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Q: You are the supervisor of coding services for an outsourcing company. You recently hired a coder to tackle OB/GYN cases. The new hire claimed to have 5 years of experience, but after a few weeks, it's clear the coder exaggerated her skills. Her turnaround time is average, but you've found several coding errors. She claimed they were "careless mistakes," but you've seen the same errors pop up again.

Should you keep the new hire on staff? How can you address her apparent lack of experience? What can you do in the future to avoid hiring employees with disappointing performance?

A: At an outsourcing company, employees need to be the "best of the best," with exemplary skills, quality of work and ethics. Many employees don't realize that when they "doctor" their resumes or purposely make mistakes on their resume to make themselves look good, they are actually committing a fraud, which can be a career-ending offense if and when they are caught.

In the scenario, it appears due diligence may not have been done in the selection of this employee. Therefore the company is partially responsible for being in this predicament. For this reason, and because a sizable investment has been made in this employee, the following steps are suggested:

• Explain again to this individual the expectation employees consistently be above par. Talk to her about her continued mistakes and "average turnaround" and ask if, and why, she was less than honest in the portrayal of her skill set and experience on her resume and during interviews.
• If, after this discussion, it is determined retaining this employee and making the continued investment is what the company wants to do (without setting a negative precedent), create an action plan and timeline for skills improvement and development. The employee will be required to read and sign off acknowledging agreement with the action plan.
• If she does not meet the goals as set in the action plan, her employment will be terminated with the outsourcing company.

To avoid having this happen in the future, the company needs to develop coding assessments that will better measure knowledge of theory and coding skills prior to employment. Also, more diligent and thorough interviewing of applicants, including the use of situational interviewing methods, to determine depth of experience and competencies should be employed. Additionally, more stringent reference checks, including tier reference checks, to verify types of experience, length of experiences and accuracy and productivity levels of applicants before hiring should be mandatory.

Once hired, new employees should complete practice coding modules and have their work checked for accuracy and timeliness with frequent feedback.

--Barbara Black, MBA, SPHR

A: There are several ways to handle this coder's case. First, understand where in the process mistakes are being made and develop a plan for improvement. Second, determine if the coder has expertise in another area and move her into that type of casework. Lastly, are her errors really careless? The outsource coding company may conclude she has a very modest skill set for her length of experience and terminate her employment. 

As part of ongoing quality assurance (QA), coding managers should meet with new coders one-on-one to determine the source of errors. With the level of expertise available in an outsource company, the coding manager can provide support to ensure errors aren't the result of crosswalk or other systematic issues. However, clients do not want outsource coders-in-training; outsourcing teams are expected to provide experts, not trainees. 

Did the coder represent her skills specific to OB/GYN work? Perhaps her expertise lies in other areas that are valuable to the company. If so, the company can choose to move the coder to a different set of casework within her realm of proficiency. To avoid this type of problem, outsourcing firms should always pre-screen prospective coders, check references and review 100 percent of the coding in the first weeks. For an accurate picture of the coder's breadth of work and coding expertise, pre-hire coding tests must use "real" charts that are category-specific. Despite outsourcing companies' best efforts to evaluate a coder's skill set, strengths and weaknesses are not always revealed in the testing phase. 

Another possibility is that the coder misrepresented her length of experience or expertise in OB/GYN coding, which is a larger issue. That means the coder's mistakes were not careless. No coding company should risk having a dishonest person on staff.  After top-level executive review of the situation, this new hire would probably be terminated. 

--Wendy Coplan-Gould, RHIA

A: The discovery of "several coding errors" from a newly hired coding specialist may stem from variety of sources, including:

• Lack of pre-employment verification of coding credentials,
• Lack of pre-employment background checks and coding experience,
• Lack of pre-employment testing,
• Lack of orientation and training,
• Unfamiliarity with a client's coding policies and procedures,
• Misinformation,
• Unfamiliarity as to where to look in the encounter for the documentation,
• Missing documentation,
• Illegible handwriting,
• Unfamiliarity when to query, and/or
• Lack of coding knowledge.

To avoid this issue in the future,

• Pre-employment verification of coding credentials and background checks of recent coding experiences should be implemented. This should include any specialty coding credentials required.
• Pre-employment testing and training should be implemented. This can consist of a combination of generic coding tests, client-specific coding tests and specialty testing areas, such as OB/GYN. Passing these tests is a requirement for hire. Coding specialists should achieve 95 percent accuracy on pre-employment testing.
• Whenever possible, the pre-employment testing should include de-identified case studies. Additionally, when seeking to place a coding specialist with a particular client, it is recommended that client-specific case studies be utilized for the testing.
• After hire, any client-specific coding policies and procedures, as well as client-specific expectations, should be provided and reviewed with the newly hired coding specialist.
• After hire, and continuing through the initial probationary period, the coding manager should monitor and assess the quality and quantity of work performed, with additional education and training provided as necessary.
• Following the probationary period, monitoring and training should continue on an ongoing basis. A random sample of records per coding specialist should be reviewed annually and/or at the client's request.

Each coding specialist should successfully demonstrate competence in coding, including but not limited to the following:

• All coding specialists must be credentialed in their field of coding.
• Each coding specialist is responsible to maintain their coding credentials by    obtaining continuing education credits specific to the profession of coding.
• Coding specialists must maintain a 95 percent accuracy rate on all reviews.

--Linda Renn, RHIT, CCS, CPC, CPC-H

This week's panel:
Barbara Black, MBA, SPHR, is director of human resources for Care Communications Inc., Chicago.
Wendy Coplan-Gould, RHIA, is president and CEO of Health Record Services Corp., Baltimore.
Linda Renn, RHIT, CCS, CPC, CPC-H, is executive director of quality and communication, STAT Solutions Inc., New Port Richey, FL.