RN auditor/coder

  1. Hello. I'm not quite sure if this is the correct place for this but here it is...

    I'm interested in a position as a Nurse Auditor. Some of these positions require coding certification and some require "familiarity" with CMS guidelines and ICD-9 codes.

    What at is the best way to "familiarize" yourself with CMS guidelines and coding? Is it really worth it to become a certified coder? I'm not sure exactly what type of experience these companies are looking for when it comes to this. I've worked in an acute care setting for 7 years and have worked closely with case management and am aware of what differentiates an inpatient vs. observation stay and what qualifies a patient for either. I'm aware of the 2 midnight rule and other basic CMS stuff. Is this enough?

    Long post short:
    1) should I obtain coding certification for this type of position even if it's not required? Is it that useful and does it make me that much more valuable as a potential employee?
    2) how do I familiarize myself with CMS guidelines?

    thank you!!!
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  2. 14 Comments

  3. by   One RN
    Hi, Rachel2932- check out this link RN-Coder | Diamond Bar, CA

    There you will see three opportunities to become certified after passing an exam; one for RN Coder, one for RN Auditor and one for ICD-10. You can take one or any combination. All courses are available online, instructions are there for that and for taking the exam(s). All classes are offered live in Las Vegas as well which is WONDERFUL. Attendees can take the exam in person on the last day.
  4. by   KathySandersSoffos
    Universities offer RN's with experience certification in ICD9 ICD10 CPT they are online CEU's once you take those you can test as a CPT and CDIP, then you must code 1 year to take the nurse auditor exam. CDIP make 60,000 year avg and work from home Nurse Auditors make 85,000 to 90,000 at least that is what I understand from my research. Be sure the course is ACCREDITED by AHIMA./'s am planning on doing this myself because after 38 years as an RN it is less physically challenging. I guess you can say old RN 's don't die they just code. Ha! the only drawback is class is small so I am waiting 8 months to get in. Once enrolled it takes about 3 months. This is what I was told if anyone else know different please speak up!!!!! The cost where I will attend for the 3 CEU courses, books and test is about 1500.00. Hope this info helps.. Some of the online schools are a rip-off so I am opting to go through the state medical/nursing school. LPN's can do this too,but they must take A&P and do not get auditor certified. If you have a BSN you can enroll in a Master's program and become RHIA certified with salary 150,000 Most schools call these programs HIM health info management, and all certs are listed under that field of study. ahima.org is the gold standard just like ANNA is to nursing. Good Luck!!!!!!
  5. by   KathySandersSoffos
    Were you not required to code for 1 year prior to auditor testing ? What school did you use? Thanks
  6. by   nur18
    Hi everyone
    I want to start a training program for coder/auditor. After reading the few post on this site I am still confused as to how to start.
    I have find different organizations that have different programs. So I'm not sure what course I would need to take. Can anyone recommend a specific program?
    I also read that to become a auditor you need experience in coding first how true is this? Are these company out there that would hire without experience?
    It seem like the people that are in this field fell into it and didn't necessary choose it.
  7. by   NurseEvolution
    Quote from Rachel2932
    I'm interested in a position as a Nurse Auditor. Some of these positions require coding certification and some require "familiarity" with CMS guidelines and ICD-9 codes...

    What at is the best way to "familiarize" yourself with CMS guidelines and coding?
    2) how do I familiarize myself with CMS guidelines?
    If you are happen to be interested in data abstraction/auditing for clinical Core Measures (not sure if that is what you mean as well) I can help you find those CMS guidelines!
  8. by   rg42284
    You will likely need a coding certification to be considered for an auditing position. You can 'easily' learn the rules and regulations, however recruiters will consider the ones with coding credentials, first. I actually experienced this, firsthand; I had applied and put my resume up on job boards with not one offer after several months. As soon as I got my CCS (through AHIMA), I received numerous offers for coding, auditing and CDI within a couple weeks.

    Auditing is not for everyone, but I truly enjoy it; If it's a remote position, working from home, or anywhere there is internet connection is a huge plus.

    As for job outlook, I think there will be a HUGE demand for nurse coders/auditors, especially with ICD-10 implementation. You'd be surprised how much fraud and abuse is going on throughout the nation.
  9. by   nur18
    Rg
    Thank for a the response. I looked at the AHIMA website that direct me to the cancer registry website for the training. Under basic coding there are over 12 different course.
    Did you take all there courses or only a few.
  10. by   rg42284
    In order to qualify to take the CCS examination, you need to take an actual class for it; these usually take a year or so.
    AFAIK, there is no course on the AHIMA website that will qualify you for the CCS.

    Certified Coding Specialist (CCS)

    Just go to the link above to read more on the CCS.

    Ask away, if you have any questions.

