A community of 30,000 US Transcriptionist serving Medical Transcription Industry

Gotta vent! - Jen

Posted: Dec 11, 2011

Okay guys, I just have to vent because I know many of you share the same frustrations and will understand where I'm coming from. I've got over 10 years of transcription experience and I'm making $10 an hour. This is a $5 per hour cut from what I made in a larger city before I had to move to a smaller one in a different state. I got divorced earlier this year and this is no longer enough to survive on for me with just one income in the household now. I pride myself on being a good, productive transcriptionist, but I feel like I'm just spinning my wheels. I sit in a cubicle up to 13 hours per day and can't pay my bills. From the other posts on this board I see that many of you have taken huge pay cuts recently. So, between the lower pay and the fact that transcriptionists may not even exist a few short years from now I thought it might be a good idea to get certified as a coding specialist. In the hospital where I currently work, they pay them a base of about five bucks an hour more than I made now, plus incentive of up to $20 an hour. Plus, no nights or weekends! I found a couple of training programs with one costing $1400 plus books (about another 300.00) and the other costing $2600. Who has that kind of money sitting around? What's a girl to do! The longer I work as a transcriptionist, the deeper the hole gets, if ya know what I mean. Has anyone else made the switch from transcription to coding and found a cheaper way to do it? If so, please share your story because I need to do something. What I'm doing is no longer working!

Before you spend that kind of money on coding classes - sm

[ In Reply To ..]
You might want to research the impact EMR is expected to have on coding/billing.

I've seen an entire coding/billing department wiped out already because of it. The doctors clicked on the diagnoses, procedure codes, DME used, etc. I also worked in another office where the coding/charge entry was done by the front office staff during checkout.

This is just my opinion, but I would definitely research it before putting that much time and money into coding.

Yep! - Jen

[ In Reply To ..]
It seems like these days, nothing is a "sure thing" anymore. Very frustrating. I just don't know what to do. I'm too old to become a doctor. ha! And that seems to be about the only thing that can't be replaced. And I'm starting to wonder about that too!

Coding classes - Anonymous

[ In Reply To ..]
The prices you quoted for training are about average, quite a few cost more. Some schools will assist you with financing if you're sure it's what you want to do. I went through a coding program last year, thinking it was my way out of MT, but I agree with the others that the EMR is having and impact on the job situation, I've seen it at my facilty. Also, it's difficult getting a job in coding without experience and/or certification. A lot of things would factor in, though, including your age and how many years you plan to work. A job that's there today may not be there tomorrow. I'm pretty close to retirment age and truthfully wish I'd saved the money I spent on coding.

But I thought...sm - Thinking of coding training, also

[ In Reply To ..]
there were other paths that branched out from coding. I actually do not want to be a coder but heard there were other things I could do with certification. I am/was planning to sign up with Andrews in January but will see what others have to say on this subject before sending in a check.

Branching out - Anonymous

[ In Reply To ..]
Yes, you can branch out into other areas - analysis, auditing, etc., but the role of coders is changing, just as the role of MTs has. I didn't want to give you false hope because I still think the job market is very competitive. Also, make sure that coding is your "cup of tea;" comparing MT and coding is like comparing apples and oranges. Because you enjoy one does not necessarily mean you'll enjoy the other.

Silly question (sm) - Coded in the past but...

[ In Reply To ..]
About 20 years ago, I worked as an MT in a very small, rural, immigrant-type hospital. When I ran out of MT work, the manager decided to "train me" on coding, which essentially consisted of giving me the ICD book and had me read the entire patient chart for the admission in question, highlighting all procedures, supplies, diagnoses, et al, and then coding from them appropriately from ICD book. She said I did very well at it but I never truly felt comfortable because I literally had no training, just handed a stack of charts and the ICD book and told to go for it. Heck, they were so small and laid-back, I'm not even 100% positive anyone even double-checked my work before submitting it to the insurance company.

Realizing technology in this area has changed massively over the past 20 years, does coding mean literally reading the patient's file on the EMR and coding each and every chargeable item as well as diagnoses, or was I way off base with what I was instructed at the rural hospital? I LOVE detailed work, which is why I love MT, but can someone briefly summarize for me how coding is done these days and if lots of research and reading is still involved?

TIA for anyone who can give me a little summary of what precisely coding involves these days and if I was actually being trained appropriately back in the day? I certainly wouldn't mind going back into it, but I'm a bit more interested in being certified for legal transcription and/or paralegal services.

