A fix for persistent staffing challenges

July 13, 2018 / By Kristine Daynes

Roughly 40 percent of healthcare financial leaders say their organizations lack in-house expertise and staffing for extremely important activities, such as managing new regulations and payment models. The gaps put providers at risk for coding backlogs, payment delays, claims denials, write-offs, compliance audits and fines from CMS.

The staffing challenge isn’t new. Coding and CDI managers have struggled since before the ICD-10 transition to recruit, train and retain qualified coders and billers, not to mention experienced managers. Why does the difficulty in staffing persist? Several factors have contributed to a national labor shortage:

• Job growth for medical coding is three times the growth rate for all other professions.
• Nearly 82 million Americans will enroll in Medicare by 2030, almost 60 percent more than in 2015, creating a need for more healthcare services and associated staffing.
• More and more care is delivered in outpatient and ambulatory settings than ever before. The code sets, guidelines, and payment models are different from inpatient care, requiring a different expertise to document, code, capture charges, and bill for services.
• The ICD-10 code freeze and physician grace period have passed. CMS is now adding new ICD-10 codes, and they won’t be forgiving of inaccurate coding. This has led some organizations to perform more coding audits, such as prebill audits, external audits or coding quality audits.
• Adoption of electronic medical records (EMRs) and other health information technology (HIT) may not reduce administrative costs and time to bill. In fact, an EMR implementation puts additional demands on revenue cycle functions to retrain staff, close out claims on one system, and test data and processes in the new system.
• For some specialties and in some regions, the daily census for a facility can range wildly from one week or one season to the next. That can result in backlogs, even with very efficient coders.

The labor shortage can be especially painful for organizations that try to staff with full-time, permanent employees to meet peak demand. In addition to the salary burden, they must invest in recruitment programs, training and supervision for what might be a larger-than-necessary team. A better alternative might be to manage staff as a variable resource, adding or reducing employees to meet demand. This can be done relatively easily by outsourcing temporary workers rather than hiring permanent employees to meet variable needs.

Outsourcing allows an organization to reduce fixed salary costs. It can also free up supervisors by offloading some responsibility for recruiting, training, and performance monitoring. There are several ways outsourced medical coding, CDI and audit services can be deployed:

• Call on an outsourced coding expert for quarterly and annual compliance audits
• Augment in-house staff as needed with supplemental coding and CDI specialists—temporary employees available on demand
• Outsource coding and/or CDI for one care setting or specialty–such as all ambulatory surgery or for the emergency department only or for a pediatric facility
• Bring in outsourced expertise to recruit and train new staff, merge disparate teams, and/or set up a new coding program. The responsibilities can be transitioned to internal management when the program is stable.
• Use an outsourced interim manager to provide leadership while a key position is filled
• Eliminate in-house coding departments and turning over operations to an external business partner. This action rarely results in a loss of jobs, since coding talent is in such high demand. Typically, it shifts employment from one entity to another (such as from the hospital to the vendor) and allows retained employees to refocus on strategic or core functions.

As revenue cycle managers look for better ways to improve staff productivity and cash flow, outsourcing is one strategy to overcome market challenges.

Kristine Daynes is senior product manager at 3M Health Information Systems.

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