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Are You Ready to Outsource Medical Coding?

By Michael Jordan

June 13, 2023

Staffing challenges, decreasing profit margins, and increased coding complexity force healthcare executives to evaluate alternatives to traditional in-house revenue cycle management teams. Many are asking if it’s time to outsource medical coding.

Deciding to outsource medical coding services and identifying the right vendor can feel overwhelming. Here are some questions you should ask before you make the decision.

Internal questions

Medical coding vendors either operate as vendors (doing the tasks asked of them) or partners (offering strategic insights and guidance).

Many vendors will take your existing processes and follow them to produce the work.

Whereas partners will produce the work and also provide process improvement recommendations, work with you to build strategies, and offer the ability to grow together strategically.

Your answer should consider many factors. Pricing will vary significantly. Your production needs should be considered while making this decision. Read more about using offshore providers.

Some organizations require medical coders to be certified. The vendor you select will need to have a plan for hiring and training that aligns with your certification requirements.

Ideally, you should already have metrics in place with your medical coders. You should share these metrics with vendor and align on metrics the vendor will be measured against. Typically, vendors who specialize in coding will offer better results than your in-house team.

Take time to review your current process documents and make sure they are current. Vendors will use them to perform the work and establish SLA’s and quality.

Questions to Ask Potential Vendors

Once you have decided to outsource some or all of your medical coding, here are a few critical questions to ask the vendors you are evaluating.

  1. Where are your coders located?
  2. Are the coders certified? If not, is there a process to help coders become certified?
  3. How do you track production and quality?
  4. What support is needed from our staff?
  5. How frequently do you meet with us and review the work status?
  6. Will you provide suggestions to optimize workflows and improve our revenue cycle?

These questions and others will help you decide if you are ready to engage a medical coding vendor, if you need a vendor or partner, and which vendor best aligns with your needs.

A partnership with an external vendor can add significant value, relieve staffing pressures, and help streamline your revenue cycle, so you are free to invest in your organization and its goals.

Michael Jordan

Author

Vice President of Customer Success

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