Yes, it's that, but no, you were not trained appropriately - RHIA, CCS

[ In Reply To ..]
Inpatient coding DOES involve reading the entire record, identifying the conditions to be coded, and coding them according to a fairly complex set of rules. It is detailed, worthwhile work that forms the basis of a facility's statistical data, which affects workload, accounting, quality measures, and which also brings in the revenue. Coded data drives just about everything--without it nobody knows what conditions a hospital treats, the resources involved in treating them, and how much reimbursement will be received.

In many of these posts here, the people who are saying coding is going away with the EHR are people who are not truly coders. The jobs they describe are either low-level coding that is very close to clerical billing activities or which are actually just clerical billing. If you are copying codes onto bills from a charge ticket, you are doing clerical work.

EHRs usually produce a bill all by themselves based on the codes a doctor clicks off. There is, in fact, no need for a clerical worker in the front office to transfer the codes from paper onto a bill, so those jobs aren't going to last very long. BUT THAT ISN'T TRUE CODING.

It is not what I do as a coder. My job, and the jobs of my coworkers, aren't going anywhere because of EHRs. My organization has been fully electronic for more than 10 years and it has EXPANDED roles and opportunties for us. I have been able to further my education and advance right along with that.

If you think you would enjoy coding, then learn to code. It sounds as though you have had enough experience to know IF you would enjoy it. You also have enough experience to be able to get a book and see if that appeals to you. Try Faye Brown by the American Hospital Association--if you search for Faye Brown on Amazon, it will come up. The title is longer than Faye Brown, but I can't remember the exact wording right now.

Very few people on this board know anything about coding. I advise you not to listen to the nay-sayers. There seems to be a few of them who are disgruntled at coding for some reason and who pop up to discourage others every time someone mentions coding.

You have to start somewhere, and coding is a fine place to begin. You aren't going to get any of those new, advanced jobs if you don't start somewhere and start soon. Avoid listening to people who only want to discourage others.

Andrews is a fine school and they do teach inpatient coding. Considering what you get from them in the way of student support, their tuition is very, very reasonable.

No jobs are safe right now, but coding is a heck of a lot more stable than others, just because it is so critical to reimbursement and the financial health of an organization.

I opted out of coding because... - Hawaii MT

[ In Reply To ..]
I'm like the rest of you. Frustrated with MT I always considered Coding/Billing the companion back-up, that is, until I happened to talk to a coder who told me about the pressure you are under to code as many charts accurately as possible. I opted out that minute. They make their money by what you can do in an hour to pay your salary. An MT gets paid for what they do which is what I LOVE! If I want to kick back, I can. Nobody's breathing down my back. I get paid for what I produce and not a penny more. Happy Holidays everybody. We're all feeling it!

This is true, it just happened in the hospital where I work. nm - MT2

[ In Reply To ..]
Of course, the schools are not going to tell you that. They still continue to crank out MTs and coders, despite knowing that the EMR will in place totally by 2014. MTs, billers and coders are all being affected by EMR with devastating results.

Well dern... - blondie

[ In Reply To ..]
I just registered to take classes at the local community college for health information data (associate degree), but I don't know if I should now. Maybe I need to change the classes I take to something else?

classes - mt1347

[ In Reply To ..]
I think you should take the classes - with a degree or even a certificate in any kind of health information date or technology field, you will be able to get a position - the change over to EMR will require people with those skills and you should be employable for many years - things are going to get more automated, not less so.

Coding - JustMe

[ In Reply To ..]
I work in a hospital setting, and regular staff are now coding. I work in transcription 2-3 days a week. The environment in which I work is absolutely horrible. I work every weekend and seem to get the junk that nobody wants that many times is left over from during the week. Unfortunately, I have a manager that allows this to happen. Any comments would be appreciated. I talked to an older coder just last week that was dreading going from ICD9 to ICD10. However, I know absolutely nothing about coding.

To JustMe - also an MT

[ In Reply To ..]
Just because stuff is left from earlier in the week doesn't mean that the work is junk nobody wanted. Maybe those MT/Coders had priorities that took precedence over that particular work type. For instance, in most instances an H&P or consultation has a shorter turn around time requirement than a clinic note or discharge summary, as these patients are still in-house and their needs must be met daily. The work still gets done, but when there are only 8 hours in a day and a skeleton crew doing them who have been taken off of MT to do other things, then naturally the clinic work or discharge summaries will be the last work to be done. It does not necessarily mean that the work was picked over and left particularly for you. Most systems these days the work flows automatically. I'm sure your manager has requirements she has to meet for Medicaid/Medicare, as there are laws as to how soon a report must be on the inpatient record. For instance, a history and physical must be on the patient's chart within 24 hours of hospital admission. This is a law, not just someone's idea. If the reports are not on the inpatient chart when required, then that affects reimbursement but most importantly the care the patient receives while hospitalized.

