Posted and filed under Careers, Coding.

The following blog post was written by one of Advize Health’s most experienced auditors; Dawn Landry.

No matter what we do in life, only experience makes us better. None of us walked, rode a bike, or swam perfectly the first time we tried. We had to invest time and effort into first learning and then perfecting these skills. The more we worked at it, or practiced, the better we became. The same principle can be applied to our schooling. We started in Kindergarten, learning the alphabet and had to continue our educations all the way through high school and beyond, building on our knowledge base each year as we progressed. After school, the same principle of learning extended into our professional career.

I have transitioned into medical record auditing, coding and billing, and compliance over the past 28 years. I earned a BS in Biology and then went to work in a hospital laboratory performing phlebotomy and specimen preparation for the Pathology/Cytology department. My next career step was as a back-office MA/nurse for surgical practices including: general/trauma surgery and dermatology. I spent 10 years in these private practice offices and was blessed to work with physicians who taught me more than what I possibly could have learned in medical school.

I progressed up the ladder in the private office setting as a practice manager; and an ATLS coordinator when I worked with the trauma surgeon. The hands on clinical knowledge I got working in this environment laid the foundation for the next phase of my career – billing and coding. I am better able to code extensive surgical cases because I have seen many of them performed. Witnessing the procedure gives me unique insight on what the physician is saying in his operative notes; something I could not have acquired in a classroom.

My coding and billing career came after I relocated to Florida. I was hired on to a medical billing company as an AR representative. I spent a year on the phone with insurance companies fighting denied or non-paid claims for multiple specialties. This gave me invaluable knowledge of healthcare payor guidelines, modifier usage, the appeal process, and much more. I was soon asked to go sit for the Certified Professional Coder (CPC) exam. I took exam, administered by the AAPC, in 2002 with no study guide or prep classes. Using just my experience and prior knowledge, I passed it on the first attempt. Several years later, I was made General Manager of the billing company and began studying compliance to ensure we were doing the best for our physician clients.

After getting my CPC certification, Auditing and Compliance work came next. I learned about HIPAA and the intricate art of auditing. I spent several years improving my auditing skills and learning about documentation guidelines. I watched my only daughter begin school, and I am still learning today, even as she is set to graduate high school this year. I have audited thousands of charts for physicians, attorneys, and payers alike and am still as impassioned by it as I was when I first embarked on his exciting journey.

To date, the only credential I possess is my CPC. I will possibly sit for my CPMA, as I spend my days doing auditing and documentation training – but getting another credential is not at the top of my priority list. I am writing this to communicate to my peers that credentials do not make you a strong coder or auditor; only experience does. Credentialing preparation courses teach you the foundations of these skills, and how to pass an exam. Many people are good test takers and can pass these exams, but still struggle to apply the concepts to our real-life work. Practical application is ultimately more important than information regurgitation.

I see a lot of social media posts by potential auditors and coders who are perhaps getting ready to take their CPC exam; or maybe they just passed their exam and are wanting to work remotely. With all the advertising I have seen about how great it is to become a biller/coder/auditor, it is imperative to understand two principals:

  1. It takes time and experience to become a strong coder or auditor. It takes much more than sitting for an exam. If you have no previous experience, the desire to work remotely can be unrealistic. Like all of us “older” coders/auditors you need to put in your time first, and truly learn the business. There are no shortcuts to experience.
  2. I read my AAPC magazine every month and over the years have watched the newly credentialed CPC-A’s largely outnumber the CPC’s. The back of the magazine now may have one page of newly credentialed CPC’s followed by several pages of newly credentialed CPCA’s. This tells me we are saturating the market with inexperienced coders/billers, and auditors.

This article is not meant to discourage anyone from entering this field. It is only intended to demonstrate the trends and pitfalls of now allowing people who may have no experience to sit for these credentialing exams when they may not be ready. I have watched the deluge of CPC boot camps and training sessions all of which cost a substantial amount of money, but can’t give you the one element needed the most to become a successful coder/biller/auditor…experience.

Most of us seasoned CPC’s are always willing to mentor and assist people looking to break into this wonderful industry, but we also get frustrated when we see potential CPC’s wanting to bypass it all by  just getting credentialed to work remotely. My purpose is not to dissuade you from pursuing this as a career, but to advise you that it may be a little more challenging than what the coding and billing schools let on.