cbteamssolutionspapersummer2016

�

On-Demand Coding Teams Solutions Paper

Table of Contents

Introduction 2How the Coding Teams Can Be Used 3Use Cases 5How Teams are Built 6Who is on the Team 6How Teams are Managed 9How Pricing Works 10Getting Started with a Team 12Conclusion 14

codebusters.com 888-978-6198 �1

http://codebusters.com

Introduction

On-demand service models have been labeled as the next generation of staffing. Companies such as Uber have created the expectation of instant service. The concept of these models is that whenever a person needs work done, s/he simply sends out the request to a group of people who are willing and able to provide the service, and one or more will perform the service promptly.

Codebusters has established an on-demand solution for healthcare institutions that need ready access to medical coders to maintain a healthy bill flow. With our solution, organizations get a team of expert coders, trained on the provider’s specific records and processes, available 24/7. Codebusters On-Demand Coding Teams fundamentally solve the problem of coding backlogs that result from insufficient levels of medical coding staff. Coding teams can be used simply when a backlog occurs, or as a regular part of operations.

Each team is custom built beforehand in conjunction with Client hiring managers. We only employ US-based medical coders who are certified by AHIMA or AAPC and experienced with the particular hospital’s complexity and patient types. Teams are managed by Codebusters’ coding supervisors, with whom clients can interact directly. All work is done in our virtual office where client managers can screen share, video conference, and voice chat with the team. Additionally, we have built a proprietary workforce platform to house the teams and track the status of records on which coders work. All of this is done on-demand and can be called upon instantly.



How the Coding Teams Can Be Used

There are a number of ways to employ the Teams to ensure uptime. Here are 3 different strategies, or levels of service, that illustrate how to incorporate our Teams with your workflow, starting with the lightest implementation first.

● As Needed Support ● Supplemental Support ● Partnership

As Needed Support

If you view your primary full time staff as your base, and your existing coding vendor(s) as supplemental staff, then in the lightest implementation of the coding teams, we could act as a backup to your staffing vendors in the rare event they are not able to fill the job quickly, or simply as an interim solution until the vendors complete the hiring process, which can take several months, so that the department does not fall behind.

In truth, this is really where we have created a new option for facilities. On-demand coding support has not been a viable scalable solution until now. As soon as a department gets even a little behind for any reason, the Teams can rush in to code any charts that remain at the end of the day. For example, we can code all records that are over 3 days old on a daily basis. The immediacy prevents backlogs from ever building up, thereby allowing a department to simplify its staffing strategy so that it does not have to over hire to get caught up in the event that there are one or more vacancies for an extended period of time.



Supplemental Support

In this level of service, the Teams would serve as a supplement to your full-time staff. There are a number of reasons and ways staffing vendors are used, from an occasional solution for short-term leaves, to a formal partnership as part of a larger staffing strategy across a multi-regional health system. Codebusters has been active as a staffing vendor since 2000, providing supplemental staffing support as a Primary Vendor and within Multi-Vendor Environments, including large scale, multi-regional MSPs (Managed Service Provider). Given that the governance of a vendor relationship can take so many different shapes, the implementation of a solution would be a highly planned process to ensure that it fits within an organization's larger, company-wide workforce strategy. Our consultants have extensive experience crafting and managing sophisticated contingent labor strategies at the fortune 500 level. The Teams can be structured as a HIM specific talent management solution, or as a line of service within an existing MSP.

Partnership

This solution is essentially the outsourcing of all or large segments of the coding department. This level of service can be executed for both small rural health hospitals to a large health systems. The facility’s current staff would be incorporated into the Team, and given first priority on all work if that was the client’s desire. The coding function would continue as normal, except that it would be managed by Codebusters. We would become in a sense your entire coding department, from supervisor, to compliance auditor and educator, to coders.



