0:02

It's time for the Contempo Coding Podcast

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.

0:05

Discussions knowledge and insight

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to help you succeed in the medical

0:09

coding industry .

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And now here's your host , victoria

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.

0:14

Hey everyone

0:16

, welcome back to the channel . I'm here with Ray Jimenez

0:19

. Ray has over 30 years in the healthcare

0:21

industry . She is the Chief

0:23

Product Officer at the AAPC

0:25

and she serves as a coding liaison with

0:27

the AMA on the CPT Advisory

0:29

Editorial Panel , right ? Yes , so

0:31

over the past 15 years with AAPC

0:34

, you've had a lot of different responsibilities Certification

0:37

exams , developing them , the

0:39

preparation materials , overseeing

0:41

the Department of Operations for the exam , distance

0:43

learning , some of the educational licensing

0:46

as well , right , and I just want to thank

0:48

you so much for taking the time to come

0:50

onto the channel today and talk with me and my viewers

0:52

. I thank you for having me . So can

0:54

you tell us a little bit about your current

0:56

role as the Chief Product

0:58

Officer at the AAPC and how your

1:01

journey went through to this point

1:03

? Like I'm always interested to like people , like

1:05

how you got into medical coding , because

1:07

no one graduates high school and goes into medical

1:10

coding . Like you never hear that story .

1:12

No , absolutely not . So

1:14

when I was

1:16

going through college I knew I wanted

1:18

to do something in the medical field . I wasn't

1:20

exactly sure . I thought it was going to

1:22

be more clinical and

1:25

I had to work my way through college

1:27

. So I started as a chart finder

1:29

in a doctor's office , just finding

1:32

the chart so that the nurses could call

1:34

, and I did a great job . So they're

1:36

like hey , do you want to learn how to be a medical assistant

1:38

? I'm like well , that's definitely pertinent

1:40

for what I'm interested in . So

1:42

being on the clinical side taught

1:45

me a lot . And

1:47

the fact that I was going to college . When

1:49

I transitioned to a smaller office

1:52

they were having claims denials

1:54

and they said

1:56

well , you go to college , here's this

1:58

book , can you read it and help

2:01

us figure it out ? So then

2:03

I just figured out

2:05

ICD-9 coding , got them paid

2:07

and then started with pre-certification

2:09

for surgeries , and that's how I

2:11

ended up being interested in the

2:13

clinical side , but then transitioning

2:16

into the business side and

2:18

then , luckily , through my career , I

2:20

was able to go into

2:22

the education and then placement

2:25

of coders into roles . And

2:27

that's really what prompted me into

2:30

getting into AAPC , because

2:32

we had started Project X-Turn

2:35

at the time . Yes . So

2:37

with my SME knowledge of

2:39

the industry plus my placement

2:41

background , they said why don't you come and help

2:43

us try to get this program off the ground

2:45

? And then , just through my evolution

2:47

with AAPC I've been there 16

2:49

years now in various roles

2:51

, and Chief Product

2:53

Officer allows me to look at all

2:55

that we're doing holistically . Me understanding

2:58

what our members need , what the industry

3:00

needs , just helps me influence

3:02

and say okay , how are we going to approach things from

3:05

a holistic approach versus

3:07

here's a book , here's an exam

3:09

, here's like little aspects of pieces

3:12

.

3:12

So I love that I never had any clinical

3:14

experience . I would say if you asked

3:16

me to take a blood pressure , if it was like an

3:18

automatic one , I might be able

3:20

to figure that out . Yeah , but that's

3:22

about the extent of it Like maybe an automatic blood

3:25

pressure and a thermometer , I could run

3:27

nothing else clinical

3:29

.

3:29

Well , I tell you I was lucky

3:31

enough to work for a few physicians

3:34

that loved teaching . Yeah . So

3:36

for the family physician that I worked for , dr

3:38

Pearl Steen , it became a

3:40

game where he'd be like okay , I'm going to do a

3:42

procedure in this room , I want you to go set up the

3:44

tray and you tell me what you think I'm going to use

3:47

in this procedure . So

3:49

when it comes to like excisions

3:51

of lesions like that

3:53

has always resonated with me because

3:56

of that clinical exposure that's awesome

3:58

.

