Editor’s Note: Jason Lewallen is Director of Sales and Marketing for Home Health Solutions and a noted speaker, blogger and author in the home health field. This article first appeared in SOLUTIONS, the monthly e-newsletter from HHS.
By JASON LEWALLEN
Outsourcing is a hotly debated issue in the home health and hospice industry. Home health agencies know they need to narrow their margins while maximizing their reimbursement, but historically, it has been thought to be more beneficial to have a person on staff to handle each part of the process. This especially applies when it comes to clinical matters. Legal risks, privacy concerns and the delicate nature of our business makes us wary about trusting another entity with these matters.
Whether outsourcing is the right option for your home health agency depends largely on how you answer the following questions.
Do you really need a specialist?
In a fluid health care market where guidance changes frequently, regulatory demands are constantly evolving and penalties are formidable, agencies recognize the indisputable value of staying fully informed and well trained. Even so, agency leaders often struggle to justify hiring specialized services. The simple fact is you would not ask a plastic surgeon to treat cardiac issues. Even as a legally practicing physician with a medical background that encompasses many of the basic concepts of how the heart works, the plastic surgeon lacks the specialized training needed to adequately address the cardiovascular system. The best results could be expected from the cardiac specialist.
The same logic applies to obtaining the best results for your home health agency by outsourcing coding services. The best clinical consultants who handle coding and OASIS review are uniquely trained to maximize your reimbursement and reduce your compliance risk.
How will outsourcing affect reimbursement?
The difference in reimbursement when switching from in-house coding to outsource coding varies from agency to agency. There is always a chance that you have an optimized coding team who can deliver optimum results, although that is not what is commonly discovered. A reputable provider will work with you to evaluate whether you are achieving the maximum reimbursement that you are due. Remember, this is money that you should be receiving when there are no coding errors.
While averages vary, most outsourcing partners can generate $200-$300 per chart for a majority of their clients simply by correcting coding errors and helping review the OASIS to ensure compliance. At a loss of just $100 per chart, an agency might be looking at $20,000 in recovered losses for just 200 patients. Outsourcing has other benefits in addition to making agencies more profitable. It frees agencies from worrying about benefits, sick days, or performance issues.
Can you trust the specialist?
This can be a loaded inquiry. We’ve all known a few subpar medical professionals, and frankly there are coding firms which do not perform at the necessary level of expertise. Having a partner who will ensure that you get the full reimbursement due to your agency for each episode is critical.
Choosing the right one requires knowing what to look for and what to avoid.
Here are a few tips:
- The right firm will have credentials, experience and a reputation in the industry for consistent performance. It will offer a demonstrable commitment to monitoring industry regulations and providing the support you need for clinical and financial success.
- Look for a firm headed by a confident, approachable coach who is in demand as a leader and teacher in the industry and can build a solid case for increased outcomes for your agency.
- Verify that you are working with a team of experienced clinicians who know how to evaluate a clinical narrative. Some outsourced coding providers will certify non-clinical individuals to save money. In the long run, this can damage the integrity of your organization and more often can help to drive down your outcomes scores as well as your reimbursement.
- Another valuable area to explore the process and ease of accessibility. Some outsource providers will require you to scan or fax mass amounts of information or have a long series of steps that make working with them seem like you are working for them. Others will not be able to guarantee that you will receive your work in a timely fashion. These days, the best providers can actually work within your electronic medical record (EHR) system to improve the timeliness of chart completion while minimizing the work required of clients.Regularly scheduled reviews to evaluate your coding and OASIS for optimization can help you determine whether an in-house coding specialist or an outsourcing partner may be the more viable and cost-efficient solution. Your agency may well have the top-notch coding talent that is helping you get the maximum reimbursement, but in today’s home health market, can anyone afford not to be sure?