Supporting Compliance in the New World of Remote and Outsourced Coding & Billing.

Rayellen Kishbach's picture

According to a recent HIM Benchmark Report, HIM department managers equally ranked Coder Productivity, Quality, and Managing Financial Metrics as their biggest challenges, while that same report noted that close to 60% of HIM professionals outsource a portion of their coding needs. Even without direct outsourcing, we notice an increase in the opportunity to do coding and billing work remotely. These trends have me wondering: how does an organization foster and support a culture of corporate compliance when the workers aren't in the office? And, specifically, what resources do remote/outsourced coders and billers need to support their work? In this article, I'll address three key issues: keeping current, getting help, and access to consistent information.

Keeping Current

If you keep up using MediRegs Daily Alerts, or Health Law Daily from Wolters Kluwer, you know all too well that coding, payment, coverage and regulatory requirements change daily. In a "normal" office environment, there are plenty of opportunities at the start of meetings, at the water cooler, or over the cubicle wall to have both formal and informal conversations about new developments in the industry. "In person" organizations have an ambient atmosphere of news, including parsing and isolating the most important changes from the general chatter. So, how does this translate with a remote or outsourced team?

I think the alerts that integral to all Coding Suite subscriptions are a critical element of successful outsourcing, because there is a need for both a comprehensive resource and the ability to filter by specialty.

  • Our daily alerts can be customized by keyword and geographic region, so subscribers get the precision they need to isolate the updates that are mission critical for them.
  • The Compliance Week In Review, which is based on national updates and includes a review of all key developments from CMS and OIG for the preceding week, provides a leveling effect. Everyone in the organization gets the exact same week in review, regardless of their daily personalizations, so no on can say "Oh, I didn't know out about that."

Furthermore, there is so much noise now, with individual professionals subscribing on their own to blogs, email alerts, chat groups and LinkedIn feeds.  It can be a challenge in any environment to isolate the key signals from the noise, and to distinguish what is truth from opinion. Since the MediRegs Coding Suite publishes primary source material from the government (including Medicaid, Medicare Administrative Contractors (MACs)) and authoritative bodies (including AMA, AHA, and ASA), what is included in our alerts is fully citable reference information.

For managers of remote staff, and for organizations that utilize outsourced staff, the Coding Suite provides a consistent, precise, and trustworthy feed of information to ensure that compliance awareness is a daily presence for everyone, directly addressing the HIM director's challenges of quality work and productivity.

Getting Help

When we work in an office environment, there is an organic and informal process of popping down the hall to ask questions. In coding and billing, that might also sound like a more experienced staff member responding empathetically to their neighbor's exasperated sigh when the software or edits aren't behaving as expected. When staff are scattered and working from home, this can become a big challenge. The Coding Suite can be an essential aid for the outsourced or remote worker. Our information is always on, easy to find, and up-to-date.

Whether you need to resolve coding issues, understand NCCI and MUE coding rules, review local coverage determinations to demystify a medical necessity edit, or validate how and why the MS-DRG grouper is behaving as it does, our code explorer tool gets to an answer quickly and efficiently. Training is free, and so is support. Our training program includes exceptional Educational Webinars for subscribers, many with free CEUs from HCCA, AAPC, and AHIMA, which is a great way to help staff keep their certification current. So rather than waiting for a team meeting, or guessing, remote staff who have access to the Coding Suite can simply click the support link to get help with research... for free!

Consistent Information

Now that so much of coding and billing happens with assistance from built-in encoders, easy code-lookups and pre-payment review tools, there is a tendency to "trust the machine" and not know how to respond when an error message or denial happens. And, as discussed above, when an edit or error message appears, there is no geographically handy "go to" person for a quick answer or discussion for remote workers. In the case of denials, when the encoder and review tools missed the error, going back into the same tool often won't provide an answer. This is where the high quality reference material in the Coding Suite comes in handy. 

A key issue regarding consistency of information is the reality that for most outsourced coders, it is a common practice to "use the tools of the client organization." This means that staff will have access to a myriad array of coding reference tools, from high to low quality, and from easy to difficult to use. These tools might provide out of date or incomplete information. When staff have to go fishing for answers not available in their client-provided references, there is a risk of loss of both accuracy and productivity. And imagine trying to train staff to work consistently when everyone is seeing different tools and screens! 

Just like the alerts can provide a "level set" for your staff, giving the entire remote/outsourced team access to the Coding Suite means that the entire team can be on the same high quality page, regardless of which organization they are signing in to help on any given day.

See for yourself

The best way to see how the Coding Suite can help keep your program current and compliant is to have a look at the tools. We'd be happy to offer a free web-based product demonstration any time.