The Transformative Power of Strategic Partnerships in Healthcare Outsourcing Services

The Transformative Power of Strategic Partnerships in Healthcare Outsourcing Services

The efficient and accurate management of medical coding plays a pivotal role in healthcare facilities’ financial health and operational success. It ensures proper reimbursements, avoids claim denials, and maintains operational efficiency. However, coding backlogs and merging facilities can quickly disrupt these processes, leading to significant financial strain. This is where medical coding consulting companies and healthcare outsourcing services offer a lifeline. We’ve had the privilege of championing two remarkable success stories where our consultants have made a profound impact.

From slashing coding backlogs by 86% in a hospital’s radiology department to improving ProFee coding accuracy for a merging healthcare facility, these outsourcing success stories exemplify the transformative power of strategic partnerships and innovative healthcare outsourcing services in addressing complex coding challenges. We’ll explore the challenges faced, the strategies implemented, and the remarkable results achieved through outsourcing.

Success Story #1: How We Helped One Client Slash Their Coding Backlog by 86 Percent

Addressing the Client’s Backlog Challenges

Our case study spanned 15 months and focused on streamlining coding for the client’s freestanding outpatient radiology imaging centers. The hospital faced a significant coding backlog exceeding 3,500 encounters. This backlog stemmed from the retirement of experienced coders and the difficulty in finding qualified replacements.

Here were our key objectives:

• Reduce the Coding Backlog: Our primary goal was to significantly decrease the backlog, aiming for a manageable level of 1,000 or fewer encounters per day.
• Streamline Internal Processes: We aimed to establish standardized coding procedures to prevent future backlog build-up.
• MIPS Coding Integration: We needed to develop a system for seamlessly incorporating Merit-based Incentive Payment System (MIPS) coding requirements into the daily workflow.
• Smooth Transition Plan: We wanted to create a clear path for the client’s in-house coding team to eventually take over all coding operations.

The Backlog Buster Approach

Our team designed a multi-pronged approach to tackle the coding backlog and establish long-term solutions. Here’s what we did:

• Increased Staffing Power: We brought in additional auditors, coders, and YES consultants to supplement the client’s existing coding team.
• Specialized Training and Resources: We provided facility-specific coding manuals and specialized radiology training materials to enhance coding accuracy and consistency.
• Structured Action Plan: We developed a comprehensive tracking system and action plan to efficiently distribute coding assignments and monitor progress.
• Automated MIPS Coding: We implemented an automated alert system within the coding software that flagged specific CPT codes requiring additional MIPS measures. This significantly reduced research time and ensured accurate MIPS coding.

The Results: A Backlog Slashed by 86%

After 15 months of collaborative effort, the results were impressive. We successfully reduced the coding backlog by a staggering 86%, bringing it down to a manageable level of 500 encounters per day. This exceeded our initial target goal and significantly improved the hospital’s financial outlook.

Perhaps most importantly, the project achieved its final objective: a smooth transition of coding responsibilities back to the client’s in-house team. This ensured the hospital’s long-term coding capabilities.

Don’t just take our word for it – here’s what one Client HIM Director had to say, “YES HIM Consulting, Inc. has provided us with relief of coding backlogs – enabling us to improve our coding turnaround times significantly. YES HIM representatives are always kind and courteous and willing to assist promptly to our needs.”

Next Steps for Your Facility

This case study serves as a valuable blueprint for hospitals facing similar coding challenges. Here are some proactive steps you can take to prevent coding backlogs and ensure efficient revenue cycle management:

• Develop Standardized Procedures: Establish clear and consistent coding processes through facility-wide coding manuals and guidelines. This promotes accuracy and efficiency.
• Maintain Adequate Staffing: Regularly assess staffing requirements to ensure you have an appropriate number of qualified coders to handle the workload.
• Embrace Technology: Explore integrating automated coding software and other advanced technologies to streamline manual processes and minimize errors.
• Partner with a Reliable Healthcare Outsourcing Services Provider: When faced with a significant backlog or staffing shortages, consider partnering with a reputable Healthcare Outsourcing services company. We offer a comprehensive range of services, including coding support, consulting, education, and auditing solutions.

