Exploring the Path of Medical Coding and Healthcare Compliance

In our latest episode of "Compliance Conversations," we’re talking about the career path to coding!

We’re joined by Sara Richards a newly certified coder, as she shares insights into the intricacies of medical coding and how it aligns with compliance in the healthcare industry.

Sara and CJ Wolf, MD, discuss:

• The certification process and how Sara prepped for the exam
• What the coding exam is really like – and what’s changed (and hasn’t changed) over the last few decades
• Career opportunities in the coding industry

This episode offers a glimpse into the world of medical coding, highlighting the challenges and rewards of pursuing a career in this vital healthcare field. Sara's journey as a newly certified coder serves as an inspiring example for those considering a path in medical coding and compliance.

Episode Transcript

CJ: Welcome everybody to another episode of Compliance Conversations. I am CJ Wolf with Healthicity and today we're going to talk about medical coding and how it fits into compliance a little bit. I thought it'd be really interesting to have a guest like Sara Richards, who is newly certified in coding and just thought it'd be interesting to talk to folks who are coming into this world, right? What they're thinking is and all that kind of stuff. So welcome, Sara, we're glad to have you here today.  

Sara: Hi, thank you for having me!  

CJ: We're excited to hear a little bit about, you know, your interest in coding and we'll talk about some of those things. But before we start those questions, love to hear a little bit about just your background, anything you want to share about kind of what brought you to the place you are now?  

Sara: So, I live in Houston and I am engaged and I have a 13-year-old son. I just finished the CPC certification program with the AAPC. So now I'm just kind of trying to find different companies to network with and to reach out to find where I can fit in at.  

CJ: And I met Sara, I was teaching one of those courses and, just a little plug; Sara, she was the best student I have to say. You are so engaged. And you were always like, get trying to get the rest of the class to be like; "Come on, guys, let's, you know, talk and do this," and then you were so organized outside of class, I think you put together some communication channels for your classmates and stuff, right? So, a plug, for anyone who's looking for a coder, Sara's the one.  

Sara: Thank you! And I'm usually shy so, but when it just came to the class like it was just so engaging. And you know how you taught and I just wanted everybody to, you know, really get involved and have the full experience.  

CJ: Yeah, yeah, it's fun to do that. And I love teaching, you know that, and I think our audience knows that that's kind of one of my passions too.  

So, Sara, tell me a little bit about, you know, what led you to an interest in medical coding and, you know, did you have any other work background, it could have been a completely different industry, but what drew you to that potential career path?  

Sara: So, I've done a lot of different things in other fields but I've always wanted to be in the health industry, but you know, without the blood! So, one day, me and my sister were just going back and forth on what I should do and where I could be in my own space and work in the health industry and computers. And she brought up her friend Stephanie, who has been coding remotely for a very long time, and I called her and she was like, you know, definitely go through the AAPC program and she's been my mentor ever since.  

CJ: There was something specific that interested you about that? Did you know what medical coding was at first? Like, I you know, I got to tell people on the plane, like, if I'm traveling, "What do you do?" And I'm trying to tell them like, "Oh! I didn't know that's how it worked!"  

Sara: I have had friends who have done it before. And Stephanie, you know, she really went over everything. I have heard about it, and I knew that it was a lot of really good remote work, so you didn't have to go into an office setting. You could be home and work at your own pace and just, I mean, I thought it was very ideal since I'm such an introvert.  

CJ: See, I didn't know that about you. Cause you, like you said, in the class, you were very extroverted, which is cool.  

Sara: Yeah, you brought it out of me.  

CJ: OK, good! Well, so tell me a little bit then about, maybe get into some details of how you prepared for the exam, like what did you maybe do on your own first? Then what did you do, like with formal courses? Because that's where we met, was it in a formal course? And then I think you took more courses after the course I was teaching, but can you kind of walk us through what that was like?  

Sara: Yeah, it was a lot of notes. As soon as I received my books. When I signed up for the program, I was so excited and I went through every page of every book. I watched all the YouTube channels for coding and the social media channels and just really tried to soak in everything to get ready for it. Then I had the practice exams. I had, you know, the courses and the blackboard that everything was just laid out. And so, I knew what to expect and I could really just go through everything and be prepared for that.  

CJ: So, was the first course that like the first formalized course, you took, the one with me? 

Sara: Yes, I did. I purchased the recommended package with them and it started with the fundamentals of medicine, which was recommended if you didn't have a background in medical terminology. So, if you weren't familiar with it, I had taken in the pharmacy technician program before, but I just didn't want to, you know, not be fully prepared, so I just wanted a good refresher for that. So, I did the medical terminology, the structure, and function, those were with you. And then after that was the CPC program.  

CJ: Yeah, and that class was a little longer, if I'm not mistaken, right? Like ours, the course you and I did was like 10 weeks or, no 12, right?  

Sara: Yes. 

CJ: And was the other 12 or am I mistaken? Was it longer?  

Sara: I think it was 12, but you had an extra two months. So, like it was in a structure to where you do the same like you know we had a live class every week and then you had your assignments to do before the next week, but they were more. It was probably like; you know where your class it had just the one assignment and then the test or the quiz afterwards. This one was more in the sections and there were the modules to do. There were case studies and also the homework that you needed to go over and then review after.  

CJ: I'm glad you brought up that. You know, some cause some people come into this career path with a little bit of healthcare background, right? Like I met a lot of nurses and people who, you know, they did some clinical work for a while. And so they had kind of that medical background. So, for them maybe that fundamentals course wasn't as vital, right, and they could jump right into kind of learning the coding, which is probably something they didn't have much experience at all.  

But it sounds like you had a little bit of kind of healthcare experience with pharmacy. What was the, if I could ask, like what did you think was the hardest thing about just kind of learning anatomy, physiology, medical terminology, and then what did you enjoy the most about that whole experience? Was there something that was really hard?  

Sara: Just that it being so new and having a different perspective on it, I mean, my teacher was a doctor, so the information coming to me was a lot different than a teacher that, you know, has no medical background. But that was probably just the most challenging, was, you know, being able to see it on a more in-depth level, but that was also the most fun part of being able to see things like we would go over something and then afterwards I'm just rereading it like; "This is so cool! I didn't even know this," and you know we're going through such deep anatomy. It was great. I really enjoyed it.  

CJ: What was your favorite system? So, for those of you don't know, when we do kind of a medical background type of course, we typically go through organ systems. So, we usually start with just some general medical terminology kind of rules and how things are, how words are combined, and then most of the other weeks were like we'd start with the integumentary system or the skin. Then we go through musculoskeletal and you go through all these different organ systems. Was there one that really stuck out to you or one that was especially enjoyable?  

Sara: The brain was really fascinating because everything we went over with the brain like they linked so much to other parts in your body and I had no idea about that and how you would put it in perspective. It was just like, "Wow, this is crazy!" Like the same names come from different parts of the body, and that's how you know they're linked. It was really good.  

CJ: The musculoskeletal system we're talking about, bones. We talk about the bones of the skull or the cranium, and we talk like the temporal bone. Well, the temporal bone is immediately covering the temporal lobe of the brain. And guess what? There's a temporal artery that you know, and there are conditions like temporal arteritis and so I think that's probably what you're referring to is how if you put in the effort to learn some things in one system. It could pay off as you're going to other systems because they use, you know, similar regions and locations and terminology, that sort of thing.  

Sara: Yeah, exactly!  

CJ: Yeah, well, cool. So, tell us a little bit about taking the exam now, I know we're not you're not allowed to, like, tell us the exact questions. But first of all, tell us when you took that exam, like how long ago was it? And then what was the exam like? Maybe like the mechanics? Was it online, in-person? You know. Tell us a little bit about that. So first, when did you take it?  

