The Pulse: The Strategic Advantages of Third-Party Coding Support


Join us as we explore the benefits of outsourcing coding support to manage staffing shortages, overcome backlogs, improve efficiency, and save money. In this episode of The Pulse, Lori Cox is joined by Melinda Craig, RHIA, CCS, AAPC Director of Coding Services, to discuss how outsourcing coding can provide a much-needed boost for healthcare organizations. They’ll explore why 90% of hospital leaders are considering third-party vendors for coding support and how outsourcing can free up valuable resources for essential tasks. From quality assurance to data security, they address common concerns and provide practical tips for vetting potential outsourcing partners. 

Discover the power of leveraging third-party coding support to: 

  • Address staffing shortages 

  • Overcome backlogs 

  • Enhance operational efficiency 

  • Save money 

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About the authors

Lori Cox

Lori Cox has over 25 years of experience working in the business side of healthcare. She began her career in patient accounts and then moved into billing and coding for a multispecialty clinic. She was eventually promoted to billing supervisor and then to compliance officer, where she wrote, maintained, and trained employees and providers on fraud and abuse. Currently, Cox works for AAPC Services as Director of Client Engagement, performing audits and education for clients across the U.S. She has spoken at HEALTHCON and regional conferences and has traveled the country educating coders and physicians on complex coding topics such as hem/onc and E/M guidelines. Cox is the past member relations officer for AAPC’s National Advisory Board.

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Full Transcript

Lori Cox: Hi everybody and welcome to the latest Podcast, of the pulse. Thank you all for joining us. Once again, I'm Lori Cox. I am the host of the podcast today, where we like to talk about everything that has to do with auditing and coding. We're especially gonna focus on coding today. So I brought on a Melinda Craig who is kind of new to our Apc team. So, Melinda, welcome. Please tell everybody a little bit about yourself.

Melinda Craig: Hi! Everyone like Lori said. I'm Melinda Craig. I have not been with AAPC that long. So yep, I'm pretty new. I've been here August. But I've been in healthcare for a really long time. I've been in over 20 years. And I have a wide experience with facility and pro fee coding as well as home health and hospice and I am loving the new change in transition with working at a Apc. Oh, that's awesome. And then nothing like joining Apc and being asked to do a bunch of webinars and podcasts right off the Bat. Right? Yeah, we like to tackle everybody and get them on board before they're like. Wait! What am I doing now?

Lori Cox: Well, thank you for joining us. I appreciate it. You recently did a webinar on coding. So we're gonna kind of walk through that a little bit. Now, I think we probably should start with telling our audience I think most of the audience kinda knows that we have an auditing division within Apc. But our coding division is relatively new. So can you tell us just a little bit about that.

Melinda Craig: Yeah, we offer the coding services. Department offers. A variety of outsourcing, coding, outsource coding. Sorry. For literally, any of your coding needs, whether it's pro fee facility. like as a home health and hospice literally anything we can. If you have a problem, a backlog, you need additional resources, whatever it might be. Or if you need some training support, we can offer that to you and your team

Lori Cox: awesome. Well, I'm glad that we were able to do this. I know that it's something. I feel like a lot of facilities and clinics. One of their struggles is providing and having coders on staff. I think everybody, no matter what industry. And I feel like since Covid is hit, we've been hit everywhere. Right? So this is definitely something I think that's gonna go over really. Well in your in your webinar. You had talked about the top challenges. What was some of the top challenges. So let's talk a little bit about that question. You'd ask the poll question, what is your top challenge? And the responses were staying current with coding regulations. Staffing shortages, retaining staff coder accuracy, coding, backlog, and of course, all of the above what were some of the answers and responses that you got from that number one which wasn't surprising was all of the above. And then the one that did surprise me a little bit. Which was staying current with coding regulations. Really, I thought for sure it would be staff shortage or retaining staff. But staying current with coding regulations was actually the number 2.

Melinda Craig: Interesting. It surprised me a little bit, but again, and a very. The another reason to outsource or have outsource support is because all of our coders are required to stay current with the coding regulations and maintain their Ceos and credentials and whatnot. So...

Lori Cox: like, I said, Yeah, that one really surprised me. I really thought it was going to be staffing shortage. I did, too. Actually, when when we looked at this beforehand, so that's interesting. But II see the challenge. I think we stay current. And that is a challenge, right? So some of the ways I'm just trying to think of ways we could tell our audience like, of course. Apc, we're gonna use their website, their newsletters, the blasts. things like that. Are there any other sites that you personally like to stay up to date?

