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coding sent offshore - Considering

Posted: Nov 21, 2012

I tried posting before but not sure if it went through. I have been considering coding, having been an MT for nearly 20 years, but do you think coding jobs are likely to be sent offshore like many MT jobs have been? I would hate to study very hard and invest more money and time in a career that could go down the tubes like MT has, but would like more opportunity for growth and advancement.

some jobs have gone offshore - anon

[ In Reply To ..]
I don't have a crystal ball. The big difference I can see here though is that if correct codes are not assigned, they will not receive money. Thus, it will hurt them in their pocketbook. It does open the doors also for other opportunities, not just 1 job like MT. I do have a friend working in house who states all of their coders are working OT AND they have sent work overseas as well, BUT they are not hiring more?

I think ALL jobs right now are hard to come by and it is going to take dedication and really hitting the pavement to secure a job.

I am finishing up coding right now so obviously I think there is a future. Good luck in whatever you decide!

I agree - Anonymous

[ In Reply To ..]
There are many opportunities for coders and people with coding background. If you can code and do MT that creates even more opportunity. I agree that employers will use temp help or send work out instead of hiring more staff, but even if you can temp or do a paid internship, it can lead to bigger and better things. That is one problem I see with coding (and I apologize in advance for my negativity) but it is difficult to get hired without experience. I would still advise you to do it because the ability to do more than one job (like MT) is going to make you more valuable and desirable to employers.

Contract coding - Coder

[ In Reply To ..]
I think it is important to be clear about exactly who is doing the overflow coding and why they do it.

There are a number of contract coding companies facilities, i.e., hospitals and medical centers, use. Most have excellent reputations and are profesionally run. They typically require AHIMA's RHIA, RHIT, and coding credentials, along with significant experience. They screen coders very carefully. These companies typically offer a wide range of health information management services from temporary HIM directors to privacy officers, and they offer consultants and outside auditing services.

That is very far from the typical MTSO. The majority of reputable companies are not setting up sweatshops in third-world nations.

When you discuss coding with acquaintances at hospitals, be aware that they might not really know where the overflow coding goes. They may also be unclear about the difference between "outsourcing" and "offshoring." Coders and other HIM workers are often unaware of the difference because they are not affected by it and have never heard of it. They may think the terms are synonymous. MTs on this board are not clear about it, assuming (incorrectly) that anything sent out is "offshored."

In most cases, coding is not sent overseas . . but it can be contracted out. Overflow is contracted out when there isn't enough of it on a consistent basis to warrant hiring a full-time employee. It may be more cost-effective to pay contract rates than to go through the expense of hiring a coder, paying an average of 45K or more per year with 25-35%+ in benefits, paying for working space and utilities and training, dealing with supervision issues, and so forth.

I'm more concerned about - sm

[ In Reply To ..]
technology versus sending coding overseas. Eventually there will be a program that will code and coders will become editors just like MTs. We use CAC (computer assisted coding) but this software helps us to pick correct codes and makes recommendations. With advancement in NLP software, I do believe there will be a day when computers do the coding.

NLP and CAC - anon

[ In Reply To ..]
The NLP must rely on the medical record. Have you seen the medical records that are being turned out now that they have decimated the MT industry? (speaking in generalities, there of course remain some excellent MTs, but there are a LOT of horrible records) CAC and NLP may cut down on how many coders are required, but I just don't see the day where they can eliminate them, regardless of advances. Just my opinion, and I hope I am right, but I didn't see what was happening to MTs for a while!

Suggest doing more research - Coding is nothing like MT

[ In Reply To ..]
You might want to do more research into what coding is. That will help you see that it is not just one restricted function like MT, but ecompasses a wide variety of job functions.

MTs have one basic job . . . transcribing. There is nowhere else to go. Once something comes along that does the typing for you, the job goes away. It is easy to send offshore because there are no great monetary or criminal stakes in the outcome . . . nobody goes bankrupt over typos and nobody goes to federal prison for word misuse.

Coding is completely different. It is far from a rote clerical chore, i.e., it is not just plopping in a code for a medical word. It is far more than most MTs believe. It involves determining which diagnoses and procedures to code AND identifying any that should be there but are not (and getting that fixed). It involves complicated, constantly changing decision-making to keep up with Medicare, Medicaid, and payer requirements about what procedures meet medical necessity for what diagnoses and which procedures can and cannot be done at the same time as another and how to get them paid if they are, and all of that varies on a state-by-state basis. It extends into a huge amount of physician education on these requirements, on documentation issues, and also requires a massive amount of monitoring and auditing.

It also involves a lot of effort to do the work so that revenue is what you should get rather than some random amount, and to do it legally. This is the income source for doctors and large facilities . . . period. Screw up the coding and federal auditors come after you with sanctions, HUGE fines, impossible conditions, and ciminal charges. Yes, people DO go to jail for fraud. Yes, doctors are driven out of business by coding failures.

It became possible to offshore coding years ago. Facilities that tried it reported that they lost money because the coding was too conservative. It missed too much. It was one size fits all coding. Facilities are also very aware of the decrease in quality that accompanied offshored MT . . . it was a disappointment but not a financial disaster. Consequently, there is little interest in offshoring. Everybody would love to save money on coding, but the price is too high. Coders are worth what they are paid. Many can show that they earn their facilities tens of thousands of dollars for every case the code . . . legally.

There are also loads of jobs around coding that cannot be automated or offshored, as well as more in health information administration that coders can advance into. There are excellent educational opportunities in HIA and health informatics from online nonprofit universities now, so there is no longer a need to be satisfied with local community college RHIT programs. Coders are getting advanced certifications and going on for 4-year RHIAs, informatics programs, and MBAs. They get into coding to fund the next move, then use that to fund the next. The point is that there is life in health information beyond entry-level coding.

Few jobs are safe from offshoring, but I think coding is less risky just because of the room for advancement.

I am sure there will be a flood of posts now accusing me of having been brainwashed, but I am in this field and see it from a different perspective now that I am far away from MT. It is a good field if you are interested in advancement. It is still good if you just want a job.

There is an article in the last AAPC journal about CAC not replacing coders and there have been several from AHIMA. You might want to look them up. Get your information from some other source than advertising rags like Advance . . . those are just shills for companies that want to put out advertisements disguised as journalism.

thanks - MT

[ In Reply To ..]
Thanks for the very lengthy and detailed and obviously well thought out reply. I have researched coding a lot and those are a lot of the very reasons why I'm looking at this field but wasn't able to put it into words like you did! I appreciate your insight.

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