Cracking the Code

Finding the Right Medical Coder Solution

Medical coding is a key factor in revenue cycle efficiency and integrity for every healthcare organization. The accuracy of an organization's coders directly affects its data integrity, its compliance, and even its healthcare quality rankings. Because prompt, accurate coding is essential to receiving timely reimbursement, coding also affects an organization's payment denials and cash flow.

To support their organizations' revenue and data needs, HIM directors and coding managers must maintain an appropriate staff of quick and accurate coders. However, maintaining coding resources at the ideal level to optimize productivity without incurring unnecessary staffing expenses requires a delicate balancing act.

Understaffing forces your available coders to code faster to keep up with the workload, potentially compromising data accuracy and compliance. Variations in coding volume and gaps in coder skills present additional challenges that can compromise your organization's data integrity, delay billing, and increase the risk of payment denials, resulting in revenue loss.

In short, handling medical coding in-house is a complex and often difficult task. Choosing the right coding solutions vendorcan help your organization boost productivity, enhance coding accuracy, and improve revenue flow—not to mention make your life easier.

But how do you crack the code and choose the ideal medical coding solution for your organization?

Know Your Options

Partnering with the right coding solutions vendor can provide your organization with several benefits, including:

Greater productivity

Fewer claims denials

More accurate coding

Optimized reimbursements

Improved compliance

Enhanced revenue flow and decreased AR days

Fewer delays in billing

Cracking the code starts with understanding what options are available to your organization. There are different types of coding solutions, each one offering distinct advantages.

Here's a closer look at the benefits coding solutions vendors can provide:

Traditional outsourced coding / full outsourcing

In this model, a third party handles all of your organization's medical coding. The benefits of this approach include:

You eliminate the headaches of maintaining appropriate in-house coder staffing levels.
Productive coders ensure that work is handled efficiently.
Accurate coders ensure coding compliance, while accelerating billing, minimizing denials and optimizing reimbursement rates.

Coding augmentation for transitional support

In this model, a third party supplements your organization's in-house coding staff as needed. The benefits of this approach include:

Your organization gets additional support during coding volume spikes.
You can be prepared for a sentinel event on the horizon.
You enable sustained performance and maintain consistent productivity levels despite staff illnesses, vacations, or in-house employee turnover.
You decrease the overhead costs associated with maintaining too many coders in-house.

Partnership with full consultative support

In this model, a third party provides consulting, auditing services, and coding education for your in-house coding staff. The benefits of this approach include:

Consulting and training help your in-house coders consistently perform at a higher level.
Your coders learn through systematized, proven third-party training methods.
Auditing identifies specific coding skills gaps so they can be remedied with targeted training.
Training can be tailored to enhance the specific coder skills needed for your organization's case mix.
You maintain control of the coding process.

What to Look for When Choosing a Medical Coding Solution

Each of these three medical coding solutions models offers many benefits. No matter which model you're considering for your organization, selecting the right coding solutions vendor is key to maximizing your return on investment.

To find the perfect fit, look for a vendor that offers the following:

Flexibility

A medical coding vendor that offers a wide variety of solutions to fit your needs gives you greater flexibility. Find a company that can adapt to your individual requirements both now and in the future, and that will partner with your organization to enhance your long-term success.

High Coder Retention Rate

Low coder turnover minimizes disruptions to your organization's productivity. It also ensures that your Discharge Not Final Billed (DNFB) goals are consistently met or exceeded so revenue flow remains steady.

Highly trained and credentialed coders custom-matched to your organization

In addition to providing trained HIM-credentialed coders, the vendor should match its coders' skill sets to your organization's specific case mix and coding needs. You also should look for a vendor that assigns dedicated coders to your organization over the long term. This provides resource continuity, and, as coders gain depth of experience, it also builds institutional knowledge.

Ongoing coder training and continuing education

Both outsourced and in-house coders should receive ongoing training in new coding guidelines and current coding issues, as well as training to address coding skills gaps. Bonus points if the vendor offers continuing education units so your coders can maintain their CEU levels at no cost to them or your organization.

Ongoing quality assurance

The medical coding vendor's in-house quality assurance program should continuously monitor coders' productivity and accuracy using multiple audit levels. These should include ongoing percentage-based audits, onboarding audits for new coders, and focused audits to identify problem areas. For optimum data integrity, look for a vendor that can identify skills gaps down to the individual coder.

A one-stop shop

Right now, coding services may be all you need from a vendor. However, choosing a vendor that offers a comprehensive suite of HIM services can give your organization more options in the future. Look for a vendor that can handle all of your HIM needs—including ROI, imaging, transcription, and auditing, as well as coding—to maximize your organization's flexibility and efficiency.

A data-forward approach

Look for a coding solutions vendor that promotes transparency of information via routine reporting, analytics, and performance tracking. Holding regular meetings with the vendor to review coders' performance, productivity, quality, and other important metrics can help ensure your organization gets full value from the solution.

Automation

Tracking coders' performance, quality, productivity, and schedules via spreadsheet is clunky and inefficient. Instead, choose a vendor with proprietary software that automates these time-consuming processes. Software that monitors key metrics, manages coders' schedules, and generates invoices and reports can greatly improve your organization's efficiency.

A company led by HIM professionals

Outsourcing your medical coding to an ordinary staffing service can leave something to be desired. To find the perfect fit, look for a coding solutions vendor where you can work with HIM professionals. You'll rest easy knowing they truly understand your industry, your challenges, and your organization's specific needs.

Obtaining medical coding support can be a game changer for healthcare organizations. To get the most from your solution and your vendor relationship, it's important to carefully assess your organization's needs and thoroughly understand all your options.

Whether you choose to outsource coding entirely, augment your in-house coding team for transitional support, or partner with a vendor that provides consultative assistance, take the time to select the perfect coding solution for you. The right choice can boost your healthcare organization's productivity, improve coding accuracy, minimize denials of payment, and enhance revenue flow.

Ciox Health offers healthcare providers numerous coding and education solutions. With a 97% coder retention rate, Ciox provides resource continuity and a depth of knowledge. Using a proprietary software system, Ciox can enhance coding workflow, provide regular reporting with advanced analytics, and can even identify skills gaps down to the individual coder. The professionals at Ciox truly understand your industry, your challenges, and your organization's specific needs.

CODER COSTS TOO HIGH? FIND OUT.