3:58

That's one of the things you miss when you're working remotely

4:00

Like you don't get that hands-on experience

4:03

. I remember I was working at one organization

4:05

and I asked if I could go shadow in the OR and

4:07

they're like , no , absolutely not . And then I switched

4:09

over to this other organization and I'm like I

4:12

asked again hey , can I shadow in the other ? They're

4:14

like , yeah , go . I'm like this is the coolest

4:16

thing ever . They're going to let me go . And

4:18

I got to watch a breast reconstruction , yeah

4:20

, and I just thought that was just like so

4:23

amazing that they let me do that . And that experience

4:25

still sticks with me to this day . So , speaking

4:27

about all of the different services the

4:30

AEPC offers and the oversight of that , I

4:32

noticed that the AEPC has been stressing

4:34

a lot of the digital tools . Recently

4:37

I even purchased the package

4:39

where , if you pre-order next year's books , you

4:41

can get the eBooks included , which was great . So

4:44

I'm starting to stress to others the importance

4:46

of using eBooks and

4:48

I think , with you know the

4:50

workforce that we've got a lot

4:52

of employers . They don't want to ship out physical

4:54

books to 50 different people in 50

4:56

different locations and I think they

4:59

need more the digital tools right , Because

5:01

they want that remote workforce to just have

5:03

access to them from anywhere , Right , but

5:05

how long do you think it's going to take for coders

5:07

to adapt using

5:10

digital tools when we're so used

5:12

to ? We love our books and we like to mark

5:15

up things in our physical books

5:17

.

5:17

Yeah , that's a great point . I think that

5:19

there's more than one aspect

5:21

at play . As long

5:23

as we continue to teach

5:25

and require code books

5:28

during exams , we're going to continue

5:30

to have people learning on books , and that's what

5:32

they become accustomed to , right . So I

5:34

think that as we train

5:37

new coders in this field , teaching

5:39

them on the electronic tools that

5:42

their employers are going to expect them

5:44

to use in the workplace makes sense . You

5:46

know , in some offices when

5:48

they had physical books , they wouldn't buy

5:50

necessarily a set for every person

5:52

, but maybe some for the department that they could

5:54

share . So now , with the remote workforce

5:57

where everyone has to have their own resources

6:00

, it's a lot economically sound

6:02

for an employer to purchase

6:04

the electronic tools , right . It

6:06

also has benefits

6:08

of using the electronic tools . They can

6:10

be updated immediately . When you

6:13

look at all of the lab

6:15

codes that get added and COVID

6:17

, for example , with vaccines , right , you

6:19

can update physical books and

6:21

you can't have access to all of the other tools

6:24

that you're going to be researching about , the codes

6:27

like the LCDs and CCI

6:29

edits , yeah , so

6:32

I am a person that held on

6:34

to my books forever too , and

6:36

that's the reason why in codify

6:38

, we've created the index

6:41

, just like you would look up in a physical

6:43

book to be able to get to those codes

6:45

. Because me , like many of our

6:48

members that I hear , they

6:50

find that navigating the books is

6:52

something they're used to and they feel they could get to the

6:54

code quicker with their books versus

6:57

doing a code search or a keyword

6:59

search and having to look at all of the options

7:01

that come up . So that's the reason why

7:03

we kept the index . It's another

7:06

reason why we have linked

7:08

codify to the code books

7:10

We've started with ICD-10

7:12

so that you can look it up like you would in a book

7:14

and then have all the electronic tools

7:17

. So I think that you

7:19

know if I were to say when

7:22

is Physical books going away

7:24

, I can't say that we're ever going to be

7:26

a hundred percent off books , but

7:28

I do start seeing the transition

7:30

to more electronic usage .

7:32

Yeah , and I think it'll be interesting to see the trending

7:35

because I know Bevan has spoken about

7:37

the certification exams and how we're

7:39

piloting , testing out how

7:42

to do the exam with an electronic book

7:44

versus a paper book and seeing you

7:46

know how that's going to play out and you

7:49

know people have different exam strategies about . We

7:51

highlight and we underline this and we circle

7:53

that and and I'm fascinated

7:55

to see how people will transition their

7:57

coloring book methodology

7:59

in the in the code books , to

8:01

the Electronic format . You know there's

8:03

tools there but not quite

8:06

as always as easy as just like . Oh , I'm just gonna highlight

8:08

that in purple .