Sara: I took the exam in May and I scheduled it. I wanted to have it scheduled so it was very close to the end of my course, but it was either going to be two months after or the week of my final class. And so, I did that, and so that was in May. And the exam they offer is either online or in person, and I decided to take the in-person because I'm really hands-on and you know, I want things in front of me.  

CJ: Okay.  

Sara: So, when I went for it, it was very professional and nostalgic, so I felt like I was sitting for the SATs. I was so nervous. And they have a timer on it. So, I was like, "Oh my gosh, you know, I'm going to go through this. I'm not going to have enough time," and I just did all of the practice exams to get ready for that and to Just really, you know, feel how it's going to be in that setting and there were a few questions from each series in the books as well as medical terminology and things from the fundamentals course. And then there were case studies as well. So, my other instructor, she prepared me for all of that, and the practice exams that they provide for you online were really spot on with what to expect.  

CJ: Great! So, you said you took it in May. We're recording this podcast in July, end of July. So, it's probably, 2 or 3 months ago about. So, when you said you took it in person, is it paper? Was it a paper test or was in person on a computer?  

Sara: It was a paper test and just how you imagined, like our old professional test in school, it had the seal and you had to break the seal and bubble in all of your information. And it was just page for page, with the questions and multiple-choice answers, and then you'd have to bubble it in on the sheet and there were people that were watching you to make sure that everything was, you know, authentic and nothing going on.  

CJ: Right!  

Sara: You couldn't have like you could have notes in your book. So, it was open book. But you couldn't have sticky notes or extra things or just long notes. It had to just be working notes. But everything, I mean it was just. I'm just grateful that I had my notes.  

CJ: Yeah! Well, your experience then is very certain. The reason I was asking those probing questions is because that's how I took that exam, man! That was like 20 sheesh, 24 years ago I took that exam and I did it the exact same way. You know back then we didn't really have online tests. And so it was with paper, exact same experience you had. So, it's interesting that that's still an option. You were allowed to bring in books, right? Because this is a coding test that it's not memorizing all the codes, it's how to use the books. So, it's like your CPT book, probably your ICD-10 book, and maybe your HCPCS book, are those the three books that you were allowed or was there something I missed?  

Sara: Yes, those were the only three books you were allowed to have. And then, you know, your pencils and stuff like that, but nothing extra. You couldn't have a medical dictionary or any outside books from anywhere else, they had to be from the AMA or the AAPC that they provide so they do let you know it is the same books that you have throughout the whole course. So, as you're going through all of the homework and studying, when you put those notes in there, those are going to come back for you, for the test. And so, if you see something you blank out on, you're like, "Oh my gosh! I don't even know what this is from. I can't think of it." You have your note right next to it. That is just lightbulb!  

CJ: That is really good because when I've taught the certification part of it before the coding part, I would be instructing students to, "Okay, write this in the margin," right? Like if you're doing, you know, I'm trying to think of something, maybe with a biopsy or an add-on code or something and say, you know, "remember this, this means an add-on code means it can't stand alone, it has to be in addition to something. So put that in your notes." And so, it sounds like you were allowed to kind of, as you were studying putting in keynotes that would pay off later during the exam. Is that accurate? 

Sara: Yeah! And really, the guidelines. So, if something is not supposed to have a modifier, you want to kind of put that next to it so you don't forget. And if you see an answer choice that does have that modifier, then instantly it's eliminated. And if it's with or without those key terms you want to highlight so they stand out to you so you don't overlook it. But those things really, those tools really helped me out.  

CJ: Well, Sara, we're going to take a short break and all our listeners will take a short break and we'll be back in a moment.  

Hey, welcome back everybody. We're talking to Sara Richards, about her kind of journey and experience into the medical coding world and for all of our compliance professionals in healthcare. You know, coding is where a huge risk in compliances, right? With submitting claims to the government. And so, doing it accurately and having qualified people is kind of the beginning, right? It's the beginning of compliance doing it right. So having people who are certified, who studied, who've learned the rules and have gained experience, that's such a critical part.  

