. I REALLY hope that the program will become available again soon, with the bugs worked out, because I think the program, along with a mentor to guide the coder, will make the "new" coder much more successful in understanding the field. I also feel that it will better prepare them for the challenges they will face, and how to do research in order to figure out what the proper codes may be.

    One more thing about the CPC test....It is a very hard test and I don't think the fact that it IS extremely challenging should be dissmissed. But I do feel that there should be some actual, fill-in-the-blank notes included in the future. But the amount of time to complete it may need to be increased...just a thought.

  9. #19
    Default
    why not revamp the existing exam, vs. adding a second exam? Just because you have one year of experience doesn't mean you can code either! I have worked with plenty of experienced coders, who were basically selecting codes based on what the person who trained them told them the right codes were for that condition. Or hey just add a modifier 25 to get paid, with no idea of what modifier 25 even means.

    Make the exam more difficult, add the clinical op notes to part 2 of exam, and elevate the pass rate to 80%. I bet that most folks could get on board with that. But, keep it one exam, and make it the same for everyone.

  10. #20
    Location
    Ft. Walton Beach
    Posts
    8
    Default "A" Removal
    UNBELIEVABLE!!!!!!!!!!!!

    So much red tape to remove an initial that means nothing (other than hendering your job search) and for what? A job paying $14.00 - $20.00 hr.

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