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ICD-10 Medical Coding: Finding the Right Outsourcing Partner

by: Sidney Liquigan

Thursday, November 15, 2018 |

Outsourcing your medical coding is a practical and cost-effective way to delegate a time-consuming and intricate process so you get to invest more of your time and money to provide quality healthcare services.

When finding the right medical coding vendor, you should look for the one that offers the right services and resources that you are looking for, along with competitive rates and scalable packages.

Compliance Standards

Ensure that you are looking for an outsourcing partner that employs a team of AHIMA- or AAPC-certified medical coders who are trained on ICD-10. Compliance with relevant quality assurance and security standards and regulations should also always be considered.

Scope of Service

It's better to outsource all your requirements to a one-stop shop. Claims processing consists of different stages, with each stage requiring specific skills and experience.

  • Initial claims entry
  • Claims status updates
  • Payment posting
  • Claims denial management
  • Collections

Look for a vendor that can provide you end-to-end revenue cycle management services.

Integration

Different vendors operate with different types of software programs. Compare the processes of each potential outsourcing partner and find out which one can easily be adapted to your operations. Most outsourcing firms allow you to specify the software and systems that you need and they will set up the resources. For transparency and accessibility, choose a service provider that uses online portals and cloud-based systems.

Pricing

In addition to comparing service rates and pricing models, also find out if there are additional fees or if they offer add-ons. Are there installation costs or startup fees? If ever you decide to increase your practice’s size, will the rates be affected? Will there be additional costs for software upgrades?

Also, remember that cheaper isn't always better. Make sure to prioritize the quality of service and the scope of services that you need to meet your needs.

Reporting

Make sure that you can access information and reports in real time, and that online databases and dashboards are easy to navigate. In addition to online access, ask the vendor the frequency of their reports and what will be included. You want to find a provider that will send you reports consistently, at least once a month. The reports that you want to be included are denial, operations, and data analysis reports.

Reviews and Referrals

Aside from looking for credentials and certifications, you must also consider what other customers think of the services and reliability of the medical coding provider. Look for providers that have clients that have the same nature of business as yours, with the same size and have outsourced the same medical coding processes that you require. It’s also best to ask other healthcare practices for their recommendation.

Contract Requirements

Medical coding and billing are crucial processes, so you must ensure you understand what the contract guarantees and that all the important details are indicated. Make sure you know what the minimum contract requirement is and that there is a clause noting how you can opt out if the provider is not meeting your expectations.

Support

When you outsource your medical coding to a provider, find out what kind of support you will be receiving. Who will be your contact person? Will there be an account manager? What is the level of control you will have? Outsourcing providers will not only help you recruit and set up an offshore office space, they also provide support services such as HR management, IT support, facilities management, and finance.

When it comes to control, firms that have the traditional outsourcing model hold all operational control. But for businesses that still want to retain control over their offshore operations and take advantage of the benefits of outsourcing, there's also the managed operations model. This approach involves a local dedicated management team that will help you oversee your operations, but the KPIs, the processes, and the standards will be up to you.

Conclusion

Ultimately, don't rush your decision. The vendor selection process and negotiations can take time, but it will all be worth it once you find the outsourcing vendor you were looking for. For everything to go smoothly, ensure that all involved are in the loop and have clear communications.

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