And when you are out in the real world, so to speak, in healthcare, maybe working for a hospital or a health system or a physician practice. You know our coders are often the folks who might notice something that might be awry or something that you know, "that just doesn't look right!" And so oftentimes you'll hear, you know, in compliance world, you'll hear from coders through their hotline or just direct communication that, you know, you're a little worried about how this is going out and how this is being billed and submitted and that could bring risk to the organization, you know, the False Claims Act or something like that.  

So, such an important aspect of healthcare compliance, and Sara was just telling us a little bit about the exam and her experience. So, Sara, once you finished the exam, how long did it take before you heard of passing? 

Sara: I did my exam on Saturday and every day until Wednesday, I was checking and refreshing 100 times a day, but then Wednesday I did find out that I passed and I called everybody, cried, I was so excited. It was such a big relief, but it did take, so if I took it on Saturday then that Wednesday, I found out those results.  

CJ: That's pretty fast!  

Sara: Yeah, it was just torture waiting for that.  

CJ: Yeah, I was going to say you probably felt like forever while you were waiting, but in retrospect, it seems relatively quick to, you know, to grade that and to get that. One thing I was going to ask you when you took it in person, was it hosted by like, your local AAPC chapter? Was that how you did it? or do you remember...  

Sara: Yes, it was the chapter leaders. They were there and there were two and it was at the hotel and how they have the conference room. So, the long tables and we all just kind of spread out and had our own space, but they were there. They made sure that the integrity of the test was maintained and nobody was sharing information or collaborating or anything, but it was very professional.  

CJ: Well, great. So, let's talk a little bit. So now you've passed the test. Now you're looking to the next stage and you know what kind of future job interest do you have in coding? Are you looking maybe to work for a physician’s practice? a hospital? I mean, there are so many places, or are you just kind of looking to get your foot in the door somewhere and kind of explore and gain experience?  

Sara: I am looking to get my foot in the door and that experience is really important because without it is so hard and that is not what I'm going through now. It's so hard to find a company that will take you with no experience and just working through Practicode to get the A removed to hopefully be able to have a better range of jobs I could apply for. But my perfect job would definitely be to work with my mentor Stephanie at her company. She works at Intellis and they're an E4 company, and I know they're very helpful in continuing education and they assist with all of the CEUs. They pay for your certifications, just real supportive and amazing company, and that's the kind of company I want to work for and grow with. But as far as like a specific type of coder, I think that's going to come with time and filling out all of the different specialties to see what I will love the most. But eventually, I want to be able to help others and share the information that I acquire along the way, and so my end goal would probably be in education.  

CJ: Yeah, well, cool! So, you mentioned getting the A removed. So let me just talk, let's explore that a little bit. So, when you pass the test and it sounds like and there are different certification tests, but you took the CPC, which is a certified professional coder and you have to kind of correct me and fill in the details here. But if you don't have a certain number of years of actual experience coding or working in the healthcare system. It's an A meaning apprentice and there are certain things that you have to do to have that A removed. Can you tell us a little bit about what you know about that? 

Sara: So, I believe it's two years working in a job setting to have the A removed, but the AAPC they offer and it's usually bundled with the package if you purchase the whole package. But you can also purchase it separately and it's called Practicode, it's 600 cases that are based on actual previous patient charts. So, it's a job setting and you have to go through each one and code them and maintain, I believe it's a 75% accuracy through it. And once you finish, you will have your A removed. So that is the one-year experience equivalent and then you also have your education hours from going through the program that also assists in that.  

CJ: Well, great! And you mentioned your mentor. Do you know what kind of coding that company does? Is it in-patient, or hospital? Is it physician coding? Do you know those details?  

Sara: It's outpatient coding and it is a really big company, so I believe that they do have other areas that they work in. But, Stephanie, she is an out-patient coder. 

