Case for Outsourced Coding


Optimizing coding and CDI with help from industry experts

The wait for 2020 and the massive changes in home health reimbursement conditions ushered in by the implementation of the Patient-Driven Groupings Model (PDGM) is finally over.

Home health agencies prepared for the new landscape for over a year and many have started to stumble over unexpected hurdles in spite of their exhaustive preparations. Those who opted to continue coding and processing claims for reimbursement with an in-house team may be running into many more of these issues than peers who chose to outsource this critical job to professional service providers.

Home health agencies with optimized coding and clinical documentation improvement (CDI) practices have fewer problems with audits, faster time to payment, and excellent capture of all possible and appropriate charges.

Outsourcing coding and CDI services to a professional external provider with a significant track record of success in the industry means an home health agency can focus its resources on expanding its referral base and improving patient care services provided rather than trying to remain current on ever-evolving coding best practices while avoiding costly mistakes.

These professional partners have the resources and ability to focus significant amounts of time and resources to ensure that coding and CDI are smooth, accurate, fast, and free of errors. Additionally, these services can provide assurances that they are aware of and abiding by any new rules or guidance put in place by CMS – no small feat with the implementation of PDGM.

Choosing to continue operating with an in-house team can of course also deliver great results, particularly for those agencies with large coding teams and ongoing significant investment in coding training for both the specialized front-line workers and their managers. But those who cannot dedicate the necessary amount of time, funding, management supervision, and support to these crucial employees are at a disadvantage.

Problems within these agencies likely will not be discovered for quite some time, leading to internalized poor practices and avoidable errors. For example, diagnosis codes that have been used for years and can no longer be used under PDGM as they will result in a Questionable Episode, will undoubtedly be one of the most common mistakes triggering claim rejections.Without an expert team, these claims could be submitted improperly and potentially cripple agency cashflow as reimbursements are stalled.

It’s important to remember that home health agencies are coping with the biggest change in reimbursements in 20 years, which affects nearly all aspects of their operations. Agencies need to be aware that even if they have successfully handled it all in-house in the past, it’s okay to ask for help and lean on expert providers for areas that can be outsourced, like coding and CDI.

Relieving stress in every area possible will lead to improved overall operations and success as the industry works through this massive transition.