8 questions to ask when outsourcing your medical coding services

1. What are the required certifications and credentials for your coders? 

Medical coding mistakes are frequent with 9 out of 10 medical bills containing errors and those errors annually cost between $17-29 billion. When outsourcing your medical coding needs, one of the most important factors is to ensure the people who handle your charts are experienced and certified coders. We focused on having our coders either AHIMA and/or AAPC certified to ensure the highest level of understanding to improve accuracy.  

2. Are the coders trained in a breadth of specialty groups? 

Each specialty requires deep knowledge to best understand and properly code charts. Practices with multiple specialties often relied on generalist coders when hiring coders for in-house positions. When outsourcing your medical coding, practices should expect experienced specialty coders that can assist with all aspects of the multi-specialty practice. This can save thousands of dollars in compensation that would be required to hire specialty coders and can prevent lost revenue by reducing claim denials. 

3. Do you have continuing education requirements for your coders? 

In 2022 alone, there were 405 editorial changes in the CPT^® code including 249 new codes, 63 deletions, and 93 revisions. Coder's handling charts regularly must undergo continuing education opportunities to minimize claim rejections, ensure legal and regulatory compliance, and reduce the risk of improper medical coding and audits. 

4. What is the compliance program put in place? 

Speaking of compliance, with all the changes in medical coding, it is vital to have a medical coding team backed by a strong compliance organization with well-documented written policies and procedures. These essential measures signal to employees the importance of accurately following compliance protocols while reducing the risk of legal violations. 

5. What is the Service Level Agreement (SLA)? 

It is important to know up-front what is expected from your medical coding provider. For example, at Greenway Health, we maintain a 48-hour turnaround with a 95 percent accuracy rate. Some providers may feel more comfortable with a longer lead time. These SLAs can be specific to your practice’s threshold. Regardless of the requirements, having an agreed-upon commitment from your provider will ensure you are receiving the accuracy and timeliness you expect.  

6. Is the pricing schedule easy to understand? 

The pricing schedule for medical coding charts can be incredibly complicated. If you do not have someone on your staff dedicated to ensuring the billing of the services is accurate, be sure to lean towards providers who have a simple pricing schedule. This will allow you to better gauge your costs – especially if your charges are on a chart basis – and determine budgets. 

7. Does the coding process include any automation or AI?  

The digitization of healthcare over the last decade has ushered in a new era of healthcare innovation, especially in medical coding. Leveraging AI and machine learning methods to identify patterns increases efficiency by decreasing the time it takes to search for proper codes, improving overall accuracy. Many automated and/or AI services tend to have a percentage of their charts reviewed by a human for quality assurance reasons. It is important to be aware of those procedures and determine the right mix of services for you. 

8. What procedures are in place to ensure accuracy? 

Medical coding is a constantly changing, highly regulated field full of rules that practices must navigate promptly to maintain compliance and ensure accuracy. Coding requires preventative measures to reduce mistakes and costly denials as it becomes more specialized. Experienced medical billing providers should adhere to the ICD-10 requirements, perform consistent audits, and take on the responsibility of continuing education for their certified coders to ensure accuracy and up-to-date knowledge of the continually changing rules are followed.