Assess remote options, software contracts, and work flow processes to save

Whether it’s a shortage of staff members or the impending transition to ICD-10-CM/PCS, external factors coupled with an already strained budget could force your facility to look beyond small cuts in a search for significant savings without sacrificing accuracy and quality.

 

To address the mounting stresses on its budget, Tufts Medical Center in Boston turned to CNG-ONLINE, an online document management ­system that allows coders to work ­remotely. The switch cut the coding department’s costs in half.

 

Tufts’ employs four inpatient coders and 11 outpatient coders distributed among various clinics. A coder shortage in the Boston area forced Tufts to rely on two inpatient contract coders. Tufts paid for the coders’ services as well as travel costs (e.g., airfare, meals, accommodations), which totaled as much as $30,000 each week. At one point, due to staff turnover and other department transitions, contract ­coders held all four inpatient coding positions.

 

“We’re a big teaching facility in downtown Boston, but nobody really wants to commute or pay for parking,” says Arnette Marbella, BS, RHIT, director of HIM and revenue cycle at Tufts. “[Area coders] could probably get the same pay at a community hospital and not have to bother with the commute.”

With the online documentation solution, Tufts eliminated significant costs associated with travel. Now the hospital only pays a monthly subscription fee based on the number of users and the volume of required file storage.

 

“Because we are prepping for ICD-10, the money that has been saved is going toward reeducation and ­retraining our coders,” Marbella says. “We’ve saved around $200,000 over the last year or so.”

The group also improved turnaround time, and has staggered coding coverage shift for 24/7 coverage. “We can essentially achieve continuous coding. And I’m feeling the benefits now in figuring out summer vacation time; it’s easier to have people cover,” Marbella says.

 

At Kaiser Foundation Health Plan Inc., & Hospitals in Oakland, roughly 60% of coders work remotely, says Gloryanne Bryant, RHIA, CCS, CCDS, regional managing director of HIM (Northern California Revenue Cycle). To do this effectively, however, managers “need to make sure checks and balances are in place for security and quality, and [they] need to ensure that the contract coders are meeting productivity.”

 

Offer a remote coding option only to those who meet productivity and quality standards, she says. If you have eight coders and three of them do not meet productivity or quality standards do not allow them the option of working remotely.

 

Determine if those staff members who cannot meet productivity/quality standards contribute to overtime costs, as well. Perhaps overtime costs are a necessity, but examine coders individually. Those who do not meet performance standards should not receive overtime benefits. “If those three coders are working overtime, you’re ­perpetuating that problem and paying overtime for it,” ­Bryant says.

 

Programs should evaluate work flow efficiencies at least every two years, and more frequently when the coding ­department undergoes system changes, Bryant says.

 

“Perform a time study, and look at all the steps. When you get your coding staff in one room and talk about the steps, people may share that they’re actually doing ­different things to code the same records,” Bryant says. “Look at the movement of the paper-are there redundancies? For those in the paper medical record world, ask if there are pieces of the medical record that are ­often missing so coders have to get up and look for it.”

 

Many times, departments initially employ ­contract coders due to extended absences or staff turnover. “­Before you know it, you’re behind in the FTE goals,” Bryant says. “Sometimes departments end up overextending beyond their thresholds for overtime and external staff.”

 

Plan ahead when you know you’ll need ­potential ­vacation coverage or when a staff member will be taking an extended leave of absence, she says. For example, if you have eight coders in your department and they each have six weeks of ­vacation, analyze the number of hours the FTEs will be gone and negotiate rates for those times with the contract coders.

 

Marbella says the online documentation management system has made reviewing the coding for quality easier to manage. The new system also reduced their discharge not final billed from five days to three because their records are scanned and coded right away.

 

The online documentation system will also help facilitate the transition to ICD-10-CM/PCS, Marbella says. “It will ease the switch because of computer-assisted coding (CAC) based on dictation and documentation,” she says. “We’re trying to blend this technology with our technology for inpatient documentation for physicians, trying to get the two systems to interface.”

 

Bryant strongly supports investigating CAC and its potential positive impact on productivity and quality. CAC uses technology to “read” charts to identify diagnoses and/or ­procedures that have the potential to be coded.

 

“That saves us the detailed job of reading every word in the ­medical ­record,” Bryant says. “Not only does it help identify ­potential diagnoses that we would want to capture, but CAC also provides you with particular potential code(s) that are ready for validation.”

 

This shortens the time required to code a record, which can help cut back on overtime costs and reduce the days in accounts receivable. CAC can also yield ­higher quality and accuracy because the system reads ­every character. Humans may accidentally skip over ­pertinent information or be interrupted and inadvertently miss capturing a diagnosis.

 

For example, CAC coding for ­ancillary services (e.g., radiology, CT scans, or MRI) can achieve 97% accuracy through automation, Bryant says. But CAC is not intended to replace ­coders, particularly in the inpatient arena, Bryant cautions. “You still have to have a validation process,” she says.

 

Look at your coding software ­expenses and consider whether it’s time to renegotiate or look at other vendors. Because of all the scrutiny revolving around compliance (e.g., by RACs), coders need an encoder or some type of coding software that includes online reference tools (e.g., access to ­Coding Clinic or CPT Assistant) instead of having to purchase these tools separately. Assess your current fee structure with your software vendor and evaluate what it brings to the table, Bryant says. “Are they meeting your needs, and could someone else do it at a lesser cost?”

 

Assess the functionality of the coding software and take a periodic litmus test of industry developments. “There’s always good competition, and things are always advancing so quickly in the technology world,” Bryant says. “It’s good to step back and determine whether it’s time for a change.”

 

Editor’s note: This article was originally published in ­JustCoding. For more information or to sign up for a free ­trial, visit www.justcoding.com.