Customer Context
Since early 2021, one of the largest providers of revenue cycle services to hospitals and healthcare systems contracted with Access Healthcare Services for delivering multi-specialty acute coding, professional coding, revenue integrity, coding audits, and coding denial management.
The customer's leadership had limited experience with offshoring processes. They were skeptical about outsourcing coding services, given its pivotal impact on financial outcomes - revenue, cash flow, and reimbursement rates. This case study describes how Access Healthcare enabled the customer to grow its coding operation from 0 to 500 coders and deliver end-to-end services to its physician practices and hospital clientele.
Challenges
At the inception of the customer, establishing the confidence to lift and shift a large-scale coding transition was vital. We went live with one community hospital in May 2021 with 13 coders.
When we embarked on the transition, we recognized the following issues and concerns:
To support the RCM services provider's rapid growth plans, Access Healthcare had to demonstrate the ability to hire, train, and deploy trained and certified coders.
Customize transition and service delivery processes for each new physician practice and hospital client they onboarded.
Plan for clearing the inherited coding backlog of high-dollar claims nearing timely limits.
Consistently exceed production and quality service levels.
Keep the training team updated about the latest business rules.
Create standardized policies and procedures across clients.
Create a governance model that promotes transparency and collaboration.
Solutions
Below are some strategies and solutions we put in place to achieve a successful transition and create a platform for growth:
Understanding customer priorities. We began with a well-laid-out due diligence approach to understanding the current needs by talking to various stakeholders in the customer team.
Structured transition plan. In collaboration with the customer's outsourcing and coding leadership, we created a customized transition plan, baking in realistic timelines to meet SLAs, clear backlogs, and improve SLA compliance.
Establishing a standardized Policies and Procedure document. Developing SOPs for each client and specialty requires the service provider and the buyer to calibrate and consolidate business rules for each facility and specialty. We set a meeting cadence to develop the SOP and update coding nuances by client and specialty. We set up a meeting cadence with the customer's SMEs and Leaders to walk through updates, get feedback to revise existing SOPs, obtain signoffs, and maintain version history. The structured approach involved everyone in the SOP development and maintenance process.
Reporting and governance. Transparent reporting is the basic premise of a robust governance structure. Access Healthcare provides daily, weekly, and monthly reports through a multi-tier governance architecture. These include reports on active users, users awaiting log-in credentials, hiring and training headcounts, available buffer, user-wise production, audit coverage, internal accuracy, daily inventory status, low inventory, and weekly dashboards. Further, the monthly business reviews provide a forum for operations leaders to identify systemic issues and set the agenda for transformation initiatives.
New client onboarding – the importance of backlog clearance. Almost all hospitals and physician practices have a significant backlog volume when they switch vendors or move to an outsourced service provider from internal teams. We inherited a considerable backlog of high-dollar claims needing attention and nearing timely filing limits from newly onboarded hospitals and practices. Access Healthcare mirrored the RCM service provider's organization by assigning delivery leaders for each hospital and physician practice account. The alignment of leaders helped us implement specific strategies to clear volumes related to older dates of service (DOS) while working on current inflow by planning for higher staffing needs in the initial phase. Structured onboarding programs helped set clear expectations for both teams (Customer and Access) and achieve these goals seamlessly.
Ongoing education and collaboration on training. We shared our in-house training content with the customer team and obtained their feedback to improve the training content.
Results
The above best practices helped establish the reliability and prove our ability to scale and sustain delivery outcomes alongside growth. This, in turn, offered an effortless offshoring experience to the customer for a complex process like coding.
Growth from 0 to over 500 coders catering to a wide range of coding services on the revenue cycle's front-end and back-end space.
Convinced the client about offshore coding quality and talent.
Exceeded the SLA of 95% accuracy by achieving an average accuracy of 98.62%.
Seamless onboarding of new hospitals and physician practices.
Structured transition and seamless delivery operation.
Robust governance architecture that drives focus on operational and strategic issues.
““Just wanted to follow up after our call this morning and tell you that you are doing an amazing job! The onshore leaders are very happy with the performance so far and it is amazing to see that quality is 99.5% across the board! Again, great job… I’m very proud of you and the team!””