Medical coding is one of the most important jobs in the administrative and operational realm of healthcare. In fact, coding and documentation are what Medical Economics call “the languages of our healthcare ecosystem.” Coders are critical to proper reimbursement, as well as documentation for population health and research initiatives. Yet, as with physicians, nurses, and other skilled clinicians, healthcare organizations are experiencing a critical clinician shortage of coding staff.
In fact, a survey by The Healthcare Financial Management Association (HFMA) reports that nearly 50% of CFOs surveyed say that it's harder today to find qualified revenue cycle workers. Another survey found that 73% of medical practices list staffing as their biggest pandemic challenge and is the #1 concern for provider CEOs. Yet, over the next decade, it's expected that there will be more than 27,000 vacant positions annually, a figure that includes both newly created jobs and existing positions left by workers who move to new roles or retire.
Recent data from the 2022 Medical Group Operations and Finance Survey suggest medical groups have been experiencing increasing strain on their workforce. The survey, conducted by American Medical Group Association (AMGA) included 24,000 healthcare providers in 5,600 clinics nation-wide. Results demonstrated an 11.3% decrease in clinical FTEs per provider compared to pre-pandemic levels with personnel susceptible to high turnover -such as medical coders – seeing a more significant decline still.
There are several reasons that health organizations are facing a shortage of medical coders. Below, we lay out three of the largest contributing factors to the hiring crisis, and conclude with proven solutions.
Burnout, “The Great Resignation” of the pandemic, and an aging workforce mean that jobs are being created faster than they are being filled—and experienced workers are the ones leaving. This comes at a time when an aging population needs more medical care, which, in turn, increases the administrative burden faced by backend staff.
Burnout is exacerbated by a constant increase in reimbursement denials, which not only complicate the revenue process, delay payment to hospitals and clinicians, and increase revenue cycle costs, but are also incredibly frustrating to coders. In order to resolve coding-related denials coders to shoulder a significant burden.
Another contributing factor to the shortage is the inability to retain medical coders. For one, it's a profession that is constantly changing. The shift from ICD 9 to ICD 10 in 2015 increased available diagnostic codes from 14,000 to over 70,000. The recently finalized ICD 11, though still a few years away from being implemented, contains over 100,00 diagnostic codes, and includes many different codes for the same diagnosis that coders must sort through and accurately assign. There has also been increased scrutiny of healthcare billing practices, and the transition from traditional fee-for-service to value-based care reimbursement models puts even more pressure on revenue cycle workers to document and code as accurately as possible.
The pandemic caused a quick shift to remote work, off-cycle code changes and additions, and other disruptions to normal workflows. Most in the industry agree that those rapid shifts are going to continue. As a result, medical coding requires vigorous, continued training, financed by the employer. Coders learn to quickly adapt to these changes, furthering their skills and expertise. This leads experienced coders to seek appropriate compensation for their work. The caveat is that this comes at a time when hospital leadership is looking for ways to reduce overhead, and, with administrative and revenue cycle tasks accounting for up to 25% of healthcare spending, medical coding is often at the top of the list when redlining budgets.
Rose Wagner, RN, MHS, FACMPE, consulting chief operations officer of AMGA, said "This situation will force medical groups to optimize, and hopefully leverage, technology to automate their processes. They have had to learn how to operate as efficiently as possible, to work with the staff they have, while also managing higher labor costs. This trend is unlikely to change for the foreseeable future."
In order to retain qualified, skilled coders, healthcare organizations need to invest in training programs that can provide value to their existing employees. Not only will this reduce turnover, but proper training and other forms of employer support can help improve job satisfaction and reduce burnout.
Implementing the right autonomous coding technology can drastically help reduce coding-related denials, while optimizing a coder's workload. This allows them to shift focus from resolving denials to more interesting, complex cases. The right technology can increase job satisfaction, optimize workflow, and help coders thrive.
While legacy computer-assisted coding (CAC) solutions stall at about 30% automation rates and require continuous human intervention, CodaMetrix’s own research has shown medical coding AI platforms can automate up to 76% of coding volumes and reduce coding-related denials by nearly 60%. Not only that, but with fewer cases needing manual intervention, coders are empowered to more confidently and efficiently code complex cases. Lastly, autonomous coding platforms can provide revenue cycle management significant costs savings, which leadership can use to bolster training programs and improving employee satisfaction and retention.
CodaMetrix has the industries-first multi-specialty autonomous coding platform. It leverages transparent AI in the form of machine learning, NLP, and deep learning to continuously learn from and act upon clinical evidence in electronic health records (EHRs). CMX uses proprietary technology to automatically translate clinical notes into codes that are sent directly to the billing system, decreasing denials due to coding, while liberating frontline clinicians from charge capture requirements and returning them to patient care.
To learn how the CMX platform made real-world changes to CU Medicine's radiology billing services, read our case study.
