Category Archives: Medical Coding Services

Medical Coding Services provider, Nearterm, offers news  and commentary on key medical coding issues.

Should Hospitals Leverage Outsourced Coding or Keep It Internal?

Hospitals have adapted many different coding models. Most are designed around contributing factors that differ from one facility to the next. However, there are three models that arguably prevail. The following is a summary of each;

MODEL I-INTERNAL

All coding functions are managed and performed by internal staff/employees. The function is generally housed at the facility. Some remote coders may be used but they are hospital employees. Hospital is responsible for audit, QA, productivity, staff management, technology, employer taxes and employee benefits.

MODEL II-HYBRID

Coding is managed internally. Most coding is done internally by hospital employees but some coding is outsourced to a vendor. Hospital manages both employees and the vendor.

MODEL III-OUTSOURCED

The coding function is outsourced to a vendor.

Each of the above can be successful. That said, many hospitals are rethinking and reinventing their processing environment. The driver is often an awareness of current state and how it has changed. Here are some examples of current state “influencers” gleaned from discussions with several hospitals and HIM professionals;

“ICD 10 coding implementation has resulted in staff increases. I have space constraints so I have no work area to accommodate additional staff. Besides, our leadership team believes the space currently occupied by HIM could be put to use for revenue generating services.”

“We are in a rural community and local coders are hard to find and retain. Turnover and leaves of absence require overtime. We usually get behind when these occur and morale is impacted. When new services are introduced, we are challenged to find coders qualified to code the new services. Billing gets behind, cash flow suffers and physicians are irritated by late query requests.”

“A recent coding audit revealed that coding accuracy among our coders ranged from 79% to 91%. This was a surprise since we had not had an audit done all year. Review of the audit results by coder made it clear that we had both performance issues and training deficits. The CFO had approached us about why the denial rate increased in recent months – now we know.”

“The DNFB standard at our hospital is no more than 3 days revenue. We meet that standard occasionally but typically run at about 7 days. Week-ends, holidays, technical issues, turnover and absences are keeping us from meeting our standard. Overtime is not approved here so performance suffers.”

Coding outsource is not for every facility but it is an option that meets the influencers illustrated above head on. The benefits of outsourcing include:

  • The facility no longer incurs certain costs shifted to the vendor:
    • Employer FICA taxes
    • Workers comp, health benefits, retirement plan
    • PTO & holiday pay
    • Software licensing and maintenance
  • Space occupied by internal coding staff can be used for revenue producing or other services deemed strategic:
    • Desks, office equipment, phones etc. can be re-purposed
  • Staffing problems are eliminated. The outsource vendor maintains expert staff with credentials and experience to accommodate any service type while meeting production standards. Coverage for vacancies, holidays, week-ends and PTO is provided by the vendor.
  • Testing, training, continuing education, meeting attendance, trade association dues, audits and other “soft cost” items are the responsibility of the vendor.

It is important to consider not only influencers but also “inhibitors” related to outsourcing when assessing the processing environment for your coding function. Inhibitors might include the absence of technology to support remote processing, the perception of job loss or merger/acquisition activity that prohibits contracting. Another inhibitor is the unwillingness to partner – the outsource option requires good communication and a “partnering approach” in order to capture the many benefits associated with it.

This article is only a summary of different medical coding options. We hope you find it thought provoking. Whether you are considering outsourcing the entire coding function or you simply need coding support from time to time, or maybe Interim HIM Leadership, we at Nearterm are available to assist you.

Feel free to call or ask the experts if you would like to access our team or offer comments about this topic.

Posted By: nearterm-admin

Medical Coding Managed Services

Medical Coding Services

Do you have a medical coding backlog?

Are you behind on your coding audits?

Need a Coding Audit Program?

Never fear, Nearterm is here!

We help healthcare organizations meet their coding and coding audit needs as part of our overall 360 RCM Managed Services.  Our national client base includes hospitals, clinics and other provider types. All of our medical coders and auditors are credentialed, certified, vetted, professionally managed, and located in the United States. Nearterm coders are held to productivity and accuracy metrics that exceed industry standards.

In addition to the medical coding and audit services described above, Nearterm also provides leadership, implementation support and project management services for all RCM activities and projects. We offer a comprehensive 360 solution from patient access to accounts receivable resolution. Nearterm resources can work from remote locations and/or onsite, whatever your organization requires of them. Nearterm can deliver top notch talent for:

  • Interim Leadership (VP, Director, Manager, Supervisor, Team Leader)
  • Consulting (Discovery, Research, Analysis, Planning, POA, Implementation Support)
  • Technicians (Billers, Collectors, AR Specialists, Coders)

If you need help, Nearterm is ready to deliver! Ask A Nearterm Expert.

About Nearterm

Established in 1997, Nearterm is an employee-owned, professional managed services company providing expert revenue cycle management (RCM) and financial management services to hospitals and healthcare organizations nationwide.

