Medical Coding Outsourcing Provides Solution to Backlogged Coding Rejections
INTRODUCTION
A leading provider of medical billing services and solutions for hospital-based doctors and medical practices that serves more than 3,000 hospital-based physicians across the nation faced a severe financial challenge in the form of coding rejections. The practice management company that the billing services company used was experiencing heavy coding rejections, and since the billing service had specialty divisions for emergency medicine, radiology, anesthesiology and pathology practices across the entire U.S., the rejections kept piling up faster than the company could resolve them, so they continued to fall farther and farther behind.
THE CHALLENGE
Their challenge was compounded by the fact that the billing service’s highly-paid coders were spending too much time working on rejections, rather than coding new cases. Coding productivity was being significantly impacted by the rejection work. Another problem was discovered in that coders were not documenting their rejection work in the billing service’s practice management system. This lack of proper documentation made it difficult for back-end and front-end staff members to know where to post a payment or denial after they had received a correspondence from an insurance company, because the information was not in the practice management system.
Cash flow was being severely impacted because revenue was going into an UNID account; add to these problems the fact there was also incorrect and slow charge entry. Everything was suffering due to the delays in coding. The company’s coders were working as hard and fast as they could, but this created another problem — rising overtime costs became a large concern.
Because the billing services company had coders nationwide, they faced the challenge of finding a single solutions provider to handle this multi-faceted challenge.
SOLUTION
The company called in GeBBS Healthcare Solutions, a global provider of high quality coding services to healthcare providers. GeBBS offers a team of literally hundreds of experienced Certified Professional Coders (CPCs) accredited by the American Academy of Professional Coders (AAPC). They have proficiency in CPT-4, HCPCS, ICD-9-CM, LCD/NCD and CCI EDITS. The company also had expertise in the exact medical specialties that the billing company served.
GeBBS sent a Transition Manager to the site to ensure a seamless transition for the pilot project and to ensure a clear communication channel was open between the client and GeBBS. The GeBBS’ team also conducted regular web-based training, provided conference calls to answer staff member’s questions and managed other training requirements.
To solve the multi-level challenge, GeBBS put in place four critical elements:
- An experienced team of coders to meet each specialties needs
- Proper staff training
- Workflow process standardization
- Implemented necessary changes in entering data into the billing service’s practice management system
GeBBS began working the rejections at the company’s various locations. The majority of these rejections were backlogged as much as 40 days or more. The project was begun by reviewing the coding rejections dashboard from the practice management system and copying the information on Excel spreadsheets. The coding rejections were sorted by – PQRI, CCI, LCD, NCD, etc., and provided to the coding manager for reference. This helped in identifying trends and the information was shared with coders working at various locations.
The coders were then able to code more accurately in accordance with reimbursement requirements. The GeBBS coding team addressed the oldest rejections first and then to continued working the remaining ones in a timely and effective manner. The charge corrections team ensured that all changes made by coders were correctly documented in the practice management system, and the status tracker was shared with all coding and charge entry managers for reference. GeBBS researched, accumulated and analyzed all the supporting documentation and determined the appropriate check amounts to be printed.
GeBBS solution allowed the billing company’s coders to spend the majority of their time working on coding new reports, instead of handling rejections in the practice management system. Coder’s overtime costs were significantly reduced by 50%. GeBBS worked the rejections overnight, so coders began each day with a “clean slate.” Audits showed a 98% plus pass rates on the rejections worked by GeBBS, and rejections at all locations are now within a week’s date range.
The medical coding outsourcing solution provided the billing company with scalability, so they can now add new billing contracts without investing in additional resources and infrastructure, allowing them to focus on marketing their services to new physician groups and hospital prospects, enhancing their overall corporate profitability.