8:09

Yes , for sure I mean , and because

8:11

if we're training people how to do it

8:13

that way , I think with electronic

8:16

tools there's ways for us to add

8:18

that highlighting and add those features

8:20

in to distinguish what , quickly distinguish one

8:22

code from another . In the beta Testing we've

8:25

been doing with the ebooks , we have

8:27

found that seven out of ten individuals

8:29

that have gone through the beta process

8:31

with us using the ebook on an exam

8:34

have recommended the ebook

8:36

over the paper book .

8:37

Yeah , I think it's easy to with the electronic

8:39

tools to just do that control f and find

8:42

and there it is , and here's . It takes

8:44

me right to and set up flipping through all the pages

8:46

exactly and wasting that time .

8:48

Yeah , looking for what you're looking for .

8:50

Yeah , speaking of the exams , you know I

8:53

hear viewers and hear these comments about

8:55

oh , the exams are so strict . When I do

8:57

the online exam , the proctors they want to

8:59

check underneath my desk and , you

9:02

know , protecting the integrity of the

9:04

exam . It is so , so

9:07

critical because if the exam isn't

9:09

worth anything , our credentials aren't correct . Can

9:12

you help my viewers understand just

9:14

how much work goes

9:17

into Creating these certification

9:19

exams and then kind of walk us through what happens if

9:22

the exam is compromised somehow

9:24

?

9:24

right , so with the

9:27

item creation , we're pulling exam

9:29

questions for from a very large test

9:31

bank and you're continually Updating

9:34

that content and there's ways of making

9:36

a very solid base question

9:38

and then changing small Variations

9:41

within that question to make a

9:43

replica or an alternate

9:45

version of that test question

9:47

. So this is a continual

9:49

development that we use committees

9:51

to help us create these items . Aepc

9:55

obviously Leads

9:58

that Development

10:00

and testing of the items

10:02

and making sure that they're consistently

10:05

written in order to adequately

10:09

Test the competency that that

10:11

question is geared toward . So

10:13

you're talking about Many

10:16

people involved in item

10:18

development . We also have the

10:20

analytical side of things . So even

10:22

in a paper environment , we were always tracking

10:24

items to see how often

10:27

is this question being missed , how

10:29

often is this question Right

10:32

. There's also forensic

10:34

analysis that they do on exam

10:37

data To let us know

10:39

if we have a problem in a certain location

10:42

, a certain proctor .

10:43

Yeah , a certain group

10:46

of people .

10:47

Yeah know if our items are being compromised

10:49

. Okay , with the paper exams

10:51

you would have to wait until all that data

10:53

came , but all the Bubble sheets came

10:56

back . You were able to load it into the

10:58

system and send those files out for analysis

11:00

. With the electronic Platform

11:03

you get that information

11:05

real time so that if there is

11:07

a compromise question , you

11:09

could invalidate someone if it

11:11

looks like they did have access

11:14

to information that they shouldn't have had prior

11:17

to taking the exam . So that's one

11:19

of the things that Really

11:21

motivated us to get to a fully

11:23

electronic platform was

11:26

because you can change out items

11:28

that are unfair to examinees

11:30

. That's another opportunity

11:32

for us is if we see a question is not

11:34

performing well , we can suppress

11:37

it from grading and saying that

11:39

question , for whatever reason , is

11:41

not performing well and it's not fair

11:44

to our test takers . So we can suppress

11:46

it from the grading so that they're not

11:48

penalized for a poorly written

11:50

item for whatever reason . So

11:53

that data capture

11:56

and constant analysis gives

11:58

us validation that we've got sound exams

12:00

that are fair , but also

12:03

that we're maintaining the integrity

12:05

, because , just like you said , it would be so

12:07

easy for AAPC to make all of our

12:09

tests so easy that anyone can pass

12:11

, but then it doesn't hold credibility

12:14

for the industry to monitor who really

12:16

knows what they're doing .

