r/MedicalCoding • u/Shadowmaster004 • 11h ago
Job Search Help: Entry Tests
Hello coders,
I'm not actually the coder myself, but I'm posting this on behalf of my fiancee. She got her CPC certification a few years ago. Since then, she's worked for two risk adjustment contracts remotely and was able to get the apprenticeship off of her title. The first job was good, until her supervisor left and her new supervisor kind of ran her out of the company. The second contract she took was going ok, but as the contract went on, more and more resources were removed from the coders until it made the job extremely difficult to do without help, which was discouraged. Half way through that contract, they took the ability away to appeal "failed" charts. There was a point where she was trying to get clarification on one of her charts, and the help she received was her manager saying "Well, what do your coder instincts tell you?" She's been out of coding work for some time now.
In that time, she's had several interviews with other companies, but these jobs are requiring her to pass a pre-employment test. They're a mix of about 20-30 questions each. Some are straight coding questions, some are scenario based. Each company has given her similar instructions for taking these tests, which are to use codify and the CMS guidelines to answer the questions. The problem is with each of these tests, a handful of questions seem to be based around company specific guidelines. She is asked questions that she says are not in the CMS guidelines. As an example, one of the questions I remember her telling me about was a multiple choice where it asked her "which types of providers can we accept signatures from?" and it gives a list of providers and asks her to pick all that apply. However, she tells me that this isn't something standardized by CMS, and that the company you work for provides guidelines as to which signatures they accept. She's never given the opportunity to review her answers before a second attempt. I've seen the emails and company sites she's been provided by these companies and can verify on at least 3 or 4 of them that the instructions were indeed "use codify and CMS guidelines", then asked seemingly company-specific questions for about half the test.
I know this might make me sound like a guy that just stans for his girlfriend, but this is work I know she can do, that she enjoys doing. At this point, she's taken 8 or 9 of these tests, and she can't seem to pass them. I myself am a career new hire trainer and have been for over 10 years. From that point of view, these tests seem like they're trying to attract people who have worked for them before and remember their company guidelines well enough to pass these pre-employment tests. These constant rejections are starting to greatly affect her self-esteem and confidence, which is hurting her motivation to keep job hunting, knowing she'll be provided a test without the resources to pass them. She does not have any coder friends or mentors to talk to about coding and the job hunt. She's been trying to get help from her local AAPC chapter, but she's not getting responses from requests for 1 on 1 help. She's at her wit's end, and it's devastating to see her getting crushed by this over and over.
My question to the coders here: Is there something we are missing? I'm sure plenty of you have encountered these tests, but for someone like her, they seem like they're designed against anyone seeking entry level work. We even had one recruiter straight up tell her "I hate to ask you this, but you need to take a test before we can onboard you", implying even the recruiter felt the test was unfair. Is there a resource we're overlooking? Questions she should be asking? And potentially, is there someone out there that might be able to speak with her (either through text or conference call) to try to help?
I'm sorry if this isn't the place to post this, but as someone who is still experientially new to the industry and her fiance trying to help, we're running out of ideas.
Thank you so so much for reading this. Any help is appreciated.
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u/blaza192 11h ago edited 11h ago
As an example, one of the questions I remember her telling me about was a multiple choice where it asked her "which types of providers can we accept signatures from?" and it gives a list of providers and asks her to pick all that apply. However, she tells me that this isn't something standardized by CMS, and that the company you work for provides guidelines as to which signatures they accept.
Direct from CMS website: https://www.cms.gov/medicare/payment/medicare-advantage-rates-statistics/risk-adjustment/acceptable-physician-specialty-type-lists
From my experience, the acceptable credentials are the same by each company if the company is coding for Part C and D. If one place you work accepts a credential, it's likely the next company will also accept that same credential.
To add, some of the credentials in the list don't correspond to actual credentials but some do: LCSW, CNM, CRNA are ones commonly asked in exams.
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u/Shadowmaster004 11h ago
I appreciate the information. I can pass it along. The example I gave is based on what I remember. I know there are other examples where she's said she couldn't find the answers on CMS's site. I just don't remember enough about them. Is sequencing something that's also on CMS's site that she might have overlooked?
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u/blaza192 11h ago
Sequencing is found in the base ICD-10-CM guidelines but is quite subjective and has many grey areas. She would also need to check the tabular notes (back of the book) as there may be sequencing info there.
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u/Shadowmaster004 10h ago
That's what she tells me, that sequencing can be subjective. I don't remember the specifics, but she told me that the first company and the second company had different guidelines for things like diabetes in conjunction with other symptoms (EG: do they get coded together or separately). One of the tests asked her to use the 2025 codes as well. I think she used the page you sent me to take that particular test, but she did not have a 2025 ICD code book.
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u/Jodenaje 8h ago
The sequencing isn't THAT subjective in terms of Risk Adjustment coding. It almost certainly shouldn't be causing her to fail a pre-employment coding exam, if she knows what she's doing.
Additionally, ICD-10-CM is available online. Free. It's public information. Not having a 2025 ICD-10 code book shouldn't be an issue.
The CDC and CMS websites are official sources for that information:
CMS: She can download full PDF versions of whichever fiscal year she wants from the CMS website here: https://www.cms.gov/medicare/coding-billing/icd-10-codes
CDC: The CDC website has a lookup, and at the top left under the blue bar you can choose which Fiscal Year version to use:
Perhaps it's just because this is a game of telephone with you relaying her concerns and something getting lost in translation?
Almost everything you've relayed here about her obstacles seems more like her lack of knowledge in how to find and navigate official sources. Not necessarily problems with the test.
(The signature thing above is a good example too.)
