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Coding Alignment – A pathway to professional and facility coding integration success

As The Wilshire Group reflects on coding industry trends, there is certainly a common theme with coding department goals for this year: continued integrative work between facility and professional coding.   

Many decisions are required on the path to integration and reinventing this workstream amid sensitive revenue cycle dependencies requires a well-defined transition plan. This work effort will begin to prepare coding departments to realize the true capabilities of robust EHR and coding software technology that position coders for congruent coding (one coder, coding both professional and facility requirements at one time).  Transition on this scale is by no means a quick process and likely will be accomplished in multiple phases. Organizations who have accomplished this level of integration have proven the transition supports broad facility objectives, including:  accurate capture of quality measures, resource containment, improved provider communication, mitigation of audit risk, as well as supporting healthy revenue cycle metrics such as reduction in candidate for billing (CFB). 

As you might expect, there are many considerations when contemplating this transition. The Wilshire Group presents a few questions for your preparation efforts: 

Leadership & Planning 

  • Does the organization’s leadership possess experience with both facility and professional fee coding, along with understanding where disparity is required between the two?   
  • Is there a good pulse on the high-level drivers and issues impacting both workstreams?
  • Is there accountability for metrics and measurements to ensure revenue cycle goals are not lost in transition? 

Staffing/Human Resources 

  • What is the approach to leveling the disparate pay grades between coding levels?
  • Do job descriptions need to be re-written, considering competencies, credentials, education, etc. for this “merged” workforce?
  • Does this change your recruitment strategy? 

Competency/Training/Career Laddering 

  • If you are expecting coders to span a new skillset (pro fee to facility or vice versa), do they have the competencies to do so?
  • Is an education plan outlined to address current as well as ongoing training needs? 
  • Are expectations for career laddering well-defined?
  • What are the quality and compliance controls necessary to ensure ongoing monitoring and feedback are a part of your transition program?  

Medical Staff Communication / Coding Queries 

  • Is there an existing platform for physician & provider communication that also needs to be merged? 
  • Is work effort required to review and revise templates inclusive of messaging addressing both professional and facility coding objectives?

Key Performance Indicators: Defining and Monitoring 

  • Have you established and communicated new measurements that will be adhered to as a part of the transition?
  • If new technology (computer assisted coding - CAC) is a part of this transition, do your metrics change?

Change Management 

  • Who is responsible for effective change management practices regarding major changes, system implementations, and requirements? 
  • Do you have processes in place to assure new tools and technology that were implemented as part of the change are broadly adopted?

These questions are certainly not inclusive of all considerations at hand, but we hope this provides a starting point for preparation of this pivotal coding transition. Our Health Information Management professionals are excited to help organizations clear their path to success in aligning coding operations. We understand the operational and system impacts with our years of experience working in the systems supporting coding.  

Look for more information from The Wilshire Group about your system design and build considerations – as Wilshire shares opportunities to continue a pathway to achieve coding integration success!  

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