Melinda Craig: Well, like you said, I'll a a PC. I also II use a heima as well. The Cms websites. I love to listen to webinars multi purpose, and you can get ceus for those as well as as the learning. We all need to keep up our Ceos. But yeah, I just pretty much scan the websites frequently and and really rely on like getting myself on lists, listservs.

Lori Cox: To get those email blasts all the time. Yeah, yeah. it is hard to stay up to date. But the yeah, that is shocking. So then the staff shortages I feel like is still an issue and retaining staff, because we have a lot of people I know. Well, remember. Think way back to when we switched from Icd 9 to IC, 10. And people are like, that's it. I'm retiring. And I feel like after Covid hit. We kind of went through that a little bit, too. People were just like, Oh, I just can't. I'm just. I'm burn out and I know we all get a little burn out from time to time.

Melinda Craig: Yeah, I know. I know. During both those transitions the the I see 10. And then, during Covid, I was working for a fairly large healthcare system at the time, and we had people. They were like, Nope, I'm done. I'm retiring. I'm not doing this. So I know exactly what you're talking about. And then, after the pandemic yeah, that was, that was a just a so unusual for everybody with staffing and and trying to find people and getting. I think there, I truly feel there is a coder shortage. It's always, always coders needed job postings for coders everywhere.

Lori Cox: Yes, I see that a lot, too. Yeah, we definitely can. That's amazing. And then, like you said there is backlog. I feel we've had some clients reach out to us recently that have said, you know, we just can't keep up because well, for example, here in my little hometown, our hospital is completely full right now we're on diversion, because we have no beds and no rooms. And that leads to coding backlog eventually, not immediately. But and then and then the denial start coming in. And you gotta work those, too. Yeah. We recently had an influx of customers that are. We're looking simply just for backlog

Melinda Craig: support as well, where they want their coders, their in-house coders, to focus on the daily incoming work, and then have us focusing on the backlog stuff, too. So that's something that's an option for us as well. That's awesome. Yeah.

Lori Cox: You had said during your webinar that 72.6% of the you did. You guys did a survey or something and found out that the outsourcing was 72. But the thing that I liked was, that 2 said it was unthinkable to outsource.

Melinda Craig: Yeah, yeah, I had. I found actually found those we didn't survey ourselves. But I did find other organizations that did do surveys and and did the proper research and whatnot. But yeah, there was that. That particular one that said 2% of respondents, won't, won't, or they think it's unthinkable to even consider that was from a study from Blackbook Market research. Oh, interesting. Yeah. And they had stated that 90% of the hospital leaders that they surveyed. Continue to evaluate using third party vendors, for for you know all the reasons we've listed before, you know, cost efficiencies help with staffing, whatever it was. And all. And yeah, that was shocking that that 2, there's still 2% out there that just will not do it.

Lori Cox: That is interesting. 90% of hospital leaders continue to evaluate working with third party vendors. And this is expected to grow so over the next few years, it's not going to go away. They're going to grow. Their outsourcing is what I'm reading.

Melinda Craig: Yeah. So so from a different survey. Different article.

Melinda Craig: there, there's expected to be almost 9% growth in the next 10 years of of some form of outsour, maybe not complete outsourcing, but some form of outsource being utilized in in all the U.S.A. market.

Lori Cox: So wow, so it's a growing for sure.

Melinda Craig: Oh, definitely. And again, I think that goes back to what we were talking about before is that just, you know, retaining people staff. you know, people not being able to keep up with the the regulations and all the changes that are always happening. You know, we used to be able to rely on once a year

Lori Cox: changes, but not anymore. Right? Remember, think back to when we had the whole telehealth fiasco when it started, and they they put the guidelines out, and then we all got used to them, and we were. I was literally writing an article, and they changed it right and like, Oh, my gosh! There's this is impossible to figure out, and it still is kinda because you got payers with different rules. And I see that being a problem, too, maybe more of a billing aspect and a coding. But we have a lot of coders that work as billers, and vice versa, too. That kind of have to know those criteria as well.

Melinda Craig: Yeah, it's it's just so crazy it is. It is a challenge to keep up with. I mean, I guess now that we talk about it a little more. Maybe it's not as surprising. But but yeah, it is. There's it just changes so much it is it all the time, all the time.