CJ: And that, you know, I think the CPC and you know there are other certifications and even different organizations that do certifications. So, for those of you that are maybe thinking of getting into coding to get into compliance or whatever, there are organizations that do inpatient coding. So inpatient coding is a little bit different, right? Especially, like if you're coding for a hospital where they get reimbursed off of like a DRG realizes heavily on the ICD-10 coding, you know outpatient coding for outpatient hospital relies heavily on CPT codes. So, for example, for Medicare, it's the outpatient prospective payment system that those rely heavily on the CPT codes and same with physicians but professional billing, either physicians or nurse practitioners or the colleges, et cetera, that do professional services, the coding there, they can obviously do services both inpatient and outpatient, but a lot of those are heavily, the reimbursement relies heavily on CPT coding.  

But a lot of, and here at Healthicity, we've done webinars and white papers and e-briefs on information about ICD coding in relation to Medicare Advantage plans, So, diagnosis coding is becoming even more and more important in those settings, because if the diagnosis coding is wrong, the risk adjustment, the HCC coding will be wrong. And then there are some compliance risks. So, Sara, it sounds like you kind of mentioned your perfect job, and from what you told us a little bit, it sounds like you'd probably want to work remotely, is that accurate?  

Sara: Yes, that is the goal. I would love to work remotely and be home in my own space. I have my whole office set up and all of my monitors so I just feel like that would be the best space for me. But yeah, that remote would be very ideal.  

CJ: Yeah! So, I think you may have known that I lived in the Houston area as well and worked in coding and compliance for some organizations there. I still have a lot of colleagues there and one of my colleagues that kind of is a director over medical coding compliance. You know, the pandemic pushed a lot of people to work from home and a lot of people stayed there. So, you know, organizations found it maybe a little easier and cheaper to have people just stay at home. And if the job duties lend themselves to that kind of work environment. And so, I talked to him a lot and all of his coders, all of the people, auditors, and educators, are all working from home. And it's working well and I'm seeing that a lot more with clients that I interact with and I think that's kind of probably the future, maybe a new normal in some ways. And we're seeing in other industries too, right? Not just healthcare, not just coding.  

Sara: Yeah, a lot of the jobs are all at home and, you know, working in your own space because they don't have to have a standing building that everybody has to come to. And I just think it's more efficient and really better for everybody to be comfortable.  

 CJ: Yeah, exactly! Let me ask you, did you find it harder because some of the folks that are listening might find your path and what you've done interesting and they might want to explore it? Did you find the ICD coding easier or harder than the CPT code?  

Sara: The ICD coding was definitely more difficult because there are way more guidelines regarding those and more details and information that you really have to pinpoint and make sure that they are accurate and that is the base of everything. So, if that is wrong, then you know everything else can kind of just fall behind and be wrong as well. So, it's definitely something you want to look over and read the guidelines as much as you possibly can to really soak in all of that information.  

CJ: Yeah, good. So, and now that you're certified, you even referenced that getting CEUs, so these continuing education units, what do you know about that? And if you don't know a lot, that's fine. I'll kind of fill in some for people as well.  

Sara: Yeah! So, is when you have one certification, it is a minimum requirement of 12 CEUs I believe yearly for your membership to stay active and you can get those by well the AAPC they do provide a lot, but there are online webinars, you can purchase some or attend conferences, but there are also free ones by the monthly magazines. You can read them and they'll test you on the information or watch a video regarding a specific field that they have that they're talking about that month and test over that as well, but it is just something that and then every certification that you acquire your CEU baseline goes up. But a lot of companies that you work for, they do assist you in getting those.  

CJ: Well, and I'm glad you mentioned kind of conferences because that's what I love. So, I do love the remote type of work, but I love going to the conferences and meeting with people in person, and there are a lot of great conferences and I know you can't always travel. And so, there's a lot of Internet-based, you know, types of CEU opportunities as well. And you mentioned reading articles and that kind of stuff.  

