Case Studies
Expense of slow coding exacerbates financial problems
While a suburban Maryland multi-hospital health system was repairing several years of financial problems, its medical records coding had slipped to an unacceptable level that made finances worse. The existing vendor was not consistently providing enough staff, which slowed processing so that accounts went 10 days or more before being billed, running up considerable carrying costs for the system. Management sought bids for new coders in the hopes it could further help the bottom line.
Kforce responded and rapidly provided a complete outsourcing solution: 10 credentialed coders and an onsite manager. Unlike the spotty service of the previous vendor, Kforce's coders were consistent, efficient and professional.
The hospital saw its billing delays drop from 10 days to fewer than four, a decrease even greater than management had requested. The health system’s improved cash flow is a welcome financial boost. Perhaps most importantly, however, the complete outsourcing solution means the hospital gets performance and accountability from an onsite staff but without any of the headaches of internal management.
One fix could lead to more valuable new system
Losing its cancer-registry contractor caused some small panic for a Southeast metro hospital, yet it also created an opportunity to evaluate the organization's health information management practices as it looked to expand interventional radiology, where coding mistakes can be very expensive. With a backlog of coding and monthly staffing shortages, hospital management didn't have the luxury of time to hire internally, but needed to regain control and maintain data integrity.
Kforce stepped in with a consultant to fill the cancer-registry spot, and also offered to help with the overall underperformance of the hospital's existing arrangements. After hiring the Kforce consultant outright for their cancer registry, the hospital also brought on two Kforce coders and two more consultants for chart assembly and analysis. Over the next year, with quality assurance at a new high, the hospital had as many as six Kforce consultants on the job at any given time.
The hospital is now seeking to expand its activity in the increasingly popular field of interventional radiology. It has hired Kforce to staff a position and create a coding program in this challenging sector, while also training hospital staff to take over.
Charity hospital struggles with limited resources
A non-profit hospital devoted to the care of the poor was struggling with staffing, particularly in medical coding. The hospital, in an impoverished part of an old Midwest steel town where the mills are long closed, had a very small budget for coding. Minimal funding made the department hard to manage, resulting in a difficult work environment that exaggerated an existing coding backlog. To make matters worse, the coding supervisor left for another job, leaving yet another gap in hospital staff.
The hospital hired the least expensive consultants while trying to find permanent coding staff, but quickly discovered the consultants were inexpensive because they weren't reliable. Kforce stepped in and worked with hospital staff to generate a mutually acceptable pricing structure for quality personnel. Filling in with coders while the hospital tried a few permanent hires, Kforce has had 3-4 consultants onsite for six months and has completely eliminated the long-standing coding backlog. While the hospital works to fill coding positions and the supervisor's role, Kforce and its consultants are supervising by proxy on behalf of the hospital's director.
Though the hospital has many issues to deal with, Kforce has eliminated some of them by actively engaging with staff at all levels to understand not just the immediate tasks but also the circumstances that created them. Willing to find appropriate matches, Kforce is also creating a consultative partnership with this institution to help solve its long-term problems.
Change to electronic records creates employee exodus
Conversion to electronic medical records caused employees of a North Carolina non-profit hospital to fear they would lose their jobs. When some of these employees quit, and others transitioned to new positions, the hospital found itself in a dire situation as unbilled patient accounts piled up. The medical records department needed employees on a temporary basis until the conversion project was complete. Without the temporary help, charts would have lagged, making it difficult to find records and causing doctors to be delinquent in signing off.
Kforce brought in two regional consultants to do assembly and analysis, buying the hospital time to complete its conversion. The consultants helped the hospital maintain a steady flow of the records. Kforce also supplied clerical help for the conversion. Over the course of six months, as many as six consultants worked on different parts of the project.
Kforce's talent helped the hospital reduce a month of backlog and avert a crisis. A hospital representative said: “Kforce allowed us to seamlessly move into electronic medical records without any direct impact on the department's administrative activities.”
Employee health affects hospitals, too
When a medical records coder had to take immediate emergency medical leave, the department director knew he would have to act fast or risk billing delays sure to be noticed by his superiors. Though the leave would likely be only two weeks, the accounts receivable could still spike by $200,000 or more, adversely affecting the revenue cycle for the Missouri hospital.
Kforce answered the director's desperate Monday morning call and, after consultation about the department's needs, enlisted one of Kforce's top consultants. The client needed an experienced coder who would need little training and was familiar with Meditech and 3M systems as well as both inpatient and outpatient records. Kforce's consultant was onsite Monday night and coding on Tuesday morning.
The client was extremely pleased with the Kforce consultant's knowledge and work. A facility that prides itself on quality billing and reimbursement, the hospital routinely reviewed all coders' work and expressed great satisfaction with the abilities of the Kforce consultant, who stepped in and carried the load despite being new to the facility. With no local solutions, the hospital was very pleased with Kforce's ability to quickly find one from outside the area. Kforce’s response time was an essential asset in this situation. With this experience of consultant overachievement, the hospital now calls Kforce first when needs arise.
