Cost containment and expense reduction have been top priorities amongst hospital executives for years, but never have they been more important than in the pandemic era we are living in today. Hospitals have seen plummeting revenue for nearly three months now – a financial catastrophe from which some may never recover.
Even for those health systems that were in strong financial standing heading into 2020, must now consider drastic measures and radical cost containment initiatives, in addition to revenue enhancement efforts, in order to make up for months of lost inpatient, outpatient, and procedural volumes. When organizations look to areas that could help make the most significant contributions to the bottom line – they ought begin with the Health Information Management (HIM) teams that serve as the gatekeepers of numerous critical functions including medical coding, auditing, and clinical documentation.
For struggling hospitals, HIM teams may just be the answer. Here are the top three strategies to contain costs that could lead to millions of dollars saved per year.
- Keep Coding Accurate and Efficient. It goes without saying that medical coding is critical and complicated, and things are always changing. Many organizations employ a combination of in-house coders and also at least one (if not multiple) outsourced coding partners which are experts with ongoing training and education, accuracy, and overall efficiency. Oftentimes, health systems err on the side of undercoding to avoid regulatory scrutiny – leaving a wealth of lost revenue on the table. An integrated team can help provide checks and balances to ensure coding completeness, compliance, and accuracy. As it relates to efficiency, a hybrid approach allows health systems to scale their coding teams up during spikes in patient volumes – and to limit costs and resources when volumes drop. Finally, many coding outsourcing partners employ advanced technologies such as computer-assisted coding (CAC) and artificial intelligence (AI) that can help health systems further streamline and improve coding accuracy.
- Audit Always. Organizations that routinely audit coding performance for accuracy and compliance (concurrently and retrospectively) will proactively avoid the perils and pitfalls that lead to higher costs, lower reimbursement, and other missed opportunities. In most cases, partnering with an outsourced organization is best practice to gain an outside perspective at the HIM team’s processes and performance. GeBBS’ iCode Assurance (iCA) technology is a comprehensive medical coding audit software as a service (SaaS) that provides detailed scorecards, robust reporting packages, and accelerates the coding audit process. iCA is customizable and is based on OIG audit methodology and AHIMA’s best practice standards – offering peace of mind for coding and compliance adherence.
- Focus on Improvement. Studies show that effective clinical documentation improvement (CDI) programs can lead to significant increases in revenue through more accurate claims reimbursement for health systems. CDI programs can provide ongoing feedback and education for coders and physicians alike by identifying opportunities for more accurate documentation that will translate into improved coding accuracy and increased revenues over time. Many hospitals report increases in their overall patient case mix index within just a few months of focusing on CDI, which can lead to exponentially higher overall reimbursement.
When it comes to health information management, getting it right can have a significant impact on your revenue cycle and reimbursement. Claims that are submitted accurately the first time get paid more quickly and reducing denials can strengthen your long-term fiscal health. While in-house expertise is critical for all health systems, looking outside to an outsourced partner can help reduce overhead while improving accuracy and performance.
GeBBS Healthcare Solutions offers a wide range of HIM solutions – including onshore, offshore, and blended delivery service models. Our comprehensive offerings and expansive team of certified coders includes coding for hospitals and physician practices, inpatient and outpatient services including a vast spectrum of specialties. Additionally, GeBBS specializes in CDI and audit services (concurrent and retrospective) that will reduce denials, provide greater accuracy, improve compliance, and enhance overall performance. To learn more about GeBBS’ technology enabled HIM Solutions click here.
