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Many healthcare organizations recently have contracted with coding vendors to provide ICD-9 coding assistance, in part to allow in-house coders to undergo ICD-10 training and participate in dual coding.

Some of these vendors employ U.S.-based coders only. However, it’s becoming more common for companies to employ a mix of both onshore and offshore coders, many of whom possess top-notch coding skills and knowledge. This article provides practical advice for health information management (HIM) directors for accessing new offshore coding support. 

The Shifted to an Offshore Model?

Regardless of size, virtually every coding company has built an overseas coding center or partnered with an existing center to meet productivity demand in the United States.

Industry experts predicted as much as a 50 percent decrease in productivity once coders began using ICD-10. In addition, there just aren’t enough ICD-10-skilled coders to go around, creating a scenario in which demand outweighs supply. 

Bringing in Offshore Support 

The uncertainty associated with ICD-10 has negated many fears and anxieties associated with offshore coding. Provider organizations are realizing that quality coding is quality coding, regardless of where a coder resides and works. This is a reassuring development, given the skill sets and knowledge that many offshore coders possess. 

For example, H.I.M. On Call employs over 300 India-based coders. They have been trained in ICD-10 since October 2010. During both ICD-10 postponements, these coders continued to receive ongoing refresher training and practice time.

Many offshore coders, ours included, also possess unparalleled clinical knowledge. Many of them are doctors, nurses, pharmacists, or medical science majors with backgrounds in transcription. Each of them holds the equivalent of a bachelor’s, master’s, or doctorate-level degree. They are also well-versed in the limitations of ICD-9 and the necessity of moving to ICD-10 since their countries have already made the transition.

Questions for Your Vendor

Now is the time to embrace offshore coding and the potential it has to supplement your in-house coding staff. When working with a vendor that employs offshore coders, ensure that a strong quality assurance program is in place, as well as a secure technology infrastructure to support a remote coding workforce. By thinking outside the box, organizations can capitalize on offshore coding opportunities and reap the benefits in terms of cost savings, labor accessibility, and turnaround time.

Consider these questions to ensure that your coding vendor provides maximum support following the transition to ICD-10: 

  • What is the vendor’s approach to ICD-10 training?
  • What is the duration of the ICD-10 training program? Dedicated number of hours? Months?
  • Did the training include anatomy and physiology?
  • What qualifications do the ICD-10 trainers possess?
  • How did the vendor assess coder readiness for ICD-10, including individual coder strengths and weaknesses?
  • What is the mix of inpatient and outpatient coders?
  • What is the mix of hospital- and physician-based coders? Most offshore coding companies or U.S.-based companies that employ offshore coders are primarily physician-based.
  • For which U.S. hospitals does the vendor provide services?
  • How will the vendor handle volume fluctuations?

Strengthen Your Bond

The transition to ICD-10 has generally strengthened the bond between organizations and their coding vendors. Many organizations even feel that the interim support they’ve received throughout the ICD-10 transition can and should be extended into a more permanent solution as ICD-10 goes live and beyond. 

Savvy HIM directors will take the extra steps mentioned above, work with solid due diligence, and vet their offshore coding vendors carefully. 

About the Author 

With over 30 years of expertise in health information management services, Manny Peña, RHIA is the chairman and CEO of H.I.M. ON CALL, Inc. Manny previously served as the senior director of the Health Information Management Department for New York Presbyterian Hospital’s Columbia-Presbyterian Medical Center. 

Manny founded H.I.M. ON CALL in 1999. Since its inception, the company has provided services to more than 100 hospitals throughout the U.S. and Puerto Rico with its core services of coding, audits, education, and data quality. 

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