    -Richard
  11. by   RHIA, RN
    Quote from QualityInfoRN
    If you are happen to be interested in data abstraction/auditing for clinical Core Measures (not sure if that is what you mean as well) I can help you find those CMS guidelines!
    Just wanted to say Hello QualityInfoRN. I abstract Core Measures too. Do you abstract concurrently or post stay? Just wondering, I have been in this position for 1 and 1/2 years and I will be trying concurrent for the first time this week.
  12. by   nur18
    Quote from RHIA, RN
    Just wanted to say Hello QualityInfoRN. I abstract Core Measures too. Do you abstract concurrently or post stay? Just wondering, I have been in this position for 1 and 1/2 years and I will be trying concurrent for the first time this week.
    Can you explain what is abstract Core Measures
  13. by   RHIA, RN
    As you can see, this information is from 2009. Core measures have certainly expanded since then, but this describes the job.
    April 2009
    CORE MEASURES 101

    By Ella Nix, RN, BSN, CCS-PCMS (the Center for Medicare & Medicaid Services) established the Core Measures in 2000 and began publicly reporting data related to the Core Measures in 2003. Currently, there are 26 Core Measures including areas such as: Heart Failure, AMI (Heart Attack), Pneumonia, and Surgical Infection Prevention.A Core Measure is the percentage of eligible patients that receive care represented by the measure. For example: The percentage of AMI patients that receive aspirin on arrival. If 100 patients with Acute Myocardial Infarction are admitted during one quarter to the hospital with Acute Myocardial Infarction and 78 of those patients receive aspirin on arrival, as documented by the medical records, that hospital’s core measure for the core measure of Aspirin on Arrival is 78 percent. The purpose of the Core Measures is for hospitals to use them as an improvement tool. The hospital’s goal would then be to devise methods to improve that value from 78 percent to a higher number. The data collection results are then submitted on a quarterly basis to CMS, who publicly reports the data to aid in hospital improvement efforts and transparency with the public. The reasons hospitals try to improve their core measure rates is to assure their community and their Board of Directors that the hospital is providing high quality care. Hospitals that reach certain benchmarks receive higher reimbursement from Medicare and other payers.This data is usually collected after the patient is discharged. A nurse on the hospital staff goes back through the patient chart to determine if the patient was an eligible Core Measure patient, if the appropriate care was delivered, and if the documentation was in accordance with the mandated abstraction process. The information abstracted is then entered into software that compiles the statistics and submits the report to CMS.With the current system, the tracking and reporting of Core Measure performance is a huge amount of work which occupies the time of multiple clinical staff members. No funding is provided by CMS for the mandate, so the cost of tracking and reporting the data is ultimately absorbed by the hospital. The number of Core Measures is expected to expand dramatically, as will the workload and cost involved. In order to increase success with the performance measures, frontline care staff needs to understand measure requirements and take greater ownership of associated care processes in real-time.Some hospitals use a more labor intensive manner. Some hire quality improvement nurses, called patient care analysts, to work with frontline providers to improve their practice patterns and use of evidence-based interventions. The analysts are responsible for reviewing patient care and records while the patient is still in the hospital. The analysts spend a significant proportion of their time in daily rounds on the medical and cardiac units, reviewing patient records. Once the analyst identifies a record where there may be a counseling, education, or documentation opportunity, the analyst works with the appropriate physician or nurse one-on-one. Identifying the “failures” in real-time gives staff and physicians the opportunity to comply with evidence-based standards and improve the hospital's performance on the specific measures. This is an expensive, but real-time method to improve patient care.Some of the problems with reporting core measures occur when a conflict of interest arises with a hospital using their own employees to report their own measures. When there is pressure to improve the numbers, sometimes only the numbers improve and not the care. Researchers are still studying whether the Core Measures program really does reduce morbidity and mortality. Another problem that can occur with the scores of Core Measures is that the result can create misleading impressions when used not as an improvement tool, but as a hospital rating tool, particularly for small hospitals. Small hospitals do not see a large enough volume of patients in some areas and thus their data may be skewed. Additionally, small hospitals may not be able to afford dedicated personnel to the Core Measures project that have enough training.Accurate and complete documentation is becoming more essential at every level of the health care industry. It is critical not only in quality improvement and patient safety efforts, but is also increasingly vital to maximizing reimbursement. For more information on the CMS Core Measures visit www.qualitynet.org.Editor’s Note: Ella Nix, RN, BSN, CCS-P is a Data Abstractor in Winston-Salem, NC for Clinical-Insights.
  14. by   NurseEvolution
    Hi RHIA RN - sorry for the delay!

    We are not yet concurrent, but we have taken months of core measure (CM) retroactive abstraction down to about being only 2 or so weeks behind. This has become easier in the last 6 months as many of the CMs have been removed, per CMS. We just have to wait for our online vendor to drop in the cases to the web tool so we can begin abstraction.

    Unfortunately, our EHR is not quite robust enough yet for us to complete realtime abstraction. We do have CMRNS who concurrently review charts on the floor to do do realtime education and have clinicians complete documentation and ordering to meet the measures.

    We're getting there - I hope this is helpful

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