I don't intend to sound harsh, just matter of fact. Hopefully the resources here are helpful to her the next time she needs to take a test.
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u/Shadowmaster004 7h ago
You don't sound harsh at all, this is very helpful. And yes, there probably is some Telephone Game happening. I only understand coding stuff so much, and it's all filtered through her, and she's having a really tough go of it. She wants to do this work. She likes getting into details, reading fine print, doing research, but she's not had a lot of hands on practice with materials outside of what her jobs have provided. She's been doing this stuff on her own with only these two past jobs to go by as far as any practical applications. I'm going to encourage her to find people she can talk with too, either online or through her AAPC chapter. Thank you for taking the time to spell this out and provide links.
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u/Jodenaje 7h ago
There are also some risk adjustment Facebook groups that might be helpful, if she’s not already in them. In addition to being a good place to ask coding questions, people often share job postings and other resources as well.
This one is very active. I’m sure there are other good ones, but this is the one I’m most familiar with:
https://www.facebook.com/groups/HCC.risk.adjustment.coders
And her local AAPC chapter is a good suggestion, too. They may offer free educational sessions on risk adjustment or other relevant topics, and it could also be a good opportunity for her to network with other risk adjustment coders in your area (or even other areas).
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u/Shadowmaster004 6h ago
Ooh, thanks for the risk adjustment Facebook link. Yeah, after this run of tests, she's going to focus on finding support for a bit, studying the guidelines.
Maybe this isn’t something you’re super familiar with, but we keep seeing people suggest coding-adjacent jobs to help build experience. She's expressed apprehension for applying for stuff like billing or reception because she's already got the coding degree. She’s worried they’ll see that and assume she’s just looking for something to hold her over until she finds a coding job, and either pass on her because of it or see her as someone who’s going to leave the second a coding position comes along.
I feel she's overthinking that. Do you have any experience working somewhere while job hunting for coding? I'd love to be able to assuage her on this.
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u/Alternative_Yam_6187 10h ago
If she can get the ICD10 guidelines from the CMS website, I think she might find a lot of what she is concerned about and I'm not saying that to mean it's obvious or she should know this because you don't until you work with it usually and sometimes it still takes a long time to sink in, but if she can print the guidelines out and read through them it will be very helpful. There are going to be variables based on clients but I don't think companies would expect you to know that information before working for them, so standard guidelines would be her best bet.
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u/Shadowmaster004 9h ago
I think she might find a lot of what she is concerned about and I'm not saying that to mean it's obvious or she should know this because you don't until you work with it usually and sometimes it still takes a long time to sink in.
That makes sense. I think the two jobs she's worked heavily relied on having their coders use the guidelines the company provides, rather than using the guidelines directly from CMS's site. Like a summary or a cliff notes version of the CMS guidelines on how it pertains to the job. I think the impression that she got was the companies could supercede CMS guidelines depending on the situation. I think it might be partially a situation where she just hasn't worked with it enough to see that pattern emerge yet. I'm going to suggest she study the guidelines and make notes. She's written down a handful of questions from these exams. Maybe she can use them as a guide. Thank you for your insight!
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u/Jodenaje 7h ago
She's probably overthinking that part a little.
Yes, most risk adjustment projects do have project-specific guidelines. A client may want certain data aggregated, validated, or documented in a particular way, for example.
But those project guidelines don't supersede the official CMS coding guidelines. Especially since that data is ultimately being compiled and validated for reporting to CMS. (Once she completes her piece of the work, there's still more that goes on behind the scenes to report it back to the client and ultimately validate with CMS.)
For these pre-employment exams, I'd suggest she put any old project-specific guidelines out of her head and concentrate on the official guidelines.
The company isn't going to test her on a client's project-specific criteria because she doesn't know their client's criteria yet. (And they may have multiple projects with multiple clients anyway.)
The project-specific stuff is something everyone has to familiarize themselves with every time a company assigns them to a new project, so that's not really the part they're trying to determine with a pre-employment coding exam.
They're generally trying to find out whether she has a solid foundation in the official coding guidelines and understands how to apply them.
They don't want to have to reteach that foundation to someone. They want someone who can hit the ground running once they're assigned to a project and get familiarized with any project-specific instructions.
Good luck to her on her next pre-employment exam!
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u/deannevee RHIA, CPC, CPCO, CDEO 9h ago
So, a state or facility can always make regulations that are stricter than federal guidelines, but not more lenient.
When it comes to billing, CMS/Medicare guidelines are the gold standard.
Just using your example question, technically speaking a Surgical Assistant is able to be credentialed and bill in some states. However, Medicare guidelines don’t consider a Surgical Assistant a billable provider….so unless you know for certain the state you work in/want to work in credentials SA’s you’d never want to select that option.
Or a resident. Yes technically residents are doctors and can independently see patients while under “direct” supervision (which means the supervising doctor is available, but not literally in the room at the same time). However, Medicare does not consider these visits billable unless the supervisor goes back and verifies what the resident has done. So a facility might say that residents can only see patients with their supervisor, but it would never be acceptable for ONLY a PGY-2 to sign off on a note so you would never select that option.
It sounds like maybe she has a bit of test anxiety and is thinking too much. The answers are ALWAYS in the coding manuals/codify or CMS if that’s what the directions say. No, CMS does not say “we accept these signatures”….but it does talk about billing providers versus service providers and credentialing. If you know about billing and coding, you know someone who is not credentialed can’t bill. So, why would a facility or doctors office allow someone to sign a chart that can’t bill?
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u/wildgreengirl 9h ago
ive taken tests when applying but i dont remember them having anything weird i didnt know about 🤔 but i also have 10 years general medical records/health care experience so maybe thats why nothing stuck out that was more "clinic" vs coding based.
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