Outsource coding and review

By guest blogger-Brandi Whitemyer, BSN,RN, HCS-D,COS-C

With ICD-10 on the forefront and the continued impact of PPS changes that have caused agencies to identify cost effective practices, the utilization of outsourced coding and OASIS review has come to center stage in the home health industry. After discussing this issue with many agencies around the U.S, the debate seems to come down to cost savings. In the end, how will the agency either reduce its current spending or increase its revenue by implementing a practice of outsourcing its coding and OASIS review? When done right, it can be a winning solution for an agency.

Agencies need to start preparing for the October 14, 2014 implementation of ICD-10. This means either the agency’s own coders need to be proficient in the ICD-10 coding system, or the agency needs an alternative plan. For larger agencies or those using all certified coders, training may be a viable option. For smaller agencies or those who use coders without formal training, the agency needs to realistically realize 1) the cost of training for a smaller staff, 2) the reality of trainability for staff.

In addition to upcoming ICD-10 concerns, agencies need to pay close attention to quality and outcomes in the current advent of ACOs. The reduction of OASIS errors and ability to submit accurate data that demonstrate outcomes has become increasingly important for home health agencies everywhere. Those who can show responsiveness, quality patient care, and, above all, superior patient outcomes are those who will be most appealing to ACOs and ultimately hold an upper hand against other agencies in the race to compete.

How can outsourcing the process of coding and OASIS review help your agency and what questions do you need to ask? Start with asking how the process can benefit your workflow and revenue cycle. Utilizing the services of a company that specializes in outsource coding and OASIS review services guarantees timeliness of the coding and review process, as well as accuracy. This process can expedite an agency’s RAP turnaround time, in addition to assuring accurate reimbursement for claims. Over time, feedback provided from expert review can even reduce the overall rate of clinician OASIS errors, providing for faster completion of OASIS and improved clinician understanding of OASIS guidelines. Take a look at the overall reduction in initial errors in submitted OASIS over six months for one agency after initiating the services of outsourced coding and OASIS review:


OASIS Error Rate over 6 months- Prestige Home Health of Canton, Ohio

For this same agency, after two years of continued use of these services, overall submitted OASIS errors now average only 1%. With an improved understanding of OASIS guidance and quick feedback from expert review, clinicians are able to submit more accurate and timely OASIS.

So with so many companies claiming to “specialize” in home health coding and OASIS review, is it really an apples-to-apples comparison? Agencies need to do their homework when it comes to choosing a company to perform this service. Saving a bit of money now may only result in having to pay for clean up down the line, so beware of making a dollars-to-dollars comparison. Some suggested questions:

1) Who will be performing the service? Will it be one person or multiple employees assigned and will the agency be able to contact the assigned individual directly? (Being able to go direct to your coder without a middleman for every question can make worlds of difference when you need an answer fast!)

2) What are the minimum qualifications and experience for the company’s employees? Is there only a requirement to be certified or is there a higher standard? While certification holds merit, an agency claiming to “specialize” should be able to show some degree of higher standards than the general population.  In addition, how often is the work of employees audited for quality and is those results available? Can your agency ask for work to be audited on request if questions arise?

3) What is the turn around time for submitted work? Can your agency ask for work to be expedited and how does the company process this. A company that has inflexible submission processes may cause delays.

After your agency contemplates all of these issues, then its time to decide the value of a dollar. Spending a bit more to assure the quality and timeliness of work now is well worth it. Finally, with any outsource coding and OASIS review company that your agency may be considering, examine that company’s readiness for ICD-10. Any company claiming to specialize in home health coding should be prepared to help your agency make this transition smoothly and should have coders on board who are AHIMA Approved ICD-10 Trainers and Ambassadors. Ultimately, don’t be afraid to spend a bit more to get the quality your agency deserves in a time where accuracy and expertise couldn’t be more important!

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