The Last Test

Vol. 18 •Issue 2 • Page 23
The Last Test

Background experience and credentials can only tell so much; see why employers are pre-testing candidates before hiring.

The candidate looked great on paper. That’s how Rose T. Dunn, RHIA, CPA, FACHE, FHFMA, chief operations officer of the HIM consulting firm First Class Solutions Inc., St. Louis, MO, described a coder with a certified coding specialist (CCS) credential who applied to her client’s hospital.

That is, until the candidate sat for the hospital’s pre-employment exam and the truth became clear—she had never coded.

“Turns out she had taken an online course and then immediately sat for her CCS, which meant she obviously was able to apply the theory of coding, but the practice of coding requires a heck of a lot more,” Dunn relayed. “Needless to say, she did not do well when she was finally exposed to what a medical record really looked like.”

Using pre-employment tests before hiring has become a common and useful practice for HIM directors and companies who want to make sure the coder, cancer regis-trar or MT they’re getting is really who they say they are.

Why Another Test?

A credentialed candidate means the person already sat for an extensive exam; so why another test?

Unlike a credentialing exam, a pre-employment test can use real charts the candidate should expect to see on a day-to-day basis at that particular facility, to show the employer how well the candidate will do if he/she started tomorrow.

“Pre-testing gives us the ability to gauge applicants’ competency levels and assess their practical skills on day-to-day work as opposed to how well they do on the exam,” said Allison Bloom, MBA, RHIA, HIM director at New York University Hospitals Center.

It also seems that, while experience, credentials and references are beneficial tools in screening a candidate, there are also many things they can’t say about a candidate.

For one, while a credential may show the candidate knows a little about a lot, it might not mean they know a lot about what you need them to.

Dennis Mihale, MD, MBA, is the CEO and chief marketing officer of Parses Inc., a Tampa, FL-based company that specializes in evaluation and management (E&M) coding. For him, pre-testing offers something 15 years’ experience and credentials simply cannot show him.

“They might have spent the last 15 years coding, but 95 percent of their focus might not have been on E&M codes,” Dr. Mihale said. “Because we specialize in those, we want to make sure the people we hire know E&M codes very, very well. The certified professional coder (CPC) certification is like being a doctor but not a specialist, it means the coder is qualified to do 10 different kinds of coding but he or she may not be proficient, specifically, in E&M.”

Some candidates may also hang onto those three letters months or even yearsafterthey’ve stoppedtheircontinuing education units. United Audit Systems Inc., an HIM consulting firm in Cincinnati, updates its 4-hour coding competency exam every year to make sure the candidate has stayed current with the regulatory changes and coding guidelines.

“As consultants we have to make sure the people we’re hiring are the highest level coders possible,” said Brad Allen, UASI’s regional market manager. “Our test is reviewed and updated annually to make sure the test is current and gets us the type of candidate we’re looking for.”

What’s (Really) In a Year

There are also those candidates who don’t know what they don’t know. A candidate may proudly state he/she has 10-years’ experience, but who’s to say it was of top quality?

Even though Registry Partners Inc., a Burlington, NC-provider of registry support services, requires that every candidate has a certified tumor registrar (CTR) credential before taking the pre-test, only 36 percent pass it on the first attempt.

Dawn DeBolt, BS, RHIA, CTR, clinical services director, attributes this to the fact that some CTRs may have learned through mentorship or have worked at a hospital that does not provide an internal registry quality assurance (QA) program.

“For many people it’s something they’ve done their whole career but may not realize they’re doing it wrong,” DeBolt said. “It’s one of those things–they don’t know they don’t know.”

A pre-test will also make it glaringly clear who has been relying on software and drop-down boxes for too long. “There are so many notes and pieces of information not built into the software system and that’s a big drawback,” DeBolt said. “We’d expect any good, thorough CTR to always refer back to manuals for every coding question.”

