A Hybrid Approach to Overcoming Coding Staff Shortages

By Cheryl Cruver, Chief Revenue Officer, AGS Health
Twitter: @AGS_Health

Exacerbated by pandemic-induced burnout, resignations, and even terminations, staffing challenges remain throughout healthcare. Medical records, billing, and compliance are the fastest-growing healthcare white-collar administrative professions, according to the American Hospital Association (AHA), which is expected to grow 13% by 2026, but there are shortages here, too, exasperated by the same staffing challenges as the rest of healthcare.

As the shortage of revenue cycle staff and coders worsens, so do the short- and long-term impacts to health organizations. As a result, addressing staffing challenges has become a priority for many health information management (HIM) directors and CFOs.

The problem is neither new nor waning. All healthcare jobs are experiencing turnover — by almost 5% over the last decade creating a ripple effect that directly impacts an organization’s bottom line. Indirect costs related to recruitment, onboarding, orientation, and retention are rising, as are expenses associated with overtime pay and temporary employees needed to prevent backlogs.

In terms of turnover, cost estimates cited by FQHC Associates range from a high of 150% of the annual salary for mid-level employees to a more conservative estimate of 20% of an employee’s annual salary – just for starters.

Costs of overcoming the staffing challenges aren’t limited to recruitment expenses, salaries, and benefits. According to a study by Training Magazine, onboarding and training new hires increase the price tag by an average of $1,286 per year per employee. This includes initial and on-the-job training, continuing education, and the cost of orientation. During the same year, employees devoted an average of 42.1 hours to training.

Outsourcing to Save

A multi-pronged approach is required while managing climbing salaries in a highly competitive human capital market. First, the solution requires a shift away from the traditional approach to problem-solving to instead focus on optimizing the productivity of existing teams in ways that avoid burnout and the potential for creating a negative workplace. The answer is adopting a hybrid approach that blends outsourced services with technology, augmenting teams with highly-trained offshore coders and process automation.

The right partner can improve revenues through increased collections, reduced delays, denials, and fewer days in accounts receivable. Outsourcing also offers access to a highly trained and experienced workforce that stays current on regulatory and coding changes, eliminating the need to dedicate time and resources to internal retraining.

Outsourced service providers eliminate bottlenecks during peak times and allow internal staff to focus on more value-added tasks, including patient satisfaction, while reducing stress and burnout.

Adding Technology to the Mix

Technology is essential for alleviating the staffing challenges around coding and revenue cycle management. For example, leveraging artificial intelligence (AI) and automation improves speed and accuracy and optimizes processes while freeing internal resources to focus on core responsibilities. As a result, internal across-the-board manhours are also reduced.

Low-skill, repetitive tasks that don’t require critical thinking skills are prime for automation. For example, AI and automation can support back-end RCM processes such as claims scrubbing, identifying patient self-pay amounts, alerting patients to amounts due, and electronic collections. Comprehensive Data Analytics software can also do a deep analytical dive and deliver visibility into critical organizational metrics.

For one Florida hospital, automating patient collection notifications alone increased collections from the high teens to about 43%. With the help of automation to reduce manual A/R workflow and improve efficiencies, a Texas practice has seen its A/R over 60 days drop by 38% after just three months of deployment.

Clinical Documentation Improvement software can also automate clinical documentation review and queries without spreadsheets. In addition, computer-Assisted Coding (CAC) leverages AI to accelerate coding decisions, and Computer-Assisted Coding Compliance software integrates with RCM workflows to automate auditing tasks.

The tangible results delivered by AI and automation have been a driving force behind the recent uptake in automation adoption – which rose by 12% between 2020 and 2021. That’s according to a survey that found 78% of health systems are currently using or are in the process of implementing automation in their revenue cycle operations. Of those responding organizations that hadn’t yet deployed automation, 37% planned to do so within a year.

Connecting with Your Match

Identifying the right outsourced service and technology partner is crucial. Still, one of the most essential attributes to look for in a prospective partner is the vendor’s depth and breadth of experience – do they have longevity and a proven track record?

Longevity not only indicates strong business and industry expertise and speaks to the prospect’s ability to understand the complexity of federal and state regulations. Regarding customer service, 24/7 support is imperative to ensure needs are consistently and compliantly met. Therefore, that representative should coordinate ongoing training, escalate support requests, and provide monthly or quarterly business reviews.

Any prospect should be capable of dedicating the appropriate resources to ensure patients have access to the best financial care. In other words, sufficient resources and expertise should be available to ensure all needs are met regardless of any unexpected surge in volume.

Outsourced providers should possess a deep bench of highly trained and college-educated coders who can work as an extension of the internal team as part of a team-oriented culture with a shared dedication to success. Coders should also be credentialed or prepared to sit for credentialing exams as soon as they are eligible.

Also, are coders dedicated to a single client? This is important because when coders are spread across multiple projects, it impacts their ability to fully understand and comply with the client organization’s policies and procedures.

Other questions to ask include:

  • Do they have a reputation for meeting Service Level Agreements (SLAs) and consistently providing quality service?
  • How many charts, on average, can they code per day, week, or month?
  • What are their HIPAA compliance policies and procedures?

Strong and open communication is needed for a successful outsourcing partnership – assuring the client that expectations are being met and identifying problems with services so they can be corrected before it is too late. Thus, frequency is vital. Touch bases are an excellent cadence to provide actionable feedback and prioritize outstanding tasks.

As important as selecting the right outsourcing partner is to establish key performance indice (KPI) benchmarks unique to each client organization. These could be related to collecting costs, days in A/R, or other metrics.

KPIs should go beyond traditional A/R metrics, too. Cash as a percentage of net revenue is another possibility. The key is to measure performance based on the areas the client seeks to improve – establishing a transparent outcomes-based model for mutual success. KPIs also help create a relationship based on transparency. Clearly defined goals that can be tangibly measured ensure realistic expectations – and honesty.

The Best Blend Forward

There is no one-size-fits-all solution regarding the right balance of technology and service. Instead, the key is to take the time to understand the organization’s unique staffing challenges and the right mix of services and solutions to overcome them.

Seek out a partner that will work as a consultant and take the time to analyze existing processes to determine the areas ripe for improvement. They should be capable of assessing your existing people, processes, and technology to create a custom solution of services, technology, and support. Doing so can amplify the qualities of your current methods that are working well while filling gaps and improving financial outcomes. Finally, recognize that revenue cycle management is not static. Any outsourced partner must be willing to tweak and adjust services and provide on-demand scalability to meet changing needs.