When trained and credentialed in the "codes" representing medical services and diagnoses, RNs increase their earning potential and augment their job security. For example, Gayla Crouch, RN, MSN, CRN-C, holds both the Certified RN-Coder (CRN-C) coding credential for RNs from the American Association of Clinical Coders and Auditors (AACCA). Formerly a critical care nurse and Cardiac Cath. Lab manager, Crouch currently works part-time for insurance-company clients doing coding -- mostly from home -- and also teaches at the University of California-Riverside, as well as teaching full time with the national RN-Coder Institute. "I choose my hours," she says, and estimates she spends about 1 week per month working away from home on coding business.

Demand for Clinical Coders

The demand for qualified coders has never been higher!  RNs intimately know their way around a patient's chart, making them among the best qualified individuals to choose accurate procedure and diagnosis codes for billing purposes.  These codes are essential for correct and maximum reimbursement for all hospital outpatient and physician services.  Coding is what maximizes Medicare and other insurance reimbursements and, ultimately, is what determines the financial health of a hospital or medical group, experts say.

"Bad coding is responsible for what ails our healthcare system," says Joyce Thomas, MHA, CPC, CCC, executive director, AACCA. The association was founded in 2003 to bring clinical experience into coding for reimbursement and compliance.  "If a coder doesn't select the appropriate procedure or diagnosis code for services rendered, the healthcare facility will not be reimbursed," Thomas explains.  "Worse, it could be audited for fraud by Medicare or Medicaid."

Sondra Strand, BSN, RN, PHN, CPC, CPC-H, CRN-C, owner of healthcare consulting firm, Veracity Consulting, Glendale, CA, describes nurses as Master Coders. "Traditionally nurse managers have looked to cutting budgets and personnel rather than enhancing revenue," Strand says. "As nurses, the more we understand the financials, the better managers we can be. And you can't understand the financials unless you understand the codes." This situation leads to lost revenues and even hospital closures, Strand says.

"It's the coders who determine how much money a hospital makes," adds John Durst, MD, an internist for 29 years who now owns Medical Compliance Analysts, Wall, NJ, and teaches coding to physicians.  Often, hospital coders are not certified by any organization, and are high school graduates, choosing codes from software, rather than understanding the CPT coding structure for outpatient services.  Dr. Durst further pinpoints the role that coding and billing play in the healthcare financial crisis:  He estimates hospitals under-bill payers two- to three-times more often than they over-bill simply because of coding errors.  Dr. Durst also teaches in the RN-Coder Institute.

RN-Coder Career Opportunities

"We are looking for Certified RN-Coders," states the founder of Clinical Coding Solutions in the Kansas City, Missouri area.  Founded in 2004 by Kurt Breeding, RN, BSN, a former trauma nurse at St. Lukes' Hospital there.  "Our specialty is auditing ER charts for missed charges -- our RN-Coders quickly "turnaround" a negative financial situation for Emergency Departments, and will quickly pay for their services -- usually in 1-2 months."

"If you become an independent contractor, your overall salary is limited only by how much you want to work," he says.  There are RN-Coders making $10,000 - $20,000 per month in this business of chart auditing and providing more accurate coding."

CRN-C Certification and Continuing Education

The CRN-C designation represents the first clinical coding exam in the nation, Thomas says. The eight-person board of directors, comprising master's-prepared nurses and other clinicians, wrote the RN-Coders certification exam.

Castle Worldwide, an online testing company that provides the highly secure, electronic testing for RN-Coder certification, making it conveniently available ANYTIME.  "The biometric security and professional proctoring are the AACCA board's main concerns and why we contracted with Castle Worldwide," states AACCA Board Secretary, Hilary Falconer, RN, MSN, MPA, CRN-C.

AACCA's certification examination is the first to provide computer-based testing of clinical coders nationwide. Candidates instantly have their score reports, rather than having to wait weeks for the results.  The AACCA is a member of the National Organization for Competency Assurance (NOCA) and will be applying for NOCA accreditation next year. The Washington, DC-based organization sets quality standards for credentialing organizations across multiple industries, including the AORN and CCRN.

Further information on RN-Coder training and certification is available at www.RN-Coder.com and www.AACCA.net.

For more information about becoming a Certified RN-Coder or Certified RN-Auditor, please go to: www.RN-Coder.com.

Joanie M. Wexler is a freelance writer and editor based in northern California.  
© 2006 RN-Coder Institute.  May be edited and re-printed with permission.