And for those of you that get into compliance and get compliance certifications, Healthicity does a lot of the webinars. I'm doing a lot of them; they have other guests and other people doing webinars and they often will offer some free CEUs for those webinars when it comes to compliance. 

One other thing Sara, just with compliance and you might not know much about this, but if you do, I'd love to hear your comments. Because Healthicity has a software program called Audit Manager and it's a really great tool for those people who are auditing coders or auditing, you know, maybe they're auditing physician services. Are you familiar much, Sara, with auditing in general and how your coding knowledge could eventually lead to, you know, helping others perform audits which is where you identify a lot of compliances?  

Sara: Right! So just basically going over the coding charts that the coder has done and looking for the accuracies or discrepancies.  

CJ: Yeah, exactly. And there's just a lot of good tools and I just mentioned the one from Healthicity, because that's one that I'm really familiar with. So, for any of you listening, Audit Manager might be a really good tool to look into from Healthicity.  

Well, Sara, we're getting kind of to the end. It's been really enjoyable talking to you and I hope people appreciate your perspective, and this is why I really wanted to talk to you on the podcast because you're just getting into this field, right? And I just think that's an important perspective for us to hear, especially those of us who've been in it for a long time to see what people are doing, what their preparation is, you know, what their goals are, what their aspirations are, what they really would like to do. And you find great people like Sara and there's out there. I know you're looking.  

Sara: Oh man!  

CJ: There's another plug, but also a lot of people are looking and so this is kind of where people are coming from and I really appreciate your perspective and kind of hearing your journey. It's been decades for me since I was where you were. And so, it's been enjoyable to kind of relive that. I really was impressed that they still do those paper tests and like your experience was very, very similar to mine.  

Sara: They're like, if it's not broke, you know, don't change it.  

CJ: Yeah, right! But they do offer some online testing. It sounds like too, like so people could potentially just do it at home from their computer or something.  

Sara: Yeah, it is more strict. So, the people that are going to be supervising your test, they want to see your entire room. You can't have things hanging up. You can't have anybody at the house, no dogs, nothing. And if your Internet goes out, then that's your test. So, it's a little bit more risky for that. 

CJ: Ah, gotcha. Gotcha. So, any other last-minute thoughts, anything that you might recommend to other people, I don't know how comfortable you are with people reaching out to you and if you are, we'll probably be able to include your maybe LinkedIn or e-mail and that sort of stuff. But what advice would you give people maybe in closing and any other last-minute thoughts?  

Sara: Yeah. Anybody could definitely reach out to me. If you reach out to me, it's a chance my resume is already in your e-mail. So, if you'd want to look at that, and then reach out to me. I would really appreciate it. But for everything else, I mean, I know it's very discouraging after you take your test and trying to find a company that is taking in those baby coders, it's really hard with that experience. So, I just really hope everybody stays positive and you know, doesn't regret all the journey and the work that it took to get you where you are, because it will be worth it and it just takes a lot of patience and just stay positive.  

CJ: Yeah, well, that's great advice and I think people who might be considering this might be interested in reaching out to you just to kind of get your perspective, maybe behind the scenes and that sort of thing. So, thanks for being willing to have people reach out to you.  

Sara: Welcome that for sure. Thank you!  

CJ: Well, thanks, Sara, and thanks everybody for joining us for another episode of Compliance Conversations, if you like these podcasts please, you know, subscribe, hit the like button. All those good things, you know, draw attention to it and share it with others if you think if you have colleagues and friends who might find these topics interesting today, of course, we spoke about medical coding and how it fits into compliance and people's journeys into medical coding but look at our podcast. We have all sorts of topics. We talked to attorneys, we talked to clinicians, we talked to all sorts of folks involved in compliance, and so we hope you enjoy these. And if you have suggestions for topics and guests, let us know. We always are open to entertain those types of possibilities. So, thanks everybody for listening. And until next time be safe and have a great day!