Today, with the inception of PDGM around the corner, it is no secret that ICD-10 coding and documentation are important. Here’s the thing, are you doing it right and keeping up with changes as they occur? Let’s look at the complexity of coding today and consider why outsourcing may be your best answer.
Top 4 Reasons Agencies Don’t Outsource ICD-10 Coding:
Being in different agencies throughout the US, there are some consistent reasons agencies still code themselves. Here are the 4 we see most frequently:
- Too Small A Medicare Program To Worry About It: Many agencies complete more Medicaid services than Medicare, so they do not recognize the importance of diagnosis coding since it isn’t linked to reimbursement like Medicare.
- Nurses Complete The Coding Process: Nurses have so many things to cover during a nursing visit. The responsibility of nurses doesn’t allow coding to be a primary focus. The reality is, complexity of the coding process requires those who code to be certified to do it right.
- Have Certified Coders On Staff: Many agencies have invested the money and time into having staff on site who are certified. Many times, agencies have these employees doing multiple roles within the agency and ultimately, the quality of the coding process and accuracy suffer.
- Outsourcing Costs Too Much: Agencies are trying to cut costs and sometimes this comes at the expense of proper coding. These agencies lose money by not coding properly and set themselves up when it comes to compliance.
Why You Can’t Afford To Think That Way Anymore:
If any of those four reasons ring true for your agency, then it is time to reconsider. Ultimately, a small Medicare program doesn’t mean coding doesn’t matter. As we move continue through more and more auditing, improper coding puts you at risk to lose dollars. The thought may be that a small fish in a big pond won’t be reviewed, but this isn’t true. Pre-Claim Review and the Review Choice Choice Demonstration (RCD) prove this is not the case. If your state isn’t currently involved, understand that in some way at some point you will be. Don’t be caught behind the 8-ball.
Is is still very frequent to see non-certified employees do coding. This may be nursing or therapy in your organization. Do not make the mistake of assuming that a medical background makes you qualified to code properly. Many agencies also have non-clinical employees coding who are basically self-taught. We hear that the “coder” attended certain seminars or webinars on coding. In these same agencies, the manuals being used are often outdated and the coding employee does not know how to stay educated as coding changes occur.
Those agencies who have a certified coder may only have one. This is a big responsibility. There is one person who doesn’t have anyone else to consider coding scenarios with or even know if an interpretation is incorrect. Have you completed a check-and-balance to assure your coder has that ongoing level of competency? This puts you potentially in the line of fire. Do a side-by-side comparison with an outsourced company to see if discrepancies exist.
Having your own coding staff is expensive as an employer. Yes, a great coder is worth his or her weight in gold and agencies should hold on to those individuals! But, agencies need to realize that keeping up-to-date with coding changes is a full time job. We see agencies say they cannot hold onto all coding staff if employees don’t function in dual roles. Therefore, you have someone who cannot dedicate the time and effort into the coding process. In dual role functions, employees tend to migrate to the job function they like the most. Does this mean your coding suffers in your agency? If so, then you can’t afford in-house coding especially considering turnover time between billing the RAP and the Final in a PDGM world.
Let Kenyon Homecare Consulting Be Your Coding Solution:
At Kenyon Homecare Consulting, we can be your outsourcing solution from Oasis and Coding to documentation review. Consider Kenyon as your back-up in times of illness, surge, or extended leave. Don’t miss the reimbursement dollars you deserve or put your agency at a compliance risk. Call us today at 206-721-5091 or contact us online to see how we can help you. We will complete 5 side-by-side re-codes free of charge to help you see the difference.