12:17

Exactly so . I know with the paper exams

12:20

there was always different versions Historically

12:22

. There was a version A , b , c , d , e , f . Is

12:24

the electronic exam the same or

12:26

is it just pulling just randomized questions

12:29

?

12:29

from the data right Randomized questions . So

12:31

everyone will have a different

12:33

version of the exam but

12:36

testing the same competency

12:38

. So you can change the

12:40

variations but still get to the same

12:42

type of competency that you're trying to test

12:44

Prior to going to electronic

12:46

. In the paper version we have

12:48

12 to 16 different versions of the

12:50

exam that we cycle through the

12:52

entire year to always change

12:55

up what the exams are so that if someone

12:57

did have information

12:59

on the exam , it wouldn't benefit

13:02

others .

13:02

Now I think there's been some confusion

13:05

with exams and what's going on in 2024

13:08

. Correct , Because I keep hearing people say there's no

13:10

more in-person exams and I'm like , no , no , no

13:12

, that's not quite correct . There's

13:14

still gonna be in-person exams . They might not

13:16

be necessarily paper exams . They're

13:18

not gonna be with the chapters . So

13:20

what can examiners expect

13:23

in 2024 ?

13:24

So in 2024 , we are

13:26

going away from paper-based . Everything

13:29

will be in the electronic format

13:31

, the electronic platform , for all

13:33

the benefits that we've already talked about . They

13:35

will have the opportunity to either

13:37

select that they wanna take live remote proctoring

13:40

, like we already have available , or

13:42

to take it through a physical center

13:45

through the measure platform

13:48

, which was Scantron , so

13:50

people that are familiar with bubble sheets . Scantron's

13:53

a well-known name , so they have testing

13:55

centers across the United States

13:57

and globally . So

13:59

the individual , if they choose to take an in-person

14:02

exam , in their email when

14:04

they purchase the exam they will

14:06

be given instructions on how to schedule

14:09

their exam in the testing center that's

14:11

closest to them . The

14:13

reason why those test centers aren't

14:15

publicized on their website is

14:17

they don't want people that aren't qualified

14:20

or approved to be taking

14:23

an exam to be showing up their test

14:25

centers . So that information

14:27

will be made available to the exam and once

14:29

they purchase the exam , then it will open

14:31

up to say , okay , here are your options .

14:34

So then , are the independent instructors

14:36

. Their students will be advised either to go through

14:38

the online remote proctoring or through the

14:41

measure locations as well .

14:43

Okay , Correct Now . Any school

14:45

can apply

14:47

to be part of the measure offering

14:50

. Oh , okay , the one thing that schools

14:52

would have to realize is that if they

14:54

do want to be a measure site

14:57

, they're gonna have to follow their

14:59

parameters of what's expected of a

15:01

test center , and it's gonna open

15:03

them up as a test center , not just for AAPC

15:05

exams , but for other exams as well

15:08

. So if they want to host exams , we're

15:10

not saying that they can't , it's just gonna have to be

15:12

under that umbrella . Okay , that makes

15:14

sense then .

15:14

So recently AHIMA has released

15:17

these micro credentials and

15:19

it's been a fascinating thing to kind of

15:21

see and there's a lot of hype around that . Is

15:25

this something that the AAPC is looking

15:27

at and kind of evaluating some of our own certifications

15:29

and own training and determining

15:32

if there is a

15:34

different sort of way we should be looking at some of our training

15:36

and credentials as far as these specialty

15:39

trainings ?

15:39

Absolutely , and it's been a product that

15:41

we've been developing for over

15:44

a year now . So we're really excited

15:47

about when we can launch the beta of this

15:49

. We're taking a little bit of a different

15:51

approach . You know , right

15:53

now we've got many CPCs

15:55

and one of the things that we hear like me

15:57

, I've had it for over 20 years now

15:59

. So what differentiates

16:02

me from others that hold the same

16:04

credential that I do Someone that just received

16:06

their CPC versus someone that's had it for many

16:09

, many years ? So the platform

16:11

that we are building is going to give

16:14

individuals many different options

16:16

as far as what's motivating to them

16:18

. It will give them an

16:21

all-inclusive library of all AAPC

16:23

content . So if they want to learn

16:25

how to code a cardiac cath

16:27

, they'll be able to search for cardiac cath

16:30

. All of our micro learnings

16:32

, articles , webinars

16:34

, anything that's in our content

16:36

library by topic

16:38

, will be available to that individual

16:41

. The other part of this platform

16:43

that they have the option is to

16:46

attain different levels of competency

16:48

. So if I say I

16:50

am an expert in cardiology

16:52

, I want to be able to show my

16:55

employer that there's going to be

16:57

a path for them to take different

16:59

levels of assessment to attain

17:01

different designations , so

17:04

they will be able to start on the intermediate

17:06

track move up to expert

17:08

, move up to master based

17:11

on this Wow , yes , that's awesome

17:13

. So there's going to be three levels of

17:15

designation by specialty

17:18

. We're starting with coding

17:20

. We will also have a version into

17:22

billing as well as auditing , but

17:24

coding is what we're going to be launching as our first

17:27

version of the product . The

17:29

other part of this is that

17:32

right now , we've got a ton of really good

17:34

content . We have the ability to

17:36

assess . This platform is going

17:38

to allow us to pair , when

17:40

you're going through these practice assessments

17:43

, what areas are you not coding

17:45

well ? And it gives you

17:47

OK , cardiac cath , you didn't code

17:49

this well . Here's the micro learning that

17:51

goes with it . Rather than just a rationale

17:54

explaining the answers , they'll

17:56

have micro learning units assigned

17:58

to each one of the competencies assigned

18:01

to an assessment , and

18:03

the other part of this is

18:05

that , from an employer's perspective

18:07

, they can enroll them

18:09

in the assessment to benchmark

18:12

how their employees are performing

18:14

. So it'll let you rank your

18:16

team based on who's

18:18

got the best scores . Who

18:21

might need additional education

18:23

. We have a

18:25

fee schedule is tied to it , so not

18:28

only can you save accuracy of coding

18:30

, but you can also tie dollars to it . So

18:33

we really are excited about this

18:35

and feel like it's going to really change

18:38

the way that we demonstrate

18:40

competency , and employers can assess

18:43

competency and give

18:45

their employees the tools based

18:48

on where they need the most help .

18:50

Yeah , and I think that's so phenomenal because I'm

18:52

someone who has one of the sunset credentials

18:55

. I have my plastic and reconstructive surgery , and

18:57

their rationale is always well , we just didn't have enough

18:59

people that were interested in

19:01

testing for it to maintain all

19:03

of the exam costs and

19:06

printing them and maintaining it , which

19:08

is totally understandable . But I feel like

19:10

now , with micro competencies , that might open the

19:13

door now to some of those additional specialties

19:15

and having training for them not necessarily

19:18

credentials , but

19:20

being able to direct someone that's like hey , I'm

19:22

having to learn this new specialty , I

19:24

don't know what I'm doing , and seeing

19:26

where they might rank and then

19:29

being able to direct some additional

19:31

training to them , I love that . I think that's so

19:33

needed in this industry right now .

19:35

We feel really good about our approach

19:37

because we've been using an employer-focused

19:39

committee to help guide us , because you wanna

19:41

make sure that you're developing tools

19:43

. If I say that someone's an expert

19:46

in cardiology , if it doesn't resonate

19:48

with the employer , then what does it mean ? Right

19:50

, it's just something that I earn that

19:52

might not hold weight from

19:54

an employer's perspective . So

19:56

in the development of this product

19:58

, we've been incorporating their

20:01

points of view so that

20:03

we know that it's going to mean something

20:06

to them . So we feel really good about the

20:08

approach . The other thing about

20:10

this platform is it will also show

20:12

you your ranking against others

20:15

that are also in the platform

20:17

. So an employer's not just gonna

20:19

be able to see how their employees are ranking

20:21

, but how they rank against

20:24

the entire universe that's in there

20:26

, so you know how competitive we

20:28

are .