Lori Cox: The one thing that I've always loved about Apc, and, like our profession, is the flexibility. You know, like most of us, work from home, we have very few of us that are actually in the Apc office, even though we'd like to go there. But we all mainly work from home and A lot of the majority of coders are women, and there are men which I'm glad to see every time we see a male at a at the conference I'm like, Oh, my gosh! It's so exciting! But we're all able to flex, you know, and raise our children on our families and and work in our community. And so I think that outsourcing kind of ties into that in a way, because you have these people that are happier at their jobs. We, you know you hear all the surveys about. If you're happy at your job, you never work a day in your life, you know. And so if you've got people that are happy and that are able to do their job efficiently and productively. The outsourcing make sense. Not that there's anything wrong with internal coders at all. You need those as to, you know, because they're on site. They can go down to the doctor and speak with them and pull the charts, and just, you know, be there to do that. But I think having one of the ways that I got into it was I was working at a clinic, and we needed a a He monk audit then, and I knew nothing about him at all. So we actually contacted Apc. And it was Charlotte Prillman, I'm sure a lot of our listeners are familiar with her name. She came to my little hometown and taught me hemog coding, you know, and I think that's something that we can do. Although we don't travel as much anymore. We can do that remotely, you know. Teach and help and get that specialty area that maybe that facility doesn't have. I think that's one of our most valuable points.

Melinda Craig: Yeah, we have. You know there's so many experts on our team that that have their little niche, you know, whether they're a hemog specialist or an Ortho specialist, or, you know, we have the whole gamut. It's just. It's incredible that we're lucky enough to have have the people that have those specific niches, and we can can reach out to them. Get them to help us with whatever whatever it is that we need.

Lori Cox: Yeah, I think that's definitely one of the biggest talking points. Okay, let's take a quick break, and when we come back we're gonna talk about some reasons for outsourcing some of the hesitation, the pros and the cons so we'll be right back.

Lori Cox: Welcome back to the pulse. We have been having an interesting conversation with Melinda Craig, who works for our coding department here at Apc, been talking about outsourcing some some different areas of outsourcing, and why to outsource. We wanted to kind of get into some of the reasons. That people outsource. So in your webinar that you did, you had a whole list of things of some of the main reasons to outsource. So what? I'm just gonna kinda open this up like, what are some of the main reasons people outsource coding, auditing, billing, and all of that.

Melinda Craig: Well. oh, gosh! there's so many reasons, and everybody's reason is different. But I think the biggest reason right now that I'm seeing is people have just a backlog, and they can't get caught up, and they just need that extra boost to get them back to wherever their baseline was, or so they can keep up with their daily. What? What's coming in the daily daily work. some other reasons.are are for the cost savings and the efficiencies, and that one is one that you know. So a lot of people and including myself. When I worked on the other side of things. One of my hesitations was, Oh, gosh! The cost is so expensive, you know. But when I coming to this side of it, and then really looking into it and really digging deep, it's it's really not, and that's kind of a Oh, oh, gosh! You know, like a a myth that that maybe we need to bust a little bit because you know, coders are worth every penny that they make. I mean, you know II can't argue enough that coders should be paid more, because you know. But when you think about it, the cost for you to employ a coder. You don't have just their salary, you have all their benefits, their retirement, their Pto if they're on site, you have their office space and all that other kind of stuff. And from my research there's a a solid 35 that you need to add onto a coder's salary. If you're going to employ that Coder and and one of the things I highlighted in my webinar was the lowest paid, credentialed Coder and, if I remember, correct, it was one of the Aima credentials, the Cca. And this was based on their salary survey. Melinda Craig: they were paid around 54,000 and you add, you know, another 35% onto that. You're now looking at a $73,000 a year person. So if when you compare, you know what vendors are, gonna charge to do the work, it's it actually gonna be cheaper than employing somebody. And I think you know Cfos and the higher up decision maker type people are starting to realize that even though you know, there might be that initial Sticker shack like. Oh, gosh! When we have an outsource person we have to pay them, you know, whatever dollar an hour. And it's truly when you figure it out, it's actually cheaper than employing the person themselves. So again, just you know, that is one of the misnomers, or whatever you wanna call it, that that misconception that I had when I worked in in the on the other side, in in the healthcare industry and not on the vendor side. But that is one reason alone, the other. Time. It takes so much time to manage people. Yes, it does. The time spent training, hiring, training, supervising, you know, tending to their every need. That's just huge. And that again, was another thing that I pointed out in the webinar like for an in-house manager, or whatever having to do all that stuff. I mean, there's other stuff that they could be focusing on. That's far more important than full stuff. So you know, what the third party vendor deal with the people stuff and take that off your hand so you can do something more important with your time, or whatever it is that you need to do. You know. And then there's always yeah. There's always you know. Same thing goes with quality. A lot of vendors will do their own quality audits on their coders, and that's not to say that you shouldn't do a quality audit on the coders as well. But if you're strapped for time.and most likely you are. If you have a backlog or anything of that nature. A lot of those outsource companies will do quality audits on their coders and give you those results as well.

