One hospital has addressed this challenge by using remote coders to manage claim edits. This is different than the commonly used practice of remote coding because the work volume includes only rejects, not initial charts and the work list is generated out of the billing system. All claims “kicked out” by the billing edit system for a coding-related reason are routed electronically to a remote coder who has access to facility records via VPN. Claims are resolved same day and returned for billing. The hospital has captured the following benefits as a result of this protocol:
Claims are turned around for billing immediately instead of enduring a routing process in the hospital. The hospital gets paid faster.
There is little or no allocation of hospital based coder time to respond to billing requests. Vacancy, vacations, volume swings and other factors driving the availability of hospital based coders to work on claim requests are no longer a problem for billing.
It is a cost effective way to access professional coding time. As volumes fluctuate from day to day, utilization of the remote coder time fluctuates proportionately.
Remote coders can focus on identification of patterns and recommend solutions easily because they are focused only on claims that have rejected. They might recommend charge master updates, new coding practices, physician education and/or many other ideas.