When it comes to managed coding, some rights may not be self-evident

Sept. 14, 2018
Dipak Patel
Chief Growth Officer,
himagine Solutions

The number of healthcare providers who are moving toward managed outsourcing of medical coding, and away from in-house coders or simple staff augmentation is growing rapidly—7% annually.1 The reasons are numerous, among them the opportunity to free up financial resources for other strategic initiatives.

That doesn’t mean providers should just let go of the reins without a firm commitment from their managed outsourcing partner to provide them with “certain unalienable rights”—in addition to simply getting the job done.

This Client Bill of Rights provides a handy checklist for healthcare providers who have already made the move to managed outsourcing of medical coding. It’s a good tool at review time to clearly identify and clarify important aspects of the partnership.

  1. Your partner should be willing to go at risk: Every medical coding vendor markets their ability to provide the best coders and offer the highest quality services. You should only work with partners that are willing to sign at-risk contracts where they are financially liable for meeting agreed-on quality and productivity metrics.
  2. You will get the most qualified resources the first time around: You should not have to review hundreds of resumes to find the best candidate yourself. Your partner should be presenting you with the best coders that meet all your needs. You can reserve the right to review resumes and interview the candidates, but you are paying the partner to initially present the best candidate. You have the right to ask how the partner vets their coders and what their success rate is for placing the right candidate the first time around.
  3. There will be a dedicated implementation team: Poor implementations can lead to several issues, including backlogs being formed due to the time it takes for the partner to begin coding, and failure to meet quality and productivity issues because the partner did not take the time to fully understand the provider’s processes and requirements. You should expect that the partner will provide a dedicated implementation team that is not the coding manager or the coder themselves.
  4. Coders will be experienced, certified, and fully employed W-2 employees: You should expect the best talent from your outsourced vendor. The best talent are resources that are fully dedicated to your vendor, which is shown by their willingness to be fully employed. The partner should provide a competitive compensation package to attract and retain the best talent.
  5. Coders will be audited by an independent group and the detailed results will be provided: The resources that audit the coders from your vendor should not report to the same person that the coders report to within the organization. You have the right to this independent review and real-time access to detailed audit findings.
  6. There will be dedicated management oversight: You should not have to manage the coders daily. The partner should provide management oversight of the coder to address not only productivity and quality, but also other work-related questions such as when the coder has a coding question or needs time off.
  7. There will be a dedicated customer service team: You should have a single point of contact from the partner that can address any issue, from operational performance to invoicing.
  8. Your partner will have scale and capability to grow with you: Your coding partner must be able to scale with you and meet your demands. The partner should have the capability to provide weekend support and a flex pool that allows coverage for coders when they take time off.
  9. Your partner will provide you with insight: Your coding partner must be able to provide you with insight from across the industry (what are they seeing from providers). Your partner should also be able to help you track the value from services provided so that you can estimate the return on investment.
  10. You will continue to invest in your offerings: Your coding partner must continuously invest in improving their services. You have the right to understand how your coding partner invests in research and development and provide input into their service roadmap.

References: 

  1. Independent research conducted by himagine Solutions.

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