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Focus on Staffing: Four Key Staffing Models Leading Up to ICD-10

Published on October 2, 2014


Coding organizations are looking to create – or travel further along – a path to high performance in the final run-up to ICD-10. Many future challenges are fairly well understood, such as the coder shortage, and the inevitable productivity hit with the seven-fold increase in available codes. Yet some uncertainties remain – including the level of detail required in completion of the outpatient coding process, and whether individual facilities or insurers will require ICD-10-PCS codes to be assigned even though they are not required by the federal mandate.

In this context, the choice of an appropriate staffing model is key. Positioning a coding organization to utilize a specific staffing model involves an analysis of organizational, financial and operational goals. Efforts to define the current state must include a close look at internal capabilities, gap analysis, performance standards and ongoing initiatives such as CDI and Meaningful Use. Over the years, have multiple processes been layered one on top of another? Are there duplicate or manual processes in the coding workflow? If so, these factors need to be addressed.

The final phase of the assessment should be a strategic analysis – identifying benefits, gaps, opportunities for improvement, and potential hurdles/conflicts to achieving efficient operations.

Current staffing levels must also be considered. Are there unfilled coding positions? Does the organization rely on an external company for overflow relief? What staffing levels would be needed for all coding to be done in-house? Has there been a change in the IP coding volume over the past month, six months, year or two years? The organization’s strategies for the future must be part of this deep-dive, taking account of any plans for additional specialty service lines and related volume increases.

The final phase of the assessment should be a strategic analysis – identifying benefits, gaps, opportunities for improvement, and potential hurdles/conflicts to achieving efficient operations. Benefits may include a young and fully certified coding staff to counter threatened coder retirements, while opportunities could include an internal vision of centralizing all coding functions.

Based on these analyses, organizations can choose between four types of staffing model, each one more efficient than the last:

  • Stage 1: Full in-house, employed by the facility, United States-based, paid on an hourly basis, and with on-site management of workflow, employees and process. The advantages of this approach are it is based on a traditional relationship, the coders are fully familiar with the facility operations, and the potential for coders to have upward mobility in the organization. With this model, organizations need to consider their costs, attrition, and the need for in-house management.
  • Stage 2: Labor Outsource, with primarily domestic outsourced support, and hourly pricing. Advantages here are a strong control of the process and the fact that quality parameters are maintained, however there is also the risk that the coder shortage impacts vendors as well as facilities limiting their capacity.
  • Stage 3: Technology Outsource, including consideration of technology-enabled services, with an expanded focus to include global outsource support, and a trend towards transactional pricing. Advantages here include enhanced TAT sustaining revenue cycle goals, and efficiency gains from use of technologies. The difference in moving to this technology-oriented stage, compared to the previous two stages, is overcoming any internal perceptions of these being unproven solutions, and addressing change management issues .
  • Stage 4: Mature Outsource, with full use of all available staffing solutions, using the global ‘follow the sun’ workflow, where tasks are passed daily between time zones, and a transition to full transactional pricing. This highly efficient stage can provide cost benefits, and promote better compliance that promotes better response and TAT to improve revenue cycle efficiencies. As organizations move to this stage they also may have to address internal perceptions that this approach is ‘not ready for prime time,’ coupled with concerns over global quality and compliance.

Over the coming year, organizations need to assess their internal dynamics to determine which option suits them best, while being sure to define operational and offshoring requirements. When considering an outsourcing perform, thorough due diligence is critical – and this should continue long after the contract is signed.

Clearly, the right staffing model for each organization will be different – there is no single “best way” to achieve the pre-ICD-10 tune-up. However, these models can be tailored to specific organizational needs, with options available anywhere along the continuum from stages 1 to 4. Starting this process in good time – and not waiting till the eve of October 2015 – will set the scene for post-ICD-10 success.