In search of ways to reduce expenses and shore up revenue streams, hospitals and health systems are beginning to explore implementing the single-path coding model. For organizations that meet the trifecta of “right coders, customized workflow, right technology,” transitioning to one coder performing both facility and professional fee coding within a single workflow can boost the bottom line.
We recently took an in-depth look at this emerging model in The Move to Single-Path Coding in the February 22, 2022, issue of the Journal of AHIMA. This blog looks at one part of that discussion – the three pillars of a successful transition to single path coding. These are:
- People – the right staffing, organizational structure, and culture
- Process – identifying vision and goals, conducting proper training, revitalization, and establishing policies and procedures
- Technology – customizing systems, process augmentation, and data-driven decision-making
First, however, a thorough assessment of current processes should be conducted to identify any necessary organizational and workflow changes, including staffing. Also, leaders from three key stakeholder groups – physicians, IT, and coding – should be engaged, as each will play an important role in establishing the pillars upon which the single-path coding model is constructed.
Pillar One: The Right People
Start with a gap analysis of current skills, the findings of which will be leveraged to design training programs that address any shortfalls. Then, bring in professional, certified coders who are cross trained on both facility and pro-fee coding, and/or with the right mix of attributes to help them make the transition. These include:
- Varied professional experience
- Independence and resourcefulness
- Reliability and dependability
- Professional communication skills
Establish a system of audits to monitor quality and set KPIs to measure coder and program success. A well-performing single-path coding model will typically drive increased charge capture and relative value units (RVUs) and reduce lag delays, resulting in extra cash on hand, cost savings, fewer coding denials, and improved coder productivity.
Finally, consider outsourcing at least some existing coding volume during the transition. Doing so alleviates some of the pressure on coders during the initial stages as they adjust to the new process.
Pillar Two: Defining the Process
Creating an effective single-path workflow involves mapping out coding processes by chart type to identify where facility and professional fee coding workflows overlap or intersect. This signals areas where steps can be combined – ideally with input from impacted coders.
Conduct a workflow analysis to identify any disconnects between what administration believes the process should be and what coders actually do. It should include an understanding of the coding process as it really is, how coding works with other departments, and the impact coding outcomes have on various operational aspects.
This workflow analysis should pull from the previous evaluation of coder proficiencies to refine decisions around training to ensure coders can concurrently and appropriately code facility and professional fees for the organization. It also provides valuable insights into just how much the process can be consolidated.
Pillar Three: The Right Technology
The technology pillar can make or break any single-path coding program. The best approach is to engage a partner that is willing to work as an extension of the project team, not just as a vendor. This will provide a solid foundation upon which technology decisions can be made.
Due to both the cost of technology and the time and effort required to successfully transition from one system to another means the best solution will be customizable. A one-size-fits all solution won’t work in a single-path coding model because workflows and processes are unique to each organization’s workflow. A unified medical coding platform is also recommended for its ability to process data regardless of the originating format.
Finally, the technology should feature natural language processing (NLP) and artificial intelligence (AI) capabilities that can suggest medically appropriate codes, as well as robust report capabilities, user-friendly dashboards, and the ability to provide feedback to coders and build facility-specific edits.
By building from these three pillars – people, process, and technology – single-path coding can be a risk worth taking.
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Author
Vivek Menon
