Author: R@road22

Many home care, home health, and hospice providers have not had the scope and ability, through no fault of their own, to develop as comprehensive a compliance program as they would like. However, in a world of ever-changing healthcare regulations and standards, the risks of failing an audit are becoming too great and potentially too costly for providers to reasonably take on the business risk of failing to have a consistent, reliable, and comprehensive compliance strategy in place.

Where the budget, size, or growth rate of an organization may not allow for a robust full-time in-house compliance support team or where there are difficulties with retaining compliance staff or filling vacancies, outsourcing compliance can be an excellent option. While there has long been hesitation in the home care, home health, and hospice world when it comes to outsourcing compliance, if you choose the right company then the risks are incredibly low and the benefits are robust. As the complications and regulatory nuances of being a home health care provider grow, it has become increasingly more important that clinical management teams are able to maintain focus on the core points of service delivery. As a result, outsourcing the activities that are not grouped among these core services is becoming an increasingly popular option for health care providers.

Where there are often concerns expressed around the risks and process of outsourcing compliance services, The Department of Health and Human Services Office of the Inspector General has stated that health care organizations may reasonably decide to outsource compliance duties and activities. Its Compliance Program Guidance states: “For those companies that have limited resources, the compliance function could be outsourced to an expert in compliance.”

Compliance outsourcing companies employ clinicians and experts with the clinical experience and regulatory familiarity required to support health care providers with their compliance programs. Additionally, the often lower cost of outsourcing allows organizations to remain up to date with both current and evolving compliance standards and supplement limited internal resources where required.

The cost advantage also allows providers to review a much larger volume of charts, which helps in tracking deficiencies more effectively over time. This, in turn, helps in offering targeted feedback and training for the clinical staff who may need more support with documentation improvement. The ideal scenario for providers would be to have an in-house clinical manager who will oversee the chart reviews performed by the outsource compliance vendor, assess their quality periodically, and work with them on analysing the data generated from the reviews to spur both short and long term improvements in compliance.

Compliance outsourcing can offer a number of different possible benefits for the improvement of an organization’s compliance and service delivery, as long as your outsourced clinical compliance support provider can offer your organization the following:

• More efficiency. Their teams are experienced in compliance support and require minimal learning to meet your needs.
• An understanding of all relevant regulations, laws, clinical standards, coding/claims processing, etc.
• Experience in a wide range of compliance issues.
• Reduced costs related to recruiting, onboarding, and maintaining full-time employees.
• Regular and accurate reporting, including for your executive management teams.
• Improved risk protection.
• The ability, due to lower set costs, to offer you the option of a larger compliance program than you may otherwise be able to manage or afford in-house.
• Reduced workload for your clinical management and support teams, often resulting in improved employee satisfaction.
• The ability to consistently invest in your compliance outcomes and better plan your compliance budgets.
• HIPPA/GDPR/SOC2 Type 2 Data security compliance, which ensures that your patient and organizational data is protected.

If a healthcare company decides to undertake a compliance support partnership with a compliance outsourcing vendor, it is essential that the vendor they outsource to is qualified to perform these responsibilities. Also critical is that healthcare organizations designate a consistent point of contact to liaise with key team members of the outsourcing vendor, so that the compliance outcomes that emerge as a result of outsourcing have a path towards accountability both within the healthcare organization and the compliance outsourcing vendor. #Powerofmore

It’s 2022, and outsourcing isn’t an outlandish idea anymore. With healthcare facilities across the country making the decision to outsource their healthcare business operations, this might lead you ask yourself – why? And should your healthcare facility follow suit?

Medical coding is one of the more commonly outsourced healthcare business functions. However, before making a decision, you want to objectively consider the benefits of outsourcing instead of merely following a trend.

As a high-quality service provider delivering comprehensive healthcare business solutions to top ‘out-of-hospital’ healthcare providers, we know more than a thing or two about outsourcing your medical coding operations. If you’re considering outsourcing these operations but still have concerns or don’t fully understand what the benefits would be, here are some reasons that outsourcing often works better that you can imagine. These reasons are strongly rooted in insights from our experience working with some of the best healthcare facilities in the industry.

1.   Increased Transparency

In theory, the idea of outsourcing may sound like relinquishing control to strangers and having reduced control over critical outcomes. In practice, with the right outsourced service provider, it actually involves greater accountability from the service provider with lower stress on your organization. When working with a high-quality service provider, your organization will have access to a pool of highly skilled coders who have well-defined metrics and targets to adhere to. An outsourcing firm is liable to meet these targets and provide you with a number of reports that are often more detailed and insightful than those that are provided by internal teams, simply because your internal teams often have so much on their plates. In this way, working with a high-quality service provider is a breath of fresh air to most organizations, purely because of the exponentially improved transparency.

2.   Expedited Insurance Payments

Outsourcing firms combine highly skilled teams of coders and well-defined processes and metrics, to minimize errors and ensure that bill payments and reimbursements are received in a shorter period of time. The streamlined workflows and multiple levels of quality control that are embedded into the system all work to ensure higher earning potential for your organization.

3.   Lower Costs

When one hires a dedicated internal medical coding team, their salaries aren’t the only expense involved. An employer also has to pay significant overhead in the form of benefits, onboarding costs, and training expenses. This can make hiring an internal team an expensive, unoptimized approach to medical coding. On the other hand, an outsourcing company provides for their own employees’ well-being and delivers better results at a fraction of the cost of a dedicated team.

4.   Consistent Staffing & Regularized Cash Flows

People are naturally prone to needing time off from work for various reasons, and workforce shortages are sometimes a given. However, that isn’t the case when it comes to outsourcing. Outsourcing makes your organization immune to the effects of attrition and fluctuations in staffing levels. A high-quality service provider ensures that their medical coders function akin to an extended team for your organization. By simple extrapolation, this consistency also ensures regular cash flows with no bottlenecks in your billing operations.

5.   Ease of Scalability

When you work with a high-quality service provider, your healthcare facility gets access to the provider’s pool of highly skilled coders. This gives your organization the flexibility to overcome exponential increases in workload, since the service provider can increase the number of coders working on days when this flexibility is required. You can also work with your outsourced service provider to plan for any significant jumps in growth for your company, through acquisitions for example, so that you can be confident that your quality and coