Save Time & Money: 4 Actionable Solutions for Hospitals’ Coder Shortages

Heather Chartier, MS, RHIA, CCA Outsourcing 1 Comment

Save Time & Money: 4 Actionable Solutions for Hospitals’ Coder Shortages

Joining the ranks of physician and nursing shortages is a medical coder shortage of unprecedented heights. Hospitals need to quickly alleviate this problem or risk losing thousands of dollars in unbilled charges.

Here’s a look at four actionable solutions to the coder shortage gap in hospitals.

First, why is there a coder shortage?

  • Sickness running rampant throughout an organization due to Covid-19 or other ailments
  • Veteran coders leaving the profession due to burnout
  • The Great Resignation
  • Not enough qualified coders joining the profession
  • Lack of hospital in-house coder education training pool
  • Hospitals running too lean 

According to the Bureau of Labor Statistics, the number of medical record specialists and coders is expected to increase by 9% from 2020 to 2030, which is a relatively rapid growth rate.1 The American Hospital Association projected among the healthcare white-collar administrative professions that medical records, billing, and compliance are the fastest growing sectors at 13% by 2026.2 Combine the increase with the current shortage and the amount of time it takes to replace a coder. You have a recipe for catastrophe if healthcare leaders do not act fast.

“It took us over a year to find a coder, and [we] had to hire a coder with little hospital experience. The issue we had was that we don’t have much room to train and keep up with the daily demand placed on coders,” Mona Mickle, the Chief Administration Officer and Chief Operating Officer at Odessa Regional Medical Center stated in an emailed statement on January 10. A primary reason it is so difficult to replace a coder is it depends on the type of coder. “An inpatient coder is more challenging to replace than an outpatient coder because of experience with query writing, understanding HACs, PSI, and POA,” stated Whitney Warren, an HIM Coding Manager in the healthcare field. Hospitals receive a higher reimbursement on longer stays, so the cases are more complicated.

These are exponentially changing times for healthcare requiring flexibility, agility, and adaptability. Hospitals will prioritize their options based on cost, time, and space constraints.

So what options are there for hospitals?

  1. Partner with 2-year colleges for new graduates
  2. Partner with vendors – some vendors have a coding university
  3. Hire an outsourcing company to handle all of their coding needs on a long-term basis
  4. Hybrid model – Hospitals develop coding universities in-house and outsource some of the work 

Although Option 3 would be less headache for facilities, it is the costliest option, and smaller health systems do not have the capital required to outsource their entire staff.

Colleges and HIM Directors need to inform the community better that medical coding is a viable profession rather than having the student google it to discover it. Lori Laco-Schiano, HIM Assistant Professor at Monroe Community College in Rochester, NY, stated, “Rochester has two large healthcare systems. Typically, students find out about us through word of mouth, or a family member who attends class tells another family member about the program or a person may work in a hospital, and a friend or family member attending class will tell the hospital worker that they need to get credentialed.” Often, graduating students graduate with a degree but few job prospects in certain parts of the country. In Rochester, the two large healthcare facilities and the college have a relationship. Still, HIM Directors in other parts of the country have not gone to the colleges to recruit new graduate coders. This is an untapped resource. Option 1 is a lower cost option but requires a time commitment and space for training which may not be feasible for hospitals trying to run lean and keep up with the day-to-day operations.

In some cases, vendors have a coding university and can reduce time constraints. Costs can be lower than a facility developing a coding university from scratch, so Option 2 is a good option; however, not all vendors offer this service, and improved quality may vary based on vendor. Additionally, some healthcare leaders, like Mickle, expressed that “it is less costly upfront, but lack of hospital specialty knowledge is more costly when trying to optimize coding.” Vendors like MRA have a solution to this by having the facility train the supplied coder on specific hospital coding policies and procedures the first time; during this session, the vendor will record the training session to duplicate efforts with any additional coders. 

Option 4 lets the facility retain some quality control, offset costs by outsourcing the outpatient coding while slowly allowing the hospital to home-grow their inpatient coders. Based on hospital priority, this may be the most optimal option as resources are shared.



  3. Laco-Schiano, L. (2022, January 11). Personal communication [phone interview].
  4. Mickle, M. (2022, January 10). Personal communication [email].
  5. Warren, W. (2022, January 6). Personal communication [phone interview].

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