 

Posted By: nearterm-admin

A Deluge of ICD-10 CM/PCS Codes is Coming to All Healthcare Facilities: What to Do?

Jim Matthews  ICD-10 CM/PCS
Jim Matthews, Principal, Nearterm Corporation

On October 1st of this year, a deluge of over 5,000 new ICD-10 CM/PCS medical codes and other changes are coming to hospitals and clinics nationwide. The stakes are high so it is important to get it right the first time. Errors may lead to delayed or denied claims, negatively impacting the revenue cycle management process and, therefore, cash flow.

On top of that, complying with ICD-10 CM/PCS requires a substantial investment in education and technology, pushing the stakes even higher.

Below, Nearterm offers suggestions on what hospitals can do to mitigate the impact of ICD-l0 CM/PCS. The big one is to create a Plan of Action (POA) to uncover and address shortfalls and unpreparedness in all RCM functional areas.

HIM Management

  • Develop a POA. Determine the level of quality and sufficiency in current coding and documentation processes by doing a formal discovery and assessment. Research might reveal that a Clinical Documentation Improvement (CDI) program is needed or should be All relevant Changes to PracticeWork Flow and Business Processes should be covered in the POA.

Medical Coding & CDI

  • Ensure all Medical Coders and CDI specialists are trained on the new/revised codes and how they may impact current business
  • Update CDI and Medical Coding policies to include directives on the new codes if applicable
  • Follow up weekly with Coders and CDI specialists to discuss specific code sets/procedures that may require updating current Queries.
  • Ensure that you have a point person assigned to regularly check coding for quality

Physicians & Practitioners

  • Physicians must be vigilant and ensure that all documentation remains at a high level of specificity
  • For high impact surgeries and diagnoses, complete a 5-to 10-chart/ provider documentation review to ensure the documentation supports the highest level of specificity
  • Include the physicians and practitioners in the audit results and provide education on documentation opportunities that support the severity of illness of their patients.

Billers

  • Billers should also become familiar with expanded ICD-10 code sets for the specialty for which they bill
  • There will likely be snafus related to reimbursements. How to create referrals and order services IS going to change. Effective October 1, 2016, Medicare will no longer accept unspecified codes for Part B. Have the POA include ways to prevent these accounts from being billed before a second level coding review can be done.

Outpatient

  • In the outpatient hospital side, queries may have to be sent back to the ordering provider requesting specificity either before the patient is seen (at registration) or at the time of coding for final billing

Vendors

  • Do not forget to make sure that vendors are up to date and ready for the expanded codes on October 1, 2016.

About Nearterm

Established in 1997, Nearterm is an employee-owned, professional managed services company providing expert revenue cycle management (RCM) and financial management services to hospitals and healthcare organizations nationwide.

Nearterm specializes in the delivery of additional “horsepower” for implementing and supporting RCM activities and projects. These resources can work from remote locations and/or onsite, whatever hospital and the POA requires of them. Nearterm delivers only top notch talent;

  • Consulting (Discovery, Research, Analysis, Planning, POA, Implementation Support
  • Leadership (VP, Director, Manager, Supervisor, Team Leader)
  • Technicians (AR Specialists, Coders)

Nearterm is a recognized authority in Revenue Cycle Management

 

Posted By: nearterm-admin

Are you Ready for the ICD-10 CM & PCS Deluge?

ICD-10 CM & PCS Deluge Medical Coding

NEARTERM WILL KEEP YOU DRY

On October 1st, of this year a deluge of over 5,000 new CM and PCS medical codes and other changes are coming your way!

  • CMS opens the dam to release the five-year hold on these codes and a one year reprieve for unspecified codes.
  • ICD-10 CM will have 1,943 new codes, 422 revisions & 305 deletions
  • ICD-10 PCS will have 3,651 new codes and 487 revisions

This represents a formidable challenge for healthcare organizations as we approach implementation of these changes. Your organization should be prepared with coder training, clinical documentation policies and new query updates already underway.

In addition, it is important to ascertain that providers are included in educational opportunities to review the new documentation requirements supporting Severity of Illness, Risk of Mortality and Medical Necessity.

There are many risks associated with the coming changes that hospital and physician organizations must consider. Here is a summary:

  • Susceptibility to denials and loss of payment if coding reported does not meet the expanded coding standards
  • Presence of staffing adequate to sustain DNFB targets – it will take additional time to navigate through coding pathways to refine coding practices.

If you would like extra horsepower as you prepare for what’s coming and/or perhaps additional support post-implementation, we are available to talk about how we can help. Our professional staff and medical coders are led by AHIMA Approved ICD-10 CM/PCS Trainers. Our coders and consultants undergo continuous education via coding clinics and “hands on” training aimed at new coding guidelines and compliant query opportunities.

We can get you ready for the deluge and we’ll keep you dry.

Learn More about our Medical Coding Services

Learn about our RCM Project Staffing Capabilities including for Coding

Ask the RCM Experts

Posted By: nearterm-admin
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