Success Story #2: How We Helped a Merging Healthcare Facility Boost ProFee Coding Accuracy

Mergers and acquisitions are a strategic move for many organizations, offering opportunities for cost reduction and market expansion. However, integrating coding practices from diverse entities can present challenges. This case study explores how YES partnered with a medical facility to address these challenges and achieve significant improvements in ProFee coding accuracy.

Addressing the Client’s Coding Quality Challenges

This specific case study involved a healthcare facility merging with a large, independent physician group. The primary concern was the potential impact on overall coding quality, coder turnover, and productivity due to integrating different coding practices.

We implemented a comprehensive Coding Quality Improvement Plan with four key objectives:

• Identify Pain Points: We thoroughly assessed the merger’s impact on coding practices to pinpoint areas needing improvement.
• Develop a Quality Improvement Program: We designed a customized program specifically tailored to address the identified challenges.
• Track Progress and Analyze Results: We implemented a data collection and analysis system to monitor the program’s effectiveness on coding accuracy.
• Future Recommendations: Based on the data, we formulated recommendations for ongoing improvement and addressing similar challenges in the future.

The Results: Seeing the Coding Quality Improvement Plan in Action

The Coding Quality Improvement Plan was implemented for 33 months, yielding impressive results:

• ProFee Coding Accuracy Soared: Over the 33 months, ProFee coders from both the facility and physician group witnessed a significant increase in coding accuracy. CPT coding accuracy for both parties rose by over 16%, with DX coding accuracy experiencing similar growth (17.65% for facility coders and 15.91% for physician group coders).
• Reduced Coder Turnover: The program fostered a supportive environment, leading to a remarkable 0% coder turnover rate for the final year. This stability further contributed to accuracy improvements.
• Successful Transition of Complex Encounters: YES HIM Consulting’s team consistently maintained a higher accuracy rate for complex encounters compared to both facility and physician group coders. This expertise ensured accurate coding and maximized reimbursements.
• Physician Group Coders Showed Improvement: While YES HIM Consulting coders remained the accuracy leaders, physician group coders also demonstrated significant progress, achieving a CPT accuracy rate within 1.7% of YES HIM Consulting coders and a DX accuracy rate within 6% by the end of the program.

This case study demonstrates the power of a well-designed Coding Quality Improvement Plan. By taking a holistic approach, we significantly improved coding accuracy for both the facility and physician group, resulting in increased revenue, improved efficiency, and a more stable coding team.

With almost two decades in the industry, YES has garnered many outsourcing success stories. Here’s what another Client Director of Coding & Documentation said, “YES HIM Consulting, Inc. has been our selection of vendor for auditing, education, and coding needs for many years. The YES team is fantastic to work with, providing timely, accurate, and professional services at all times. The personal attention they provide to our specific needs and/or requests is invaluable. They are and will continue to be our ‘go-to’ vendor for many years to come!”

YES offers a comprehensive suite of ProFee coding solutions. We possess the expertise and experience to assess your unique needs, develop a customized program, and achieve optimal coding performance within your organization.

Interested in Learning More About Our Healthcare Outsourcing Services?

We understand that every healthcare facility has unique needs and challenges. In addition to the success story and recommendations above, we’ve compiled some additional resources to help you optimize your coding processes:

Case Studies Library: Explore a collection of case studies showcasing how YES has partnered with various healthcare facilities to address their specific coding and HIM needs. Gain valuable insights into how we can tailor our solutions to meet your unique challenges.

Don’t let a coding backlog and disjointed coding processes cripple your hospital’s financial health. Our team of experts at YES is here to help. We can help you proactively address your coding backlog, standardize coding practices, and implement sustainable solutions for long-term efficiency.

YES is committed to helping hospitals achieve optimal coding performance. We offer a complete suite of solutions designed to address your specific needs, from backlog reduction and process improvement to ongoing coding support, education, and auditing services.

Contact us today to schedule a free consultation and discuss how we can help your hospital achieve efficient, accurate, and compliant coding practices.

Together, we can ensure your coding operations run smoothly and contribute to the overall financial health of your facility.