Goodall-Witcher Hospital Authority discovered that outsourcing medical coding could reduce headaches—and increase revenue
Soon after Adam Willmann, FACHE, took over as president and CEO of Goodall-Witcher Hospital Authority in October 2012, he discovered problems with the hospital’s medical coding process.
Most of the hospital’s six coders were not credentialed. The accuracy of the coding was far from 100 percent. Even worse, there was a two-week lag time to get charts coded. On top of the hospital’s automatic 10-day hold on inpatient billing, and by the time the busy physicians got around to completing the chart, a month—or three—would have passed before bills went to patients.
“You can’t run a lean ship that way,” Willmann said. Goodall-Witcher is a 25-bed, critical-access hospital in Clifton that operates two rural health clinics, one home health agency, a wellness fitness center and a 42-bed nursing home. “The longer it takes to get that bill out, the harder it is to get paid 100 percent. We’re a rural facility, so turnaround time lags, accuracy issues, and a lack of timely follow up with doctors really affect us. Then, staff was leaving, and I couldn’t find a registered health information administrator-certified coder or anybody to manage the coding.”
Willmann knew he needed to change the coding system, even if others didn’t like that idea—and they didn’t.
Within months, Willmann contracted with Healthcare Coding and Consulting Services to take over and reform coding services.
The Value of Outside Coding Services
Outsourcing coding services can mean the difference between a rural hospital staying open or going out of business, said Bill Cronin, CEO of HCCS. “Coding can be a big issue; if you get audited by a government agency or contractor, a MAC or a RAC, for example, they can rake you over the coals, and you may have to pay money back. You don’t want that. That becomes very expensive, very time-consuming for a hospital.
“A medical record director once told me coding is 5 percent of her staff and 95 percent of her problems.”
HCCS can eliminate those coding headaches. “We provide a one-stop shop,” Cronin said. “We can take care of the audits, coding, charge entry and clinical documentation improvement. A hospital can outsource the whole coding function to us so they don’t need to worry about it. And it costs them a lot less than if they were doing it themselves.”
HCCS audited Goodall-Witcher’s coding process and reaffirmed what Willmann believed: There was too much budget devoted to coding staff, and it was taking far too long to get the bills out the door.
HCCS took over most of the coding for the hospital. HCCS only has the equivalent of 0.7 full-time coders devoted to the Goodall-Witcher account. The difference is that coding time is divided among several different certified coders who only code in a single area—such as emergency medicine or inpatient services—so they bring that specialized knowledge to the coding.
“In small communities, hospitals don’t have the budget or ability to keep their coding staff trained,” Cronin said. “A hospital has to take care of a lot of other things. Coding is a very small part of their overall staffing, but it is a critical function. It’s very expensive for a hospital, for example, to have a highly proficient inpatient coder and a highly proficient observation coder and so on.
“A coding company of our size and structure has the ability to do that. This is all we do.”
Increasing Revenue Through Outsourced Coding
When Willmann brought in HCCS to augment the staff coders, the manager of medical records resisted the change. But challenged by the need to improve the quality of the hospital’s coding process, Willmann didn’t see another good option. Although the transition to HCCS prompted some staff turnover among those who resisted the change, the team realized many of the lean operations goals Willmann desired.
Now the health information management department “sends” the charts to HCCS by changing the status to “waiting/ready for coding.” The coders, who have remote access to the queues, pick it up from there, with 24-hour turnaround.
“Our return on investment’s been great because the coding is better and much faster,” Willmann said. “Ultimately, HCCS gave us what we needed, and we’ve seen a great increase in accuracy and level of coding.”
Not only is Goodall-Witcher saving money with HCCS, its approach is also realizing missed opportunities to capture charges, Willmann said. “It’s generating revenue because small coding details aren’t missed. Revenue turnaround is faster, and we don’t have to pay for vacation, sick time and a backup for vacations.”
Willmann devotes those resources instead to new equipment and services to improve patient care and increase capabilities to generate more revenue. For example, when the new home health manager started in December 2017, the system had 19 home health patients. In just five months, she increased that volume to 62 patients.
That growth is partially because the hospital took the burden of coding off her desk, Willmann said.
“If she had to sit there and code 40 charts, we wouldn’t be able to build that service,” Willmann said. “Now we’ve freed up many hours’ worth of my department manager’s time to take on new assessments.”
HCCS has brought capability, reliability and expertise to solve Goodall-Witcher’s coding issues—and won over all the staff in the process, Willmann said. “It wasn’t a popular move at first, but HCCS has been a great partner for this organization. And
that’s why we’ve continued our relationship with HCCS.”