Health Information Management

Despite gains, coders dissatisfied with compensation given increased responsibilities

JustCoding News: Inpatient, April 11, 2012

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During the last year, the buzz from the health information management (HIM) and coding community has consistently reflected that, as a whole, the industry continues to feel the strain of tight budgets and squeeze of limited resources, especially with the approach of ICD-10 implementation.

So it may come as a surprise that out of the 1,023 respondents for the 2011 JustCoding Salary Survey, 71% reported that they received a raise in the last year, up from 67% in 2009. Of this group, the bulk of the respondents (74%) said their raise was a 2%–4% increase.

More than half of survey respondents (55%) reported that they make between $30,000 and $49,999 annually. Of those who responded that they perform inpatient coding, the majority of salaries were evenly distributed among the following ranges: $30,000 to $39,999 (21%), $40,000 to $49,999 (22%), and $50,000 to $59,999 (30%).

In contrast, of those who responded that they perform outpatient coding, most said they make between $30,000 to $39,999 (43%), with a smaller percentage (26%) earning $40,000 to $49,999. Salaries for outpatient coders drop off significantly beyond that, however, with only 9% of outpatient coders reported making between $50,000 and $59,999.

Comments from respondents reflect dissatisfaction with these amounts. “Coders where I work—at practice management—are severely underpaid when you look at what our hospital coders make,” wrote one.

Another coder expressed that outpatient coders should earn salaries equal to that of their inpatient counterparts. “I want to emphasize that outpatient coder jobs are just as complicated as inpatient coding, if not more, with aspects such as local coverage determinations and interventional radiology coding,” said the respondent, who was an inpatient coder for 23 years. Having switched over to outpatient coding, she said she believes outpatient coding involves managing many more coding changes—all this on top of learning ICD-10.

Compensation inadequate in light of responsibilities

The resounding theme among most survey respondents is that compensation levels still do not suit the increasingly complex role coders play at their facilities and the wider breadth of responsibilities they bear.

It’s clear that the “coder” job title now involves a variety of functions, including training, auditing, and data reporting. While 72% of survey respondents’ job titles is either inpatient or outpatient coding specialist, survey results showed that respondents are also involved in the following tasks:

  • Training related to ICD-10-CM/PCS: 30%
  • Training related to new software systems or electronic health record systems: 18%
  • Data tracking tasks, such as entering information into a spreadsheet: 11%
  • Internal auditing activities: 10%
  • Recovery Auditor related activities: 7%

And 24% of survey respondents said that they had taken on additional responsibilities related to all of tasks listed above.

Coders react to compensation deficiencies

The majority of survey respondents (65%) indicated that overall, they do not think they are fairly compensated for the work they do.

“I feel like coding is getting more complicated with the audit processes, and you can’t just code from physician documentation anymore. You have to be an auditor also, and it is much more time-consuming,” one respondent wrote. “Now, queries are even directed at ruling out things the physician has documented as a diagnosis just because you feel like an auditor will take it away if it is your only CC or MCC.”

Many coders wrote that they are constantly asked to learn more, perform better, and take on more jobs and responsibilities (e.g., gather statistics and benchmarking data, audit charges, assist in developing the chargemaster, and act as a liaison with physicians) without getting more compensation for it.

Although most survey respondents (68%) stated that they do not work overtime, 25% reported that they worked about 41–50 hours a week. And of the 136 survey respondents who said they do not get paid for overtime, more than half of them reported working 41–50 hours a week.

Others raised the point that the role of coders is evolving with the increasing presence of computer-assisted coding and electronic health records. Coders are expected to expand their technology skill requirements amidst an environment where information technology resources are stretched thin.

Also, coders’ roles related to physician education are greater given the unique documentation challenges that result in an electronic environment, not to mention with ICD-10 adoption on the horizon.

“With the increased scrutiny from [Recovery Auditors] and all carriers, the role of coders in reimbursement and compliance has never been more critical to healthcare providers,” this respondent wrote. “These skills and responsibilities should be recognized and compensated for particularly when experienced coders are in short supply.”

Another respondent spoke to the variety of responsibilities coders have. “The demands on coders have drastically increased with no compensation,” the respondent stated. “Coders have had to take on increased clinical education, ICD-10 education, RAC audits, to name a few. Our facility has very few coders to support these demands, and coders are getting burnt out quickly.”

Many coders benefiting from remote opportunities

With mounting responsibilities and added scrutiny and compliance pressures, some coders are looking to examine the benefits of remote coding.

“Our facility is doing wage reviews right now to see about getting a pay scale raised for coders. If this does not result in a substantial increase in pay, I will be forced to go to another type of setting that pays better,” one respondent wrote. “I have been approached many times for remote work, but have not seriously looked at it before now.”

This sentiment is growing. The flexibility and competitive pay that remote coding offers some is becoming a more attractive option.

“Coding from home is increasing, and so is the pay rate. A coder at our facility makes an average of $15 an hour. Coders from home start at around $20 an hour,” said one respondent. “That is a big difference, and it’s much more [convenient]. I feel that facilities must maintain a competitive wage.”

Feeling undervalued weighs on coders’ minds

The underlying message of many of the survey comments regarding compensation vs. responsibilities is rooted in feelings of being undervalued and underappreciated.

“I believe that coders are becoming more and more relied upon so that the hospital can be paid properly. It is a huge responsibility on our shoulders to make sure that we follow all the guidelines and code to strict regulations. In some ways, we feel like we are at the bottom of the pay scale.”

With the growing compliance pressure and financial demands on hospitals and providers, coders believe that they play a much bigger role in their facilities’ success than in years past.

“I feel coding is the financial backbone of this industry. Without coders, the industry would be in shambles. When you look at the income generated by healthcare, coders get a very small percentage of the pie.”

Editor’s note: E-mail your questions to Managing Editor Doreen Bentley, CPC-A, at dbentley@hcpro.com.



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