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.
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.
With outsourcing, you will have a team of expert reviewers dedicated solely to OASIS & coding accuracy that have the knowledge and skills to quickly review charts for patient data that supports the claim. They also know when additional information and documentation is needed. Because it is all they do, they do it more efficiently than a staffer who has additional responsibilities such as quality assurance, or intake, or scheduling.
Prompt and proper payment:
Expert reviewers ensure that every patient is assigned to clinical group 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.
Lower cost of doing business:
Outsourcing your OASIS & coding 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.
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.
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.
Return on Investment:
What is 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.
An overarching concern for many agency owners is the challenge of assuring accuracy and compliance when tasks are completed remotely by outsourced reviewers. That a reasonable worry, which is why agencies are encouraged to thoroughly vet potential outsourcing vendors. Ensure your outsourcing vendor has an extensive quality assurance team. At McBee, each review withstands a rigid quality assurance process and all of our reviewers maintain a 97%+ accuracy rate.