I stopped reading the local newspaper’s Op-Ed page, as well as viewing Sunday opinion shows, a long time ago. It wasn’t the constant back and forth between factions of opinion that turned me off. What irked me was the very idea of the people offering their opinions being regarded as “experts” simply by their presence in a certain forum, when in fact what they actually had were good industry connections in order to be able to spout off any kind of nonsense imaginable. As time passes, a resigned acceptance takes hold within the reader / viewer that a particular person stands as an expert in their field, when in actuality they are nothing more than a human embodiment of a long-existing restaurant in a good location.
I have been thinking about this as it relates to my chosen profession lately. At the root of my experience is my 14-year-old coding certification. Medical billing and coding has become the “hot” job in America over the last two years. Twenty years ago, if you had a day off or a sick day and you were watching afternoon TV, the three main commercials you would see were “Have you been hurt in an accident?”, “I’ve fallen and I CAN’T GET UP!” and “Are you looking for an exciting career in trucking/hair styling/graphic design?”. Today, between scenes of “The Rockford Files”, you still get the ambulance-chasing attorneys, but the latter two choices have been replaced by commercials for Medicare Part C plans and technical schools offering courses in medical billing and coding.
As a result, there has been a significant influx of people in my profession who are just entering my occupational universe. This comes at a time when a paradigm shift is about to occur in the basic tasks of a coder, that being the looming implementation of ICD-10. When I sat in a hospital meeting room in Pennsylvania in 1998 to take my 5-hour certification examination, I had been involved in the administrative side of health care for over 8 years. I passed that examination, as well as a subsequent one a few months later, which gave me a couple of spiffy acronyms after my name conveying the imprimatur of expertise in my field. In the succeeding decade and a half, I have worked hard to continually improve the work product of myself and others in my chosen field.
If only I could say the same for my certification body.
About 5 weeks ago, I traveled to Las Vegas and attended the annual national conference of the American Academy of Professional Coders (AAPC), the organization that oversees my two coding certifications. The AAPC has been in existence since 1988, but went through a change in stewardship in the middle of the last decade in the wake of separate controversies regarding the founder and his estranged spouse, who was the president at the time of the takeover. As a result of this purchase, the AAPC is now a for-profit certifying entity. While the new owners did have some positive immediate impact upon acquisition, their actions since, as embodied by the national conference I recently attended, couldn’t come at a worse time.
I have a few beefs with the AAPC that I was unable to move up the chain of command in Las Vegas, thanks to the coding game shows, simplistic, beginner-level presentations and the ongoing abomination that is modern popular music being blasted over the speakers during every general session. Lucky for my readers, they get a dose of my attitude here, and it comes with better music.
A cursory look at the AAPC website shows that in addition to their most important core credential of Certified Professional Coder (CPC), they list twenty-five additional certifications. Twenty of these deal with individual areas of coding expertise, with the remaining five being certifications in hospital outpatient facility, auditing, “payer perspective coding”, interventional radiology and compliance. A majority of these certifications have come into being in the last five years. In creating this alphabet soup of credentials, the AAPC has created the unintended consequence of weakening their core CPC credential for physician practice coding.
Which leads me to everyone’s favorite topic, ICD-10. With the exception of the first presentation I attended by Michael Arrigo of No World Borders, who expertly connected the dots between ICD-10, payment reform and the revenue cycle, the balance of the information presented on ICD-10 at the Las Vegas conference consisted of “prepare now”, “it’s coming” and “it will affect things here and here”. This approach came complete with a guy dressed up like some mutated form of Elvis and an ICD-10-CM book (I wish I was kidding). Instructing the 2,200 coders and other professionals who attended just how to prepare and how things will be affected was conspicuously absent.
It helps to contrast the approach of the AAPC towards ICD-10 with that of the American Health Information Management Association (AHIMA). Because AHIMA certifications have more to do with hospital billing and coding, AHIMA has been engaged in the ICD-10 implementation process for over a decade. This included the 36 days of field testing that was done back in 2003 that is now seen as sufficient for implementation of the code set. As this recent article points out, AHIMA vigorously defends the need for the code set, has no tolerance for outside opinion to the contrary and is leading the charge toward a smooth transition.
Meanwhile, last week, the AAPC created yet another new certification and has taken the position that training in the code set should be undertaken no more than one year before the implementation date, which is set to move again soon after the CMS comment period on the latest proposed rule closes next week.
With the number of coders suddenly multiplying thanks to afternoon TV advertising, we now have an army of new AAPC-certified coders who not only are brand new to the administrative side of the industry, but who were proficiency-tested on ICD-9, which won’t be around 2 1/2 years from now. Meanwhile, the AAPC page on LinkedIn.com consists mostly of postings from newly certified coders who are still looking for work months (or even years) after attaining certification. The AAPC’s answer to this is to have a membership count proudly displayed on the home page of their website.
While I do plan to submit some rather pointed and mocking comments to CMS regarding the lost opportunity about to be undertaken so close to worldwide release of ICD-11, I am resigned to the fact that ICD-10 is a reality that is best planned for sooner rather than later. To those who took a break from afternoon TV and happened upon this article, might I suggest that rather than entering the overpopulated world of medical billing and coding at a high tuition cost to you, maybe instead try to draw Tippy the Turtle for an art school scholarship. A brand new CPC certification from the AAPC, in its current form, will mark you as an expert two years from now about as much as anyone on a Sunday afternoon talk show. Trust me when I say that’s not saying much. Do yourself a favor and try a new restaurant.