At Precyse Solutions, Wayne, PA, provider of HIM services, the candidate’s ability to access the test is actually the first “test.” Precyse’s pre-test for oncology data management (ODM) consultants is administered via a Web-based educational tool; and the candidates’ ability to successfully navigate and complete the 4-hour test helps Sandy Overton, BS, CTR, director of oncology services, identify who will be able to “hit the ground running” when placed at a new client site.

“They need to be familiar enough with computer programs that they can do some trouble-shooting,” Overton explained. “If a person has a lot of difficulty even logging into the site, it might be a red flag. Our clients want a person who is experienced, confident and can figure out at least some of the problems on their own.”

A Help Not Hurdle

For job-seekers, pre-tests don’t have to be viewed as a stumbling block to employment. In fact, many employers use them to determine where you’ll be happiest.

SPi, a business process outsourcing (BPO) provider headquartered in Brentwood, TN, uses an online exam through Career Step to test its MTs on everything from spelling, grammar and medical terms to their ability to expand abbreviations and take a transcription test.

Cheryl Douthat-Parrish, CMT, senior recruiter at SPi, does not consider the test score a be all and end all to employment, but a way for her to see where the candidate excels and where he/she will be happiest.

“I look at everything, the test and their resume, and I really sum up what I feel someone’s experience is and what area they’d be good in,” Douthat-Parrish said. “I’m interested in what they feel they’re the best at and what they like, so I can place them in the right position in our company. That’s a win-win.”

Precyse considers pre-employment testing a service not only to their clients but to the candidate as well. “When our clients call us they’re often in trouble; it would be a disservice to the candidate to place [him/her] into a very difficult situation,” Overton said. “It’s much better to test thoroughly and identify those really high performers who can do the job instead of putting someone into a situation where she’s not going to be happy or successful.”

Surprise Benefit

The implication of a pre-employment exam is that it’s going to shut candidates out, but who could guess it would be a way for companies to reel qualified candidates in?

Brenda Ray, CCS, CCS-P, CPC-H, a coding auditor, educator and independent contractor, had the skills and experience any HIM consulting company would dream of. Yet it took her 1 year on and off interviewing with seven different companies to finally find a remote auditing job. It turned out the problem wasn’t her, it was them.

“At one company, when I interviewed with the general manager of coding, it was a circus,” Ray recalled. “He was talking to someone else out the side of his mouth; I could tell he had nothing to do with coding. I had prepared 5 hours refreshing myself on coding guidelines and that was very unprofessional.”

It was actually Kforce Inc., a Tampa, FL-based staffing firm’s rigorous pre-employment testing and 1-hour phone assessment—in which a Kforce compliance officer drilled her about her skills—that helped Kforce land her.

“If Kforce did not add up to my expectations, I would not be working for them,” Ray said. “I want to know I’m working for a company who knows coding and goes the extra length to make sure who they’re putting out in the field representing them is who they say they are.”

A pre-employment test may be able to pull out many things about a candidate that a credential and experience can hide, but there’s still one thing no amount of testing can determine: work ethic.

“The best person in the world could be put on a project and the test cannot guarantee they’ll continue to be productive or continue to do it the right way,” DeBolt said. “That’s why we have such a thorough QA program; it’s the only way to make sure you’re going to get what you paid for.”

Ainsley Maloney is an editorial assistant with ADVANCE.

Pre-Test Prep

As a human resources recruiter for United Audit Systems Inc., Holly Saylor knows what it takes to excel in the pre-test. She offers these tips:

1. Utilize all relevant resource material that you would routinely use on the job.

2. Read each question and case carefully, but don’t read more into the question than is there.

3. Take your time: remember this is to test your accuracy and skill, not productivity. Be prepared to answer the productivity question in the interview process, and answer honestly.

4. Proofread your answers, particularly if you are typing them in. A typo can be costly and show you may be careless while on the job.

5. Take a deep breath and calm down–if you know your stuff, you should do well.

Create a Coding Exam

Many HIM directors are expected to create pre-employment coding exams on their own, because they know best what their needs are. Rose T. Dunn, RHIA, CPA, FACHE, FHFMA, chief operations officer of First Class Solutions Inc. and author of More With Less, Second Edition: Best Practices for HIM Directors, tells us how.