All work types are important, but an inpatient's report is considered more urgent and more important than an outpatient report or discharge summary. Also, if you consider the work to be distributed unfairly, consider this: would it be fair to the patient lying in a hospital bed for the report of the specialist consultation to be delayed in getting the information to their physician because a note dictated on a clinic patient who was told to return in 6 months or a year was dictated sooner, when that person left the clinic and went shopping or home with their family? To me, the choice is obvious. Inpatient reports of history and physicals, consults, and operative reports are much more urgent than a clinic note. If this means the clinic notes take 3 or 4 days to be transcribed because of only 2 or 3 full-time people to do the work, then so be it. It seems to me the hospital needs to get another full-time person. Then if work is low, that person could also be trained to code or do other activities, but allow the dictation to flow in a more timely manner for the clinic notes and discharge summaries.

Also, just as an aside, be happy you have a job and work to do. Some of us run out of work on a daily basis and would be glad to have something to transcribe or edit, even if it is old or "junk" nobody else wants, in your own opinion. Work is work. Lines are lines. It all has to be done. If you are that unhappy, I'm sure someone else would LOVE to have your hours/lines/minutes. I know I WOULD!

Another MT - JustMe

[ In Reply To ..]
Don't get me wrong, I am happy to have a job. I didn't totally explain the entire story. First off, I am a PDN employee which means I get no benefits, no PTO. I have worked holidays, worked when extra help is needed. I realize the importance of H&Ps and consultations being on the chart. I do some reports on the weekends that the TAT is out of compliance simply because some MTs don't want to do them through the week. Our ques indicate when a report is out of compliance. H&Ps and consultations are priority on the weekends for me and for everyone through the week and then I get what has been left over. I don't know who you are, but you seem to be a little disgruntled! Well, our system is designed for work to flow automatically but that is not the way it works where I work. Don't think you know enough about the full picture to understand my position. In addition, we work on an incentive program. AND I am concerned about patient care. I think that is what I am there for.

To JustMe - also an MT

[ In Reply To ..]
What does PDN mean? Is this a hospital-specific term or is this something that is only where you work? Do you work for a small hospital or a large one? As far as you working every weekend and working holidays, many of us work every single holiday and weekends, too. For a good many of the services there are no paid holidays. If you are scheduled to work, you work. If you are not scheduled or take off, you don't get paid. A lot of the services have no PTO or benefits. If they do offer PTO, if your account runs out of work you must use PTO (if you have any) or not get paid. Occasionally, you have an opportunity to make up your time/lines but if the account runs out of work at the end of the pay period, you are out of luck.

What are your hours? Do you get to work first shift or are you put on second or third shift with only 0.025 cents for shift differential (when any is offered)?

And an incentive plan? I would love to have an incentive plan. I assume this is based on how much you type. Is your work straight editing or transcribing? Do you get paid by the line or by the page? If you get paid by the line, are you paid half or less of your line rate to edit and are you required to produce twice as much work just to make ends meet? Do you basically make minimum wage, if you are lucky, because your line editing rate is so low? Are you docked down to 1 cent a line for reports you send to QA with a question or blank because you send too many,(in their minds)? If you make a mistake are penalized? Does your pay get docked for mistakes in reports? Are your reports routinely scrutinized because they must be absolutely error free or you face discipline up to and including termination for making an error?

Are your hourly? What is your minimum quota of work you must produce? How much of your work is VR? How much is ESL? Do you do the same doctors and work types all of the time, or are you bounced around from account to account with hundreds of different dictators, sometimes never even hearing the same voice more than once? Are your specifics for your hospital or work type the same or do you have to have a 20 page or longer file of account specifics, where each physician or work type wants something different?

With you not being in the office every day, how do you know what happens on a daily basis when you are not there? Are you sitting and watching every single move the other MTs and manager makes? How many other MTs are there in your office? How many are full time and how many are part-time?

Let's say there are 3 full time people in an office doing the work with an average of 125 minutes of dictation transcribed by each person. The amount of dictation dictated daily by the doctors is 400 minutes, including H&Ps, consults, Ops, discharge summaries, and clinic dictations. With an average of 400 minutes a day being dictated and only 375 being transcribed, that leaves 25 minutes a day "left over". That left over minutes adds up in a 7-day week to 175 minutes. Then we add in the fact that the MTs are required to code every day in addition to transcribing. Even if only 2 of them code, and they spend half their day coding, that would reduce the amount transcribed down to 62.5 minutes a day per person. This would add to the amount of dictation left over, to 125 minutes per day of work not getting transcribed. In a 7 day time period, this would add up to 875 minutes of dictation a week not getting transcribed. Then you figure that the other MTs work 5 days a week, not 7, and you have even more work added in that's not being transcribed. To put it simply, the other MTs just flat run out of time!