Use Cases


short term leave

resignation/quitsreplacement of staff

temp until perm fill

unique specialties

strike

Use Cases

fill in during staff training

sick days

vacation season

retirement

spike in patient volume

backlog reduction

special projects

ICD-10 supplemental staff

annual or monthly or

weekly audit

spot audit


How Teams are Built

The Teams are comprised of highly experienced and vetted medical coders who are placed according to the settings and specialties within the client’s facilities. The essential idea is to build in redundancy so the teams can act as a backup and ensure the time to code after patient discharge remains steady at 3 days (or any other target number of days set by the organization). The teams are built so that coverage can be provided for each hospital department. Specialties that have unique and complex coding rules, such as interventional radiology, are at particular risk if a coder is lost. We would aim to have complete coverage of each department and 20% of the total coding staff depending on the size of the client.

The process begins with an in-depth analysis of the volume of encounters for each department. Many coders are proficient with only one type of setting or physician specialty. We would ensure that the team skills match up with each department, and that there is coverage to replace 100% of the work done by one or less coder, and provide 20% extra capacity in specialties where there is more than one coder. Depending on the anticipated impact of ICD-10 on certain departments, however, we would ramp up to the capacity of the team to match the actual loss in productivity.

Who is on the Team

Coders must undergo a thorough vetting process in order to be placed on a team. All coders admitted to the team are required to have a minimum of two years’ experience in the setting for which they are providing support. Each coder must then pass a comprehensive competency test in their given specialty, demonstrating accuracy and productivity. Coders then go through a formal interview with an HIM specialist, a complete employment and reference verification, and criminal background check. Coders finally must demonstrate the



ability to code proficiently in the client’s system. The coding supervisor/coding lead will monitor the coder for during the first shift or two to ensure that the coder is truly capable of coding with the utmost precision. Coders are spot audited on a regular basis, to ensure coding guidelines are being met. ICD-10 auditing rates are be particularly aggressive given the complex nature of the code set and lack of clear guidelines.

�


Vetting Process

Minimum 2yrs experience

Competency Test

Formal Interview

Employment Verification

Reference Verification

Background Check

Training/ Orientation

Day-1 Coder Shadowing

Regular Spot Auditing

Quality Assurance Process (24/7 Supervisor Management)


We provide coverage for all coding departments and specialties, broadly: ● Inpatient ● Interventional Radiology ● Outpatient Surgery ● Emergency Room ● Physician-based (Pro-fee)

�



How Teams are Managed

Teams are first and foremost highly accessible to any of the client’s hiring managers or team leads. All team members can be viewed and communicated with through our proprietary workforce management platform. Clients will be able to send group messages as well as individual messages via HIPAA complaint, encrypted email. Additionally, all work is performed inside of our virtual office, Sococo, where client managers can screen share, video chat, voice chat, instant message, and hold group meetings. Clients can literally watch the work being done, just as if they were in the same room.

Each facility will be given a secure virtual office where only coders assigned to that team have access credentials. Each team will have a team lead/supervisor who provides orientation for new team members and does regular audits. Coders track their work product in real time reports, which are available to designated client stakeholders. Clients are given one or more account managers who ensure that client coding needs are immediately attended to by the coding team. Regular



Business Review meetings will be set up, based on client preferences and the needs of the program.

How Pricing Works Billing is structured to be based on a fixed fee for each record type, therefore clients do not have to constantly monitor productivity to ensure that they are getting a fair value for their money. Historically, coding services are billed like many other contingent staffing services - hourly. However, because the work product of the medical coder is clearly definable and typically only takes minutes, not hours or days to complete, piece work billing is a highly functional model. For inpatient records, we charge based on the length of stay. There are several advantages for an organization to use a “per record” pricing model rather than hourly billing. The foremost advantage is that coding supervisors or managers do not have to spend several hours compiling and analyzing productivity reports to ensure that contract coders are meeting the established coding rate guidelines. An associated result of the piece work model is pricing transparency and predictability. The cost to the organization to get the work done can be perfectly calculated, and not subject to estimation as a function of the productivity rates. Additionally, there is no fee charged to assemble and implement the coding teams. There is also no charge if the record needs to be re-coded due to coding errors that affect billing.

Different prices are established for different record types, largely based on the time it takes to code each record, and the level of complexity. For example, ED records are priced less than inpatient records because they take less time to code and the skill set needed is not as high as required for inpatient coding. In general, we established our pricing on hourly market pay rates.



Invoicing can be customized to fit almost any request, but generally occurs monthly. Coders track each record they work on in real-time, so clients can see at any given moment what work has been performed. Our account managers verify in the EHR system that the stated work product is complete prior to billing. Though not all records are given a second level review by an auditor, we do audit 10% of records coded each month, which is many times the recommended amount by AHIMA.

Inpatient $20/pt day $19/pt day $17/pt day

Outpatient Surgery & Int.

Rad.$20/rec $19/rec $17/rec

ED $10/rec $9.5/rec $8.50/rec

Monthly Spend Up to $50,000 Over $50,000 Over $125,000

Volume Discount *based on

monthly spendNone 5% 15%

Est. FTEs 0-2 2-5 5+



Getting Started with a Team

Getting started with CB’s on-demand coding teams is simple. Below we have listed the process to which we take to create a team for your facility needs.

Needs Analysis

The first step is for our implementation team meet with your HIM Director/Coding Supervisor to establish the volume and types of records for which you may need coding support. Our goal is to identify where you have coding gaps now and potential gaps in the future. Our coding supervisor will work closely with your managers to understand your coding guidelines.

Building a team

All teams are built based on each facility’s needs analysis. All teams include certified and experienced US-based coding experts. In our search for the best coders, all candidates must pass a rigorous pre-screening process:

● Specialty specific pre-employment exam ● Situational interview by coding expert ● Background check (criminal, employment history, education, license)

We work closely with the HIM hiring managers to hand pick each member of the team. Coders will be selected based on familiarity with client systems and experience working in similar settings. Once chosen, coders will be taken through your agreed upon contractor on-boarding guidelines and given system access by your IT department.



Orientation & Training

Our coding supervisor will train the Coding Team on your unique coding guidelines and data entry/abstracting requirements. All coders will be shadowed by the supervisor until they have demonstrated the ability to work error free. If they choose, your managers can work right alongside our supervisor and coders in a dedicated virtual office. The virtual office works great for group trainings and team updates. We make certain that all coders are given a thorough orientation, and do not work independently until they have proven they can code exactly as required.

Team Management

Our HIPAA compliant workforce management software gives you the ability to upload policies and other documents, and monitor coding progress as it happens. Coders document each record they code in the Coding Teams Workforce Platform. You will have full access to monitor daily progress and run reports. You can see which records are pending or completed, flag a record and add notes, stop work on a record, and see if a record has been audited or invoiced. We commit to auditing 10% of the records, many times greater than industry recommendations. We will have one or more dedicated coding supervisors depending on the size of the team. Overall we provide a coding supervisor to:

● Monitor work progress ● Immediately address questions and concerns ● Provide quality assurance audits ● Perform quarterly business reviews (QBR)



Each record will fall into a specific record type with associated pricing to be invoiced at month end. Teams can range from one backup coder to an entire department. All coders work from our virtual office, where your managers and leads can collaborate in real time.

Conclusion

Codebusters’ on-demand medical coding solution solves the needs of a variety of different healthcare institutions, regardless of size or record type. From small hospitals to large health systems we can guarantee that our coders will be able to efficiently integrate with your workforce in order to reduce backlogs that you may have or to create head wind and get ahead of the problem. This is a just-in-time, sometimes, or all the time coding solution. The on-demand/on-call model is revolutionizing the delivery of coders who are critical to ensuring a proper function revenue cycle.

To get started, simply reach out to our solutions team:

Amy Smith, Program Coordinator [email protected] 213-483-9836

Mitch Cardoza, VP of Client Solutions [email protected] 949-981-0055

Vincent Kobayashi, CEO [email protected] 661-904-1610


mailto:[email protected]




cbteamssolutionspapersummer2016

Documents