Over the years, Meditec has watched as medical transcription services moved from totally in-house operations to highly outsourced operations, and to become great home business opportunities. We believe that medical coding will follow suit. To demonstrate how simple and successful coding from home can be, here is an article by Jennifer Shearer about a hospital group who set up a home coder process with great success.

Remote Coding at Home: Tips for Success
by Jennifer Shearer, RHIA

Look at any HIM periodical and you’ll see numerous advertisements for clinical coders, some offering sign-on bonuses as high as $10,000. Why such a high price tag? Many healthcare organizations today are experiencing a shortage of qualified coders.

Inova Health System had experienced this very problem for several years. Inova Fairfax Hospital, a 656-bed acute care facility in northern Virginia, had experienced a 20 to 25 percent vacancy rate for coders in the past three years. It seemed that once a vacant position was filled, another coder would resign.

Like many other organizations, Inova Fairfax Hospital had tried many solutions with little overall success. With more than $2.7 million being billed on a daily basis, the organization could not afford to have coding vacancies and the resulting increase in accounts receivables due to coding backlogs.

Despite spending significant amounts of money on outsourcing backlogged work, paying out more than $50,000 in retention bonuses and more than $6,000 in recruitment bonuses, and requiring mandatory overtime, the hospital was not making significant enough progress in relation to the overall shortage of qualified coders. With APCs on the horizon, it was very clear that something new and innovative had to be done.

Here’s how the hospital successfully implemented a remote coding program, boosted retention, increased morale, and improved the overall performance of the department.

Coders Go Home to Work
In October 1999, Inova Fairfax was approached by an application service provider (ASP) company about in participating in testing and development of an Internet-based coding application that would enable coders to code from any remote site that has Internet access, including home.

Until then, coding from home had never been an alternative the hospital had been efficiently able to offer coders. Inova Fairfax transcriptionists had worked from home for several years, and coders had always expressed an interest in doing the same. Using an ASP and transferring charts securely over the Internet would enable coders to work at home and increase coding options with regard to contract coders and outsourcing capabilities.

After several meetings with the ASP’s management and carefully reviewing its security capabilities versus the hospital’s internal security requirements to ensure compliance and readiness for potential HIPAA requirements, the facility enthusiastically embarked on this new project.

During the early stages of the beta test, only two coders tested the system from home and provided feedback. Their excitement about the new system, however, soon had most of coders anxiously waiting their turns. Shortly thereafter, 10 coders were able to work remotely. We were restricted in volume only by our inability to connect remotely to our abstracting and clinical systems, as well as the encoder. We resolved the abstracting at home capabilities using terminal emulation software, and the coders willingly gave up reliance on the encoder to be able to work from home.

Coders took home reference materials that were supplied by the hospital. When they had questions they could not answer using the reference books, they e-mailed the on-site data quality manager. Similarly, questions for physicians were forwarded to the data quality manager, who passed them along to the clinicians. Sometimes coders were able to call physicians directly with questions as well.

Within two months of allowing coders to work remotely, we had no vacant coding positions and actually had a waiting list of qualified coders who wanted to work from home. Sixteen of our 18.5 coders now can work remotely. What’s more, the department was able to:

  • increase productivity by approximately 20 percent
  • eliminate many of our outsourcing costs
  • significantly reduce accounts due to coding receivables (a more than $11 million reduction in three weeks)
  • tremendously improve coder morale

Overall, a cost benefit analysis indicated a net savings/gain of more than $380,000 annually.