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Do You Need to Hire Medical Coders? Keep These 5 Tips in Mind

You may need to hire medical coders but are unable to find qualified applicants. Because several health systems are facing the same issue, we recommend outsourcing these positions to an agency with experienced, certified coders. We also have five (5) tips we think you should keep in mind when evaluating that agency before a partnership.

1. Are They Fully Certified?

This might seem like an obvious requirement, but some service providers may not verify that they use certified medical coders. This puts unnecessary risk on the accuracy and privacy of your patient data. It’s best if you determine which certifications a medical coding team has, and how much experience that includes for each of their members. HCRS has a wide pool of coders who are all fully certified by either the American Health Information Management Association (AHIMA) or the American Academy of Professional Coders (AAPC). They also have at least three years of experience.

2. Do They Adhere to Cybersecurity Best Practices?

Healthcare is consistently the worst-affected industry when it comes to cybercrime. There’s too much valuable patient data and medical billing that your team manages on a daily basis to risk an outside contractor being the reason that information is compromised — especially when so many cases of ransomware now involve clients and partners of the original providers who are being extorted.

What are some of the key areas where cybersecurity is important? 

For starters, passwords. You might be surprised how easy it is to make a strong password — and just how easy it is to do the opposite. Requiring coders to update theirs periodically, and enforcing strict policies against sharing account access with fellow users, are also important.

Data backups ensure that medical coding is retained even in the event of system downtime or a potential hack. Digital backup recovery on local data servers offers as little interruption as possible to your normal operations. These backups should be part of a larger incident response plan, which is already a requirement under HIPAA.

Coding specialists should use virtual private networks so that the data they send and receive is unreadable to unauthorized users. This is especially valuable for remote medical coders, or those who are able to “bring their own device” (BYOD) to work.

You can learn more about cybersecurity best practices that our coders use by visiting our blog. All of these serve as protection for your organization’s data, its reputation, and the wellbeing of your patients and providers.

Note: We believe that the Cybersecurity Maturity Model Certification (CMMC), which is required of all government contractors, is the ideal standard for all healthcare providers to meet. It’s how we’ve established our own robust digital privacy, which we extend to the medical coders we employ, and the data management projects we complete on behalf of our clients.

3. Are They Up to Date With Coding Guidelines and Standards?

Each year, the American Medical Association (AMA) releases updated versions of their Current Procedural Terminology (CPT) code set. The latest for 2023 offers 225 new codes, 75 deletions, and 93 revisions. The goal of CPT is twofold: first, to reduce administrative burdens for providers, thereby allowing them more time to focus on delivering high-quality care; and second, to improve upon the categorization system that those providers use to maintain accurate records for their patients and appropriate reimbursements from insurance companies.

The outsourced coders you hire will need to have full knowledge of medical terminology, understand the changes that have been made to the latest CPT codes, and how those changes will influence the work they’ll be performing for you. 

Our experienced medical coders already have this knowledge. 

This includes understanding of the more recent code additions regarding tools that leverage artificial intelligence, augmented intelligence, and virtual reality, as noted by AMA: “Responding to the fast pace of innovation, a new appendix has been added to the 2023 CPT code set with a taxonomy for artificial intelligence/augmented intelligence (AI) applications. The new AI taxonomy provides guidance for classifying various AI-powered medical service applications, such as expert systems, machine learning, or algorithm-based solutions, into one of three categories: assistive, augmentative, or autonomous.”

4. Do They Offer Specialization?

Specialized medical coders are becoming more important in healthcare for factors we’re already discussed, from high-quality care for an aging population, to the rise in tools for medical automation. 

When it comes to the latter, it’s worth noting the concern that some have voiced about AI replacing their jobs. We’re more inclined to agree with the perspective taken by MedCity News: AI may be beneficial for automating some very basic tasks, but it won’t be responsible for “complex specialties — like interventional radiology (IR) and complex surgical cases — that need a human touch.”

Additionally, AI won’t change the fact that doctors’ notes may be incomplete, or that data abstraction services will still be needed to make sense of valuable patient information, whether it relates to core measures or medical records. Core measures abstraction involves verifying that your data presents evidence of how your organization is compliant with national standards of care and treatment. Medical records abstraction is about extracting valuable data points and using them to improve health outcomes and minimize complications.

Coupled with expert coders from HCRS, these services can be used to enhance patient care and operational excellence.

5. Will They Stand By You in an Audit?

Coding and auditing go hand in hand — sometimes at the same organization. You’ll want to verify with your coding agency what they plan to do in the event that your records are audited. Similar to our advice about evaluating a managed service provider, the ideal agency will be present or available during an audit, and will assist with any documentation requests for full transparency and compliance. 

Ready to Hire Medical Coders?

We hope that if you decide to outsource your medical coding, you’ll give our team your consideration. We’ve spent roughly 25 years partnering with healthcare organizations and contractors at all levels of government for improving their coding services and data management, not to mention cybersecurity, abstraction, and auditing. 

If you have questions — either about what a program with us would entail, the tips we shared above, or additional advice for your medical billers — we welcome a conversation. 

Contact us today to get started.

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