Top 4 Reasons to Outsource Professional Fee Coding

by | Feb 15, 2023

Professional fee coding has experienced several big changes in the last few years. In fact, in my 14 years with KIWI-TEK, I believe the last 5 years have seen the most change. An outsourced profee coding model can help your healthcare organization save time and money. Here are my four top-of-mind reasons, compiled from years of experience and direct client feedback:

1. Evolving academic medical centers

Academic medical centers play a central role in our healthcare system, and they’re rapidly adapting as technology evolves and business pressures increase. But increased labor costs can gnaw at an academic medical center’s (AMC) bottom line. AMCs are treating more patients across the United States each year, which in turn drives up their case mix index (CMI), average length of stay (ALOS), and operating expenses.  For instance, patient days at AMCs rose by 17 percent between 2008 and 2020. By comparison, patient days at non-AMC hospitals dropped by 7 percent over the same 13-year period.

When it comes to medical coding for all of these encounters, it’s not just about maintaining the patient volume, it’s also about being able to flex with the volume fluctuations. An outsourced professional fee coding model allows revenue cycle leaders to be nimble and reduce overhead costs associated with full time staff. 

2. The coding industry is still catching up after COVID

As much as we don’t want to dwell on covid, the coding industry went through lots of attrition when coders across the nation were temporarily sent home, laid off or let go. Pre-covid, doctors had their own coders on-site at stand-alone practices. Post-covid we’ve seen an influx of individual practices folded into health systems via mergers and acquisitions, and as a result, inpatient professional fee coding has increased. Combine this with a smaller coder pool and we’re seeing more coding backlogs across customers nationwide. Outsourced profee coding fills the lingering staffing gaps that were created by covid, years later. 

3. E/M coding guidelines are constantly changing

Beyond staffing gaps related to volume, outsourced profee coders have a keen eye for new 2023 E/M coding guidelines.  They have to be extra thorough to select the appropriate level based on one of two things: services rendered / medical decision making or physician’s time spent. If time is documented as 20 min but the coder sees really involved medical decision making notes, the coder needs to make a decision on how to code. This involves going through the 3M encoder tree or grid to determine how and what codes should be applied. All to say, it’s complicated! 

4. Internal staff doesn’t have enough time

We all know there’s a limit to how long we can bill for a patient encounter. If the timeline is 90 days and a healthcare organization doesn’t have enough staff for timely filing, they can’t submit. Let’s not forget that each insurance company has their own guidelines and deadlines. Let’s consider if a facility is short staffed and patient is in the hospital for seven days. If they’re seen by a provider each day, there could be at least seven if not 21 documents just for one patient. With only 90 days to bill, coding could always be backlogged. Outsourcing your profee coding gets bills out the door! 

“We are very invested with KIWI-TEK as a partner. They’ve always done a good job for us. Case in point: we’ve expanded their services beyond hospital walls to professional coding for 400 physicians in our network.”

Marva Rothmeier RHIT, MBA HIM Director, Medical Center Hospital (MCHS)