The HIM profession is continuously adapting to change, as driven by the practice of medicine, coding guidelines, government regulations and information technology. For medical coders and their managers, this means not just learning the new ICD-9 and CPT codes each year, but understanding new and updated rules related to abstracting and billing and keeping up with changes in the workplace and work processes. The Internet and secure remote coding applications have extended the HIM department into coders’ home offices. Document workflow and imaging systems are helping to reduce the paper chase that bogs down operational efficiency by providing online access to patient records. However, this technology requires coders to learn new systems and methods for finding information and entering data.
Add to this the shortage of qualified coding professionals described in a recent American Health Information Management Association (AHIMA) survey. Published in the September 2006 Journal of AHIMA and titled “Coders Wanted, Experience Required,” the study found that 76 percent of respondents who had open coding positions within the preceding 12 months reported having difficulty or extreme difficulty filling the positions. Lack of qualified resources puts an HIM organization under stress and causes coding managers to consider other options to supplement their staff or increase productivity. Outsourcing of coding work can fill those gaps, either on a temporary or long-term basis. Also, computer assisted coding (CAC) technology is emerging as an option that can enhance productivity and provide other benefits. While not strictly an either-or choice, outsourcing and CAC have both competitive and complementary aspects that are worth a closer look.
The Outsourcing Relationship
How does a manager choose the approach that is best for her organization? There isn’t a one-size-fits-all method for outsourcing or a single CAC application that works for every organization. Apart from the financial terms, four common factors describe an outsourcing relationship:
1. Scope
2. Control
3. Location
4. Duration
Scope is the extent of the coding process covered by an outsourcing arrangement. For example, a very small scope is a single coder working in single medical specialty such as radiology, while a large scope is the complete coding operation for a billing service or provider organization representing hundreds of thousands or more patient visits per year.
Control is the division of management and operational work responsibilities between the HIM organization and its outsourcing partner. This includes managing the day-to-day workflow, coder training, exception handling, auditing, technical support and performance assessment. An important consideration in the workflow and training is the responsibility for payer specific and site specific coding requirements. Those requirements should be explicit and clearly documented for the outsource resources to assume responsibility.
Location is not just where the outsourced resource is geographically located, but also how the location affects the manner in which the work is done. Outsource coders can work either on-site or remote, and the remote location may be anywhere from across town to across the globe. An important aspect of location is whether the outsource personnel will be directly interacting with the HIM organization’s computer applications or using their own computer applications. Using different applications requires interfacing between the two systems.
Finally, duration is the length of time of the outsource contract. This can vary from a few days to work off a small backlog or cover vacations to multi-year commitments.
To be successful in an outsourcing relationship, a manager should understand his/her organization’s goals and expectations with regard to these four factors. Also, just as employee performance should be regularly evaluated, outsourcing relationships should have performance measures with established benchmarks for coding quality, turnaround time, compliance with privacy and security policies and customer support.
The Benefits of CAC
CAC applications can be described by four potential benefits. Not all CAC applications will offer all four benefits in every situation, so decision makers should evaluate closely what an application can offer their organization:
