Many Agencies Pay A Lot For In-House ICD 10 Coding. Meanwhile, Your Profit Margins Continue To Shrink. Make The Change Today. (Part 2)

April 16, 2022

In part 1 of our ICD coding series, we looked at an overview as to why smaller agencies can’t afford to do in-house coding. In part 2, we will look at the dollars and cents of coding in-house. If you currently have employees in this role, have you broken down the true cost to your agency and determined productivity standards?

Cost And Productivity Of In-House ICD 10 Coding:

When we think of productivity in our agencies, we normally talk about clinical employees. Many agencies to not track the number of charts individual coders complete or monitor accuracy in a meaningful way. An RN who is certified in Oasis D and ICD 10 coding should be able to code 12 charts per day or 60 charts per week. If your in-house coders aren’t completing 240 charts a month, you may need to ask why. Our numbers come from a nationwide outsourcing company with many nurse coders on staff. It should also make you ask why you have multiple coders if your admission numbers don’t justify it. It is not uncommon for us to see several in-house coders for agencies with 200 admissions or less. So, let’s do math on cost.

The national average according to Zip Recruiter for an RN who is Oasis D and ICD 10 coding certified is $67,571 base salary. If you consider the average overhead rate of 34% of salary ($22,974), then your overall cost per coder is $90,545. Now, this is just the average. So, we realize there are agencies paying less and agencies paying a whole lot more. The same nationwide agency providing productivity numbers stated it is not uncommon for their coders to be paid $78,000 for base salary. Based upon this number, an in-house coder would cost a total of $104,520 ($78,000 base salary + $26,520 overhead). Now, let’s break these costs down for your agency numbers.

Based on the national average of $90,545 ($67,571 base salary + $22,974 overhead):

1. An agency averaging 100 admission per month is actually paying $905.45 per chart for a coder of this caliber.

2. 150 admissions per month cost the agency $603.63 per chart for the coder.

3. 200 admissions per month cost the agency $452.72 per chart for the coder.

4. 250 admissions per month cost the agency $362.18 per chart for the coder.

5. 300 admissions per month cost the agency $301.81 per chart for the coder.  

If we look at these same numbers based on the $78,000 base pay with overhead to total $104,520, the numbers look like this:

1. 100 admissions= $1045.20 per chart for coding

2. 150 admissions= $696.80 per chart for coding

3. 200 admissions= $522.60 per chart for coding

4. 250 admissions= $418.08 per chart for coding

5. 300 admissions= $348.40 per chart for coding


Kenyon Homecare Consulting charges $65 for ICD coding and Oasis analysis/ review. Based upon those numbers and the level of expertise and certification, you need to do the math for your agency. If your RN coder is doing 240 admissions per month and is certified and accurate, your in-house coding may work well for you in a cost analysis. In our experience, agencies doing 240 admissions per month with in-house coding normally have several coders on staff. So, the costs for your coding department go up drastically. You may be paying the national average of $90,545 for three or four coders to handle your admissions. Suddenly, you are paying between $271,635- $362,180 per year just to keep your ICD 10 coding in- house.  Those same admissions done by Kenyon Homecare Consulting's RN Coding Specialists will save you anywhere from $76,635-$167,180 per year to complete 250 admissions per month.

Let Us Be Your Choice For ICD 10 Coding:

At Kenyon Homecare Consulting , our ICD 10 coding department works with agencies to help them improve documentation and get the dollars they deserve to service patients. All our coding staff are Oasis and ICD 10 certified RNs who know our industry and the requirements in documentation. Call us today at 206-721-5091 or contact us online to see how we can help you save money and still receive excellent coding accuracy and efficiency.

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controlling chronic diseases
By Ginny Kenyon April 25, 2026
In the rapidly evolving landscape of healthcare, the burden of care is increasingly shifting from clinical facilities to the home. As the population ages, the prevalence of chronic conditions—such as heart disease, diabetes, and respiratory disorders—has reached unprecedented levels. For home care agencies, the quality of service is no longer just about assistance with daily living; it is more and more defined by the clinical competencies and disease-specific knowledge of your field staff. Chronic disease education for home care staff is not a luxury, is a strategic necessity that directly impacts patient outcomes, caregiver confidence, and the business’s bottom line. 1. Enhancing Clinical Outcomes and Safety Home care staff are the "eyes and ears" of the healthcare system. When aides and clinicians are highly educated on chronic disease processes, they can identify subtle shifts in a patient's condition before they escalate into emergencies. · Early Intervention: An educated caregiver can recognize the early signs of fluid retention in a Congestive Heart Failure (CHF) patient or skin changes in a diabetic patient, allowing for proactive adjustments rather than reactive ER visits. · Medication Adherence: Understanding why a medication is prescribed for a specific chronic condition helps staff reinforce the importance of adherence to the patient, reducing the risk of complications. 2. Reducing Hospital Readmissions Hospital readmission rates are a primary metric for home health success. Chronic diseases are the leading cause of "revolving door" hospitalizations. By providing specialized education, agencies empower their staff to implement Evidence-Based Practices at the bedside. When staff can effectively manage symptoms and educate patients on self-care, the likelihood of a patient staying stable at home increases dramatically. This not only benefits the patient but also strengthens the agency’s reputation with referral sources like hospitals and physician groups. 3. Boosting Staff Confidence and Retention The home care industry faces significant challenges with staff turnover. Often, burnout is fueled by the stress of feeling unprepared for complex patient needs. Knowledge is Empowerment: When staff members receive robust training, they feel more confident in their roles. This professional growth fosters a sense of value and belonging within the organization, leading to higher job satisfaction and lower turnover rates. 4. Improving Documentation Accuracy In an era of increased regulatory scrutiny, clinical documentation must be precise. Education on chronic diseases ensures that staff members use the correct terminology and focus on the most relevant clinical indicators during their assessments. · OASIS Accuracy: For Medicare-certified agencies, a deep understanding of chronic conditions leads to more accurate OASIS scoring, which directly influences reimbursement and quality ratings. · Audit Readiness: Well-educated staff produce notes that clearly reflect the necessity of care, making the agency much more resilient during regulatory surveys or audits. 5. Bridging the Communication Gap Effective chronic disease management requires a multidisciplinary approach. A caregiver who understands the nuances of a disease can communicate more effectively with: · Physicians: Providing clear, clinical updates that help doctors make informed decisions. · Family Members: Offering clear explanations and peace of mind to stressed family caregivers. · The Internal Team: Ensuring a seamless transition of care and consistent messaging across all disciplines. Conclusion Investing in chronic disease education is an investment in the agency’s future. By elevating the knowledge of the frontline workforce, home care providers can transform from basic service agencies into high-value clinical partners. In the end, the goal is simple: providing the highest quality of life for patients in the comfort of their own homes, a goal that can only be met through a highly trained and knowledgeable staff. If you do not know where to get comprehensive education for Chronic diseases, contact Kenyon Homecare Consulting at gkenyon@kenyonhcc.com or call 206-721-5091. We are here to help
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