1.Include a mix of coding guideline questions and real patient charts the applicant will likely code in a regular business day. Ask your current coders once a month to identify a case that was particularly challenging and make a complete copy of the record to set aside as a potential test chart.

2.Update the test each year based on the code changes and any new guidance from the American Hospital Association’s Coding Clinic to see whether the applicant has kept current.

3.Provide the candidate access to all of the normal tools they’d use in coding, including the encoder and proper books.

4.Allow 2-4 hours for the test. For 10 inpatient records, allow the candidate 3 hours (25 minutes per record); 10 ambulatory surgery cases, 2 hours (15 minutes per chart); 10 emergency department encounters, 1 to 1 hours; and 10 ancillary procedures, 1 hour. Remember, the time will be longer because the applicant is not familiar with the format of the chart. Her exams have 60 questions, 20 charts and take 3 hours.

5.Expect a pass rate of 80 to 90 percent. Don’t expect it to be as high as the accuracy rate for your department (95 percent) because you won’t have those easy, newborn cases in the mix.

–By Ainsley Maloney

Test Your CTR

When Pamela Melton, LPN, CTR, cancer program coordinator at St. Louis (MO) University Hospital, hired a certified tumor registrar (CTR) with experience at a hospital registry, she was thrilled. That is, until she checked the candidate’s work and found her compliance to be significantly below the hospital standard.

Melton attributed this to the fact that the previous facility was not Commission on Cancer-approved, had no quality control of data and required the candidate to teach herself.

“I thought her work experience and being certified was positive proof of her skill level, but unfortunately she was allowed take the exam four times without further education until she passed,” Melton said. “In some ways she is a victim herself. I plan on using a pre-test from now on.”

The National Cancer Registrars Association (NCRA) is currently in the process of developing a pre-employment screening aid to help managers like Melton identify exactly what type of cancer registrar they’re getting before they’re hired.

“We recognized the need for there to be a helpful tool for the manager to learn more about the skills, strengths and weaknesses [of the candidate] they’re considering,” said Lori Swain, MS, executive director, NCRA. “It’s a project we’ve been working on for about 4 months. It’s a way to give people a little more control and information.”

The pre-test tool is set to be ready in February and will be available online as a subscription service through NCRA’s Web site,

–By Ainsley Maloney

Before You Make the Offer

For more on pre-employment testing and other strategies you should use before making a candidate an offer, visit our Web site at to read the article titled “10 Tips for Before You Make the Offer.”

If you are an HIM professional who is looking for a new job, we have a variety of tools on our Web site for you as well. You can search through thousands of health care jobs all over the U.S. using a variety of search options. Plus, you can sign up to receive future job listing notices via e-mail. Just visit

At this site, there is also a Career Center, which was created to provide allied health professionals with career advice, tips and resources.

You will find the following helpful sections:

E&MLaunching Your Career: Are you a new graduate, or just new to the profession? Look here for tips and advice on starting out in the work force.

E&MWorking Life: Balancing your personal and professional responsibilities is often a juggling act. Look here for insight into effectively prioritizing and organizing your life—both in and out of the office.

E&MGetting Ahead: Ready to take that next step? Visit this section for information on how to shape your education, experience and goals into your career reality.

E&MLanding the Job: Learn how to effectively market yourself to poten-tial employers with our resources covering resumes, interviews, networking and more.

If you are a recent or soon-to-be graduate of an accredited program in HIM or related fields, you are at the threshold of an exciting career. Our Student Center, at, provides valuable articles and resources.

This week in the Student Center you’ll find:

  • Certifications/Credentials: Take Pediatric Coding to a Higher Level–Learn about the American Academy of Professional Coders (AAPC) pediatric coding credentials.
  • College Corner: Second Interviews–Overcome the hurdles in the path to your new job.

    E&MRecent Graduates: Two Sides to Every Question: Part Three—This is the third of a series of articles on common interview questions and how best to answer them.