Lori Cox: So again, another time, saver, which again equals money, I agree with you. I don't think they take that into consideration when they see oh, they're gonna charge me X number of dollars per hour per chart. And they they think, Oh, that's just too much. But really, when you take the total look, the high picture of everything that you're talking about.

Lori Cox: it is cheaper, even even the little things that you don't think of such as I know I had a a boss. Tell me once when I was talking to him about outsourcing, he said. It's even things like the cost of toilet paper for your employees that are in the office, right? And electricity. And yeah, they you don't think about that. I mean.

Lori Cox: maybe it's minor. But still it's something that all of those things come into play when you have people in the office, and if you're outsourcing it, you don't have to worry about that. That's a good one. I didn't even think about that. I know it always tickled me that when I think about that well, you didn't have to buy toilet paper for your employees. So

Lori Cox: let's talk about some of the hesitations that we've mentioned a couple through the podcast but some of the hesitations. People have the outsourcing. I know one of them and we hear this from our clients as well is like communication and language barriers. Speaking and specifically to offshore

Lori Cox: because we do use some offshore, auditors and coders and in India, and they're they're beneficial to us because they do help us. But we have clients that are like, no, we want to keep everything.

Lori Cox: you know, in the United States. I feel like that is one of the hesitations. That kind of comes up frequently.

Melinda Craig: Yeah. And I'm actually seeing a little bit less and less hesitation. There, I'm not 100% certain on the reason why I might have to start asking but I am starting to see a little bit less hesitation with the offshore. And people becoming more and more comfortable with that.

Melinda Craig: I can tell you our our offshore folks communicate extremely well. And are very well spoken. Speak English very well, and you know, to be honest, their their quality is absolutely amazing, too. Right? They don't cut corners. And I would almost. I would almost bet that you know they

Melinda Craig: they do a better job than us here in the Us. Not to say that that we're bad or anything. We're certainly not. But I'm just saying that they they really make sure that they're

Lori Cox: crossing their t's and dotting their eyes. Yeah, they really do when it comes to the coding. When you're just coding and auditing charts, I feel like, and that leaves it up to the people that are in the Us. And and if they're on site especially that that leaves them free to do the more in depth.

Lori Cox: kind of digging type of research, you know, or clinical auditing or clinical coding things that that need somebody that's really in in it, you know, right there in the mix of it. And I feel like that frees up their time by using either outsourcing either onshore offshore. To allow them to be able to do that. Digging.

Melinda Craig: Yeah, 100% definitely

Lori Cox: security, I know. We have to go jump through hoops with some of our clients. And that's a good thing. Sometimes it's like, oh, I gotta do this again. I have to reset my password. I just reset my password, you know. But I know that's a concern that some people have is that they're afraid that their data is not gonna be secure. And with a recent breach that happened and change helpful

Lori Cox: care, I think everybody is really on edge. Now, right about are we making sure that things are secure? But I feel like we I, at least here at Apc. And I think that's a good thing. And we're gonna talk about evaluating some of the outsourcing partners next. But I think that's a good thing to check into when you're looking at outsourcing is, what are their protocols for security?

Melinda Craig: Yeah, most definitely. And for us here at Aapc, you know, our data, even though we have folks overseas. Our data doesn't leave the Us. We have them logging in to based. And I'm not the technical it type of person, but they connect up to the Us. And so everything they do stays in the Us, even though they're physically located. You know, overseas. And and you know, technology is just an amazing thing. And and II know, change. Healthcare folks are probably like, Oh, gosh, no, it's not.

