I’ve been a coding manager at KIWI-TEK for 16 years. It’s safe to say I’ve seen it all when it comes to the coding profession! After spearheading several professional fee coding programs for clients, I’ve learned what can strengthen the process. Here are three attributes of a strong profee coding program, compiled from years of experience and direct client feedback:
Proactive approach to quality monitoring, action plans and follow through
This sounds easy enough in theory. But when you dig into the details, there are a few factors to consider and implement. For one, profee coding has huge volume versus facility coding. Facility coding has one set of codes while profee coding for doctors providing inpatient services can have numerous (15-20!) encounters across multiple specialties. Documentation and guidelines must be followed for each of those encounters throughout the stay, as every encounter must stand on it’s own should it be audited by an outside payer. Quality can’t be underscored enough with high volume and a wide spread of specialties.
For example, at a large client site, KIWI-TEK reviewed 11,125 encounters in 2022. This was an average of 927 encounters per month at just one site! This means a large number of coders required to manage this volume, coupled with high standards to monitor production and quality.
One of KIWI-TEK’s policies is monthly coder reviews versus the industry standard quarterly review process. A lot of coding vendors conduct quarterly reviews but this has limitations to the client and coder. One limitation is that this method only pulls a small sample and runs the risk of missing issues or identifying errors coding managers aren’t aware of. On the other hand, monthly reviews provide so many learning and growth opportunities for the coding team. The monthly cadence identifies issues in specific chart type areas, pinpointing education for individual coders on a concurrent basis. Education and identification on a monthly basis eliminates the issue. Coders appreciate the feedback and education. They’re happy with tools, management resources and education to be successful.
Real-time review and education addresses quality issues right away, including being put on a review process, given limited volume, and the QA team looking at everything that goes out the door. This high touch workflow helps coders overcome whatever challenges they’re facing.
Backlogs are kept at bay in the background
KIWI-TEK started as a backlog solution in the hospitalist area, with the narrow scope of coding support until the backlog was resolved. It was one of the largest backlogs I had ever seen as a coder – roughly 25,000 encounters! Over 2-3 months our team added coding resources and ramped up production. But more importantly, we set goals to resolve the backlog which the client was very happy about. So much so that it led to our team branching out into other professional fee coding areas.
Every situation is different, but this big backlog stemmed from staffing issues and internal changes. For a healthcare organization to eliminate any type of backlog, there needs to be enough coding staff dedicated to cover the daily volume of incoming work and the backlog. If there are only enough resources to cover the daily inflow of say 300 charts per day, backlog won’t be addressed. An organization would need to almost double their coding resources to eliminate the backlog which is often not financially attainable. Therefore, outsourcing profee coding can be a great supplement to current coding staff.
Outsourced professional fee coding
HIM directors, revenue cycle leaders and coding managers deserve a coding partner that meets their needs on every level. They should expect a staffing plan geared toward timely goal achievement, while also ensuring high quality. An experienced professional fee coding company should provide a manager to oversee those resources to best serve the client without adding to the internal team’s workload.