Patient increase had hospital ailing
A Minnesota hospital found itself short-staffed when an upturn in patient numbers buried its medical coding department. The sometimes complex procedures that made the hospital's reputation also generated large accounts, so if billing was slow, it could be very costly. Furthermore, the hospital's sophisticated systems made finding capable coders that much more difficult. The circumstances conspired to cause a serious and growing problem in accounts receivable.
Kforce drew on its extensive resources and, in a matter of days, was able to quickly provide 10 sharp coding consultants who stemmed the coding decline and stabilized the department while the hospital planned a correction. The hospital then had the luxury to improve its regular staff and provide intensive cross training while Kforce took up the slack on an ongoing, as-needed basis. By being able to supply the same consultants on successive occasions, Kforce also removed the hospital's need to re-train coders for each wave of business.
The hospital was so pleased it developed a long-term relationship with Kforce to handle spikes in coding needs. Kforce’s coders helped in a crisis and also shortened the time the hospital took to bill accounts. Had the hospital not been able to rely on Kforce, it would have suffered accounting difficulties at times when it most needed smooth business operations.
Slow coding costing hospitals millions
Not sending bills for a month is an expensive inefficiency and one that a multiple-hospital system in Ohio could not afford. After seeing that an existing vendor was taking up to 10 times as long as necessary to code emergency-room visits, the hospitals decided they needed a new staffing partner for that task.
Kforce offered to develop a more efficient system for their emergency-room coding. The previous vendor would burn document scans onto a CD and mail them to coders. Kforce suggested using its electronic transfer system to speed things up. After a six-week collaboration between the hospitals' staff and Kforce to develop procedures, the new system went live, sending digital documentation to Kforce's remote coders throughout the continental U.S.
By incorporating some of the hospitals' existing workflow and improving on it where possible, Kforce managed to reduce the hospitals' billing time to a more conventional 3-4 days, decreasing unbilled accounts by $3 million. Kforce cleared up the data backlog and had the process running smoothly in a month. Now reading and coding some 200 documents a day, as well as interpreting and documenting doctors' voice notes, Kforce's team has been asked to perform the billing itself for the hospitals.
Interim manager conducts long-term repairs
When the coding manager fell suddenly ill and had to take an extended leave of absence in the midst of a system conversion, a major Southwest medical center had to scramble to keep pace with its billing needs. A transformation to remote coding would have to wait because even day-to-day operations were not getting done.
The medical center called and, within 24 hours, Kforce had a coding manager on a flight bound for the hospital. The Kforce senior coding manager not only got basic operations running but also implemented new education policies, additional audits, and innovative quality assurance measures while reducing the time for accounts to be billed. The interim manager implemented the system change to remote coding and the hospital eventually brought on five remote Kforce coders.
After the planned six weeks of the original assignment, it became apparent the hospital's original coding manager would not return. The Kforce team has now been on the job for more than a year and continues its work with the medical center. Kforce had reduced outstanding receivables from $13 million to less than $5 million, the lowest level in more than three years. The hospital's director of medical records said Kforce had provided much more than a coding manager, it had provided someone who took an interest in the success of the department and the continuing excellence of staff. “We could not have done it without the help of Kforce and their staff,” she said.
Charge Master Review
A primary-care hospital in rural Louisiana hadn't updated its 7,000-line charge master in many years and feared it was under-charging and losing money. Lacking internal expertise, hospital staff sought bids on fixing the problem.
Kforce's consultative approach revealed that the hospital needed to fix the immediate situation, understand how it occurred and prepare to avoid it in the future. Other bidders merely offered a software package to update the master once with no meaningful follow-up. Kforce's charge master expert and a quality-assurance professional dug into the project and wrapped up a comprehensive solution with recommendations in just four days.
The hospital not only discovered it was undercharging $9,000,000 each year, but through Kforce's evaluation and assessment, they were able to see the need to make strategic changes in maintaining the charge master. Administrators were so pleased with the results and comprehensive solution that they requested a long-term relationship with Kforce to keep the billing systems in-step with a changing business landscape.
MPI Clean-Up
Overdue for file clean-up, a Northwest acute-care hospital faced a system conversion deadline in less than four months and would require merging files and eliminating some 13,000 duplicate records. As part of a larger medical system and as a pilot site for this process, all had to be processed flawlessly, furthermore managers had a tight budget.
Kforce sent a project manager to the site for a MPI assessment and realized the tight time frame would require a creative response to keep quality high but costs low. By finding inexpensive extended-stay accommodations, Kforce's three out-of-town consultants were able to focus directly on the task for longer without frequent travel. The project manager streamlined training and work flow to maximize efficiency. Along with four local experts, Kforce accomplished the file merge without taking facility directors away from their daily tasks.
Kforce's ability to respond quickly and efficiently won the contract over two competitors, plus the hospital also beat its deadline for system conversion by two-and-a-half weeks and set an example for its sister facilities facing the same task. Kforce's hands-on evaluation and innovative consulting arrangements also kept the job well within budget and saved the client more than $20,000.
Contact an HIM representative at himsupport@kforce.com.