As far as me being disgruntled, if you look up disgruntled in the dictionary, it means angry or dissatisfied. I think you need to look in the mirror. I believe the problems are not the other MTs, but with yourself. Someone that is that unhappy and accusing others of lying, stealing, cheating, etc. cannot be a very happy person, and in my opinion, sounds bordering on paranoia.

I bet you make more than minimum wage, and with an incentive rate (which you didn't mention the amount), I bet you average out to make a pretty decent amount. I know things are not perfect in any job situation, but you have to take the bad along with the good. There are many, many MTs who would kill to have a job where they have enough work to do on a daily basis to earn a decent living, make a decent wage, and get an incentive rate. You said you work in an office. Do you have office parties? Do you have someone to talk to, share things with, tell jokes with? Most of us that work from home are very isolated. Yes there are benefits to working from home, but there are disadvantages, too. There is no listening ear when you can't understand something. You can't leave it for another person to listen to. If you have a problem, you have to e-mail or call a supervisor, who may or may not respond. If you have computer issues, you have to trouble shoot it yourself before calling tech support, and if you are lucky they can fix it. If it's your own computer, you are out of luck and not able to work until you can get it fixed. By working in an office, if the computer you use quits working you have others available to you.

Gee, to me, it sounds like you have it pretty good! Wanna trade jobs?

Oh, and by the way, do you get raises? I bet you do. Many of the MTs working from home for a service have not had a raise in years! In fact, many of the services if not most have reduced wages/benefits. Don't even get me started on the amount of work that is being sent overseas to other countries because it's cheaper!

If you so are unhappy, why don't you apply and test for some of the companies to work from home? YYour work automatically downloads into the transcription system. It's assigned based on your test results. Of course, you must pass the transcription test to even get an interview, regardless of whether you have 30 years of experience or 1 year. You must also be familiar with the BOS. Then if you are hired, you must be able to quickly learn the platform(s), account specifics, dictators. When you run out of work, which you will, you have to learn another account quickly. Most of the companies require 98 to 99% accuracy on the reports, which means 1 critical error can make you fail an audit and cost you your job. You must produce absolutely letter perfect reports every single report, every single day, and do this without help. And of course, if you are editing, you are doing this for the average rate of 3 to 4 cents a line. To make $9.00 an hour you have to produce 300 lines an hour at 3 cents a line.

Yep, I think you are pretty well off. If I were in your shoes, I would just keep my mouth shut and do my job without complaining. Like I said earlier, there are MTs who would be glad to take your job and your "horrible working conditions" off your hands.

Also an MT - JustMe

[ In Reply To ..]
I responded to your post, but lost it somehow. I will answer more questions when I have more time.

Continuation on our conversation - JustMe

[ In Reply To ..]
Without reading your post again, I can't remember all the questions you asked and for privacy reasons, don't feel I should answer some. Who knows, my employer may be on this board. I hurt for all MTs and the direction you and many are going through that worked hard to learn this profession. My job will probably be phased out because of VR but I still have a job and for that I am grateful although the conditions are not good. PDN stands for per diem...sort of like an on-call employee except my hours have been every weekend and Mondays. Now, just recently, I have been changed to Wednesdays and still weekends. Incidentally, I am almost 68 years old and would like to work from home since I have arthritis and hate getting out in the cold weather. Don't know what I will do when I am phased out. It is very hard to live on SS alone. Merry Christmas to you and I hope things get better for you.

I have been thinking LPN then if I like that either - sm - XXX

[ In Reply To ..]
go on to RN somehow, not quite sure I would handle that, or maybe phlebotomy though don't see too many job listings for them, see lots for LPN around here, though I know that is the lowest of the low in terms of nursing. The best nursing school here is an accelerated program (2.5 years), no breaks, pretty much guaranteed a job at the hospital though (unless you really sucked I presume), though the shifts offered are probably 2nd and 3rd, guess like any other job you need to put in your dues before you get day shift or work in a doctor's office. Also have a nursing program at a community college in the city near here, that would probably work better for me, both are a good 45 minute drive. Or maybe medical technologist, a few schools here do those certificate programs, not cheap though. But I definitely am not gonna try coding.

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