Melinda Craig: But it truly is an amazing thing. And I just I just am not that person to understand the ins and outs of how it actually works. But it's pretty incredible. Those who that do. And we do go through

Melinda Craig: some pretty extreme measures here, and we have a really great security team here at to make sure that we're we are staying safe and keeping everything in the Us. So

Lori Cox: so let's expand on the what we were talking about a little bit about evaluating. So when somebody is thinking, okay, maybe we need to do some outsourcing. I feel like there's some definite steps. Because there are a lot of companies out there. I mean, you can go Google, Outsource Coding Company, and probably come up with at least 1,000.

Lori Cox: I think vetting them is very important. Ii would always say, you know, don't just get a quote from one company. Go to at least 2 or 3 and get quotes and discuss the process with them, because maybe they're not a good fit. Maybe they're an excellent fit. Maybe they're a little bit more higher priced, but the fit is better than with a company that's lower price. But they may not have the specialties that you need.

Melinda Craig: Yep, absolutely.

Lori Cox: Oh, sorry. Yeah. Go ahead. So some of the Co. We talk about costs and their contractual terms. We make, you know. Maybe they lock you in to. You have to do so many a month or so many a year, and maybe that's not a fit for them.

Melinda Craig: Yeah. And and you know, finding the right vendor. You know, you're finding a partnership, and like all partnerships, and Stephanie always teases with me, you know. It's it's your vendors like being in a marriage. Either you work or you don't work. You have to find that that marriage and some some things just just don't work and some do some of it can be as much, you know, as silly as some personalities just do not match. And that partnership isn't going to work, and it's and it's not bad necessarily. It's just, you know. Look for a different vendor that may have the the personality you're looking for.

Lori Cox: yeah, goes along kind of with like looking for that cultural fit, too, like, do you? Do you share the same?

Melinda Craig: You know. Expectations? Do you share the same.

Melinda Craig: you know. Might sound silly. But morals, ethics, definitely. Are you? you know. Do you adhere to

Melinda Craig: the the guidelines, and are are you willing to be swayed or not swayed. You know that for some people is huge like, no, we need to follow.

Melinda Craig: We're gonna follow these rules whether you like it or not. Kind of thing, and others are like. No, we don't want you to do that. Well, that might not be a good fit. So you really have to

Melinda Craig: think of of your vendor as as a partner

Melinda Craig: or as as a marriage. I agree and be able to

Lori Cox: dissolve that marriage if if needed right, and there should be something in the contract that require some type of notice or the ability to cancel. If things aren't a good fit. I mean, it's happened here with us. You know we've had clients that they just were not a good fit for us, or we weren't a good fit for them. It happens, and I think that vetting them appropriately and even into the

Lori Cox: contract, you know the coding or the auditing get started. And you realize, you know this that we seem to be on a different page. How can we fix it? Can we compromise to come together to a solution? Or maybe we just need to move our separate ways. So I think that that's important, too. When you're when you're looking at outsourcing as well as getting some references. We

Lori Cox: references for a lot of when our clients are interested in coming to us for coding or auditing assistance. We can provide them with. Hey, we did work for So-and-so organization. Here's the contact person feel free to reach out to them. I think that's important. Oh, absolutely

Melinda Craig: the in the communication back and forth. I mean it

Melinda Craig: just like a marriage again. Stephanie was so right when she says just like a marriage, though, like the communication back and forth. If there's something that that you know your vendor is doing, that you don't like you, you need to speak up about it and not just let it let it go, and vice versa. If the vendor is finding something

Melinda Craig: in your charts and your documentation in your coding, whatever it might be. You know, we need to communicate that back as well. So yeah, it's a 2 way street. It needs to go and and really need to find and that's, you know, taking the time to to talk to whoever you're thinking about partnering with is really going to make the difference, and you get a feel for what you're getting into.

Lori Cox: Yup, I agree. Well, this has been really great. We're out of time here. I wanna thank you very much for for joining us today and discussing the coding topics with us. Much appreciated.

Melinda Craig: Yeah, no problem, thank you, Laurie.

Lori Cox: absolutely. So. Thank you all for joining us. If you are interested in talking with Melinda about some coding options. You can go to our slash business and reach out to us. We're happy to talk to you in the meantime. Thank you for joining the pulse, and we'll see you again next time.


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