The 2nd annual HIM Benchmark Report sponsored by ADVANCE for Health Information Professionals and himagine solutions provided some very interesting insights from HIM leaders across the country. Perhaps the most compelling data point by respondents was related to the challenges they experience with outsource coding vendors. Two-thirds of the 2016 survey participants indicated coding quality was the biggest challenge they faced with vendors, which nearly doubled from the 2015 report where only 34% of respondents stated vendor quality was their biggest challenge.
Clearly, outsource coding vendors are not meeting the quality expectations of their customers. This article will offer insights that will help you overcome this pain point and achieve your department objectives.
Find a Partner, Not a Vendor
How many coding vendors do you currently work with? I know of many large health systems that have worked with as many as 7-9 vendors. Why so many? In most cases providers engage a number of companies, given that one or a select few cannot meet their ongoing needs.This transactional approach creates a number of issues. First, managing all of these vendors is time consuming and takes you away from your core responsibilities. Second, many providers only engage outsource vendors to fill short-term needs and are unable to make any significant commitment to vendors. In this type of model vendors have very little incentive to make the appropriate investments in their coding resources to ensure consistent quality. The result is -- you guessed it -- an underperforming coder and unsatisfied client.
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The word "vendor" implies a transactional, short-term, and even sterile kind of relationship. What if you looked at the coding volume you typically outsource in a year's time and allocated it to a qualified partner who could work with you to focus on your specific needs, agree on quality and ongoing audit expectations, who focused on continuous education training and made a formal commitment to qualified management oversight of their coders so you did not have to manage them yourself? I think we would all agree that is a better outcome for all involved -- but how do you find a partner?
What to Look for in a Coding Partner
The outsource coding market is highly fragmented, with few companies of adequate scale. Many are simply staffing companies that place coders, in addition to a myriad of other types of positions that may or may not even be healthcare-related. As you vet potential partners, here are some key questions to ask to ensure you identify someone who is truly a fit for you:
Are you focused exclusively in healthcare? Why would you work with a company that places IT and accounting roles? You need a partner that understands healthcare and HIM and has a track record of commitment in the space.
What infrastructure do you have in place to manage your HIM professionals? This question is very critical. In many cases, a "vendor" will say that a coder will have ongoing management support, but when you peel back the onion they are really reporting to a "staffing" manager who has no HIM expertise. Ask specifically if their coders report to an HIM supervisor or manager. What is the typical ratio of coder to manager? If they do not know or it is more than 20 to 1, then that is a huge red flag. Ask for a copy of their HIM operations organization chart complete with years of experience of their leadership team. Ultimately, you want your partner to manage their coding resources so you do not have to. These questions will help you determine if they are truly able to do so.
How do they audit their coders and what is their commitment and plan for continuing education? Many companies say they audit their coders, but in reality it is more of a reactive versus proactive practice. Ask the company what their minimum recommended audit program is. How many auditors do they have on staff to meet these requirements? You can quickly figure out if they are staffed appropriately. Do they have an auditing software tool to help streamline audits? Ask them for an example of a typical auditing report so you can see how comprehensive their work is. Lastly, code sets are in constant change and coders need continuing education to maintain and develop their skills. Ask a potential partner if they have a continuous education team that is responsible for training their HIM professionals. Who runs this program and what is their experience in HIM? What technology do they use to educate their coders? You should be able to quickly determine how sophisticated their operation is based on the answers you receive.
Finding a coding partner is not easy, but with a good vetting strategy in place you can identify the companies who have the expertise, scale and vision to meet your needs. It does take some time, but the alternative "vendor" model will take more time in the long run and you will continue to be unsatisfied with the results. Put in the time upfront and the return on that investment will make it worth it.
Andrea Romero, RHIA, is senior vice president of HIM Operations at himagine Solutions and an active member of AHIMA and the Florida Health Information Management Association.