Pros and Cons of Outsource Coding and OASIS Review

By Corinne Kuypers-Denlinger, Vice President, Post-Acute Care Growth Strategies, QIRT. Originally published in the e-newletter of the Illinois HomeCare & Hospice Council

This is the first in a three-part series of articles about outsource coding and OASIS review. The purpose of this series is to help home health and hospice agencies determine if outsourcing this critical business function is the right path to take and how to identify the right vendor partner.

To outsource, or not to outsource? Every home care agency administrator asks that question at one time or another. There is no right answer. There is the answer that is right for your business. And even that can change over time. But, there are some things to consider when you reach that reflection point in your agency’s business development.

Advantages of Outsourcing (Pros)

Expertise:

CMS’ rules and guidelines governing code selection and sequencing and OASIS responses are complex and ever-changing. A mistake repeated on claim after claim, however innocent the intent, can be construed as fraud, costing your agency time and money. Outsource coding companies are staffed by expert auditors who are carefully screened before hiring, regularly trained to new rules and guidance and routinely monitored to ensure continued accuracy.

Efficiency:

Contracted coding companies do one thing, and they do it very well. Expert auditors have the knowledge and skills to quickly review charts for patient data that supports the claim and to know when additional information and documentation is needed. Because it is all they do, they do it more efficiently than a staffer who also is responsible for quality assurance, or intake, or scheduling.

Prompt and proper payment:

Expert auditors ensure that every patient is assigned to the HHRG that most accurately reflects the level of skill needed to achieve treatment results, leading to prompt and proper payments, lower risk of audits and improved cash-flow management. Further, some outsource companies are staffed 24/7, 365 days a year so your claims always are promptly processed.

Lower cost of doing business:

Outsourcing your coding and OASIS can reduce the number of full-time positions (FTEs) or allow you to focus your staff on the most important work: patient care. Working with the right outsource coding partner also can help lower your annual training costs, as reporting on individual and agency-wide knowledge and skill gaps from your vendor helps you pinpoint precisely where training is needed.

Improved scores:

In today’s patient-centered regulatory environment, scores matter: outcome scores, of course. But your Home Health or Hospice Compare Scores, Star Ratings and value-based purchasing bonuses all start with accurate OASIS assessments. Your expert partner can work with your in-house quality team to ensure that every patient encounter is properly reported.

Patients First:

Patient-centered care isn’t just a regulatory directive; it’s the reason most of you are working in home care. Outsourcing coding and OASIS review and other operational/administrative tasks allow you and your clinical team to put their full energy and attention on the caregiving, not the record keeping.

Disadvantages of Outsourcing (Cons)

Loss of control:

The number one reason cited for choosing not to outsource operations and administrative tasks is fear of losing control — control over workflow processes, control over quality, control over staffing. While that concern is understandable, you have more control over vendor output than you do over staff output. Outsource coding companies are only as good as the last audit they did for a client. Repeated failure to meet expectations is easily handled by ending the contract. There are all sorts of HR issues to navigate when terminating recalcitrant staff.

HIPPA protections: 

Many agency decision-makers worry that protected patient health information will be compromised.  That’s a legitimate concern, and it’s important when exploring outsourcing options that you know what protective measures a prospective vendor has in place, and how often those measures are reviewed and upgraded.

Cost:

Always the CFO’s first question: what’s outsourcing going to cost? When looked at as a line item on your P&L, outsourcing can appear to be expensive. However, you should consider the cost savings of fewer employees, salary, and benefits, or the value of having those same staff members perform work more appropriate to their skill and education. Also, consider that expert auditors with outsource coding companies often deliver higher episode payments through more accurate code selection and sequencing.

Quality Assurance:

An overarching concern for many agency owners is the challenge of assuring accuracy and compliance when tasks are completed remotely by non-staff. That a reasonable worry, which is why agencies are encouraged to thoroughly vet potential outsourcing vendors.

 

Look for the next two articles in the series:

  • Asking the Right Questions When Selecting a Vendor Partner 
  • Factors to Consider When Deciding to Outsource 

 

About QIRT: QIRT leads the post-acute industry in coding, billing, and consulting. Across the United States, QIRT provides agencies with multi-level internal and outsourced coding, quality assurance, appeals, billing, consulting, and education. Only QIRT’s Advantage Platform tracks processes with real-time checkpoints and Quality Cycle Management (QCM) tools along the journey to compliance and success. For more information on the Journey Program, email ContactUs@QIRT.com or call 855.485.QIRT (7478).

Up ↑

%d bloggers like this: