1. Internal resourcing:
- Finding an experienced certified cardiology coder eager to educate and spend significant one-on-one time with physicians is difficult. In addition, employees must be self-directed and highly motivated.
- Employed coding staffs are dedicated to a single practice and rarely have the same amount of comparative experience as consultants do.
- While employed coding staff have immediate access to the necessary documentation, they are typically directed to perform audits strictly for compliance purposes only (i.e., did the documentation meet the level billed?) and are rarely “incentivized” to educate physicians or pursue missed revenue. Some practice administrators actually discourage communication between coding staff and physicians, opting for a management-level only approach.
- Employed coders must take significant time to remain current with coding rules and regulations by attending costly seminars and multiple webinars throughout the year.
- Employee turnover creates a “hole” in the compliance program until a new employee may be hired and provided extensive training.
2. Bandwidth:
- Most business offices typically do not have the resources for auditing, compliance and continuing one-on-one education functions. The bulk of staff’s time is spent on such revenue cycle management tasks as obtaining authorizations, posting charges and payments and working denials.
- In order to be effective, physician education and compliance audits must be conducted on a regular basis year after year. This annual requirement pulls resources away from an already stressed billing office, taking time away from revenue cycle management, which is what revenue cycle staff do best.
- Coding departments are often understaffed and overstressed just focusing on compliance, which does not allow for an appropriate review of physician documentation.
- Consultants can dedicate more one-on-one time than in-house staff to educating physicians and focusing on issues that need the most attention
3. Expertise:
- Physicians often disregard in-house coding staff’s recommendations and instruction because they do not have the same level of confidence in their own staff as they do in external experts who dedicate their careers to coding education.
- Consultants are generally certified, credentialed and have years of experience in auditing and educating physicians and staff across multiple practices. Consultants also focus solely on the audit procedure, which enables them to provide quicker, more accurate results. Physicians tend to become more engaged with such a responsive approach.
- Because of their level of education and experience, consultants can interact with physicians on a higher level than employed coding staff, who may lack the confidence and clinical knowledge to discuss cases with a physician.
- Consultants have experience with intense, one-on-one physician education and dealing with all personality types and are, therefore, more likely to be affective at changing bad documentation habits.
- Because consultants have experience with a number of physician practices, they can share proven processes, ideas and best practices.
4. Process:
- Outsourcing offers an expert, independent opinion and will improve compliance while providing third-party assistance with RAC audits and appeals.
- Outsourcing provides professional resources and education for procedure coding. Many employed coders are not experienced or simply not comfortable coding the more difficult peripheral vascular, electrophysiology and cardiothoracic and vascular surgery cases.
Cost:
- Outsourcing coding expertise often costs less than the labor costs of an additional FTE.
- Historically, outsourcing coding expertise has more than paid for itself, with an ROI of 300 percent or more in many cases.