20:28

Yeah , I know it's exciting and it's a little scary , Like

20:30

I like when we do that to physicians . But now I'm like

20:33

, oh , I don't know how I feel about them do , about that

20:35

happening to us now .

20:37

But yeah , we're really close to being

20:39

able to show a

20:41

little bit of the product and

20:44

we're excited about it . We will be

20:46

releasing a beta version to get people

20:48

in there and just get feedback , make sure we're

20:50

on the right track before we build out all specialties

20:53

. So we're excited .

20:54

Yeah , one of the things that I

20:56

always say , like if I could snap my fingers and fix the

20:58

problem . As everyone says , oh well , you

21:01

know , I can't find a job , and we have

21:03

these also assessments out there saying

21:05

oh well , there's a shortage of medical coders

21:07

and I'm like , well , I think it's more so a shortage of experienced

21:10

medical coders Once they have two

21:12

plus years experience and can hit the ground running doing

21:15

, you know , gi surgery or

21:17

something like that , and that

21:19

might be a good gap for that as well . Is there anything that

21:21

you wish you could like snap your fingers and fix

21:23

in this industry ? Wow .

21:25

I wish that we could definitely

21:29

make sure that all patients have access to

21:31

healthcare . Number one . Number two

21:33

is reducing some of the administrative

21:36

burden and make it more consistent

21:39

so that it's not so hard

21:41

to navigate . You know , big

21:43

problem that we're having right now is clinician

21:45

burnout just from all of the

21:47

administrative burdens and

21:50

just the difficulties of getting reimbursement

21:52

in . You know , when you look at in

21:54

the proposed rule , physicians again

21:56

are going to get a decrease . They

21:59

can't take on all of this cost

22:01

with less dollars

22:04

coming in . So some

22:06

of the regulation and some of the complexity

22:08

I don't think is needed .

22:10

And now it's even affecting patients that it's taking

22:12

forever to get into just to see

22:14

your provider for a

22:17

routine visit or even if you're

22:19

having a concern . You know there's just so

22:21

much that they have to track anymore that they're

22:23

so behind . And yeah , healthcare

22:25

is not easy .

22:27

Well , and unfortunately there's those that game

22:29

the system that kind of ruin it for everybody

22:31

else . You know you see , it

22:33

in all of the audits . Now with telehealth

22:35

, it was a good concept

22:38

to open it up and make care more accessible

22:40

, but you saw people that saw that as a

22:42

vulnerability in the system and took

22:44

advantage of it .

22:45

Right is there anything else coming up with

22:47

the AAPC that you want to let my audience

22:49

know about or that you're excited about ?

22:51

Well , I know that there's a ton of talk

22:53

about AI and some

22:56

of the insecurities of what

22:58

that means and , just like any technology

23:01

, I think I compare this a lot to

23:03

the electronic health record and

23:05

the kind of scare that we received , where , with electronic

23:08

health records , coders jobs

23:10

are going to go away , we're not going to be needed . Anytime

23:13

technology is incorporated

23:15

, it change and

23:18

modifies our jobs but opens

23:20

up other opportunities . You

23:22

know , I think CDI is going to be so

23:25

important because garbage in , garbage

23:27

out , you know , and the audit

23:29

aspect afterwards , the compliant

23:32

aspect afterwards , there's

23:34

going to need to be a check and balance .

23:36

Yeah , I think I have some friends that

23:38

work in in the legal end of things and

23:40

they're like we're pop and like business

23:42

. I can't hire people fast enough to

23:44

keep up with the case load that's coming , and I think

23:46

we'll probably see more than that coming

23:49

up over the next few years , especially as

23:51

even physicians are adopting AI

23:53

and we're finding out that . You know

23:55

we're seeing incorrect information and repetitive

23:57

information and the challenges that are going to come

23:59

with that as well Exactly Well

24:02

, thank you so much , ray , for taking your

24:04

time out to speak with me today . I'm

24:06

going to link below all the AAPC

24:08

social media so that people can follow more

24:10

information about the AAPC and what they're doing

24:12

and check out all those products and services that

24:14

are going to be coming up .

24:15

All right , thanks , and thank your viewers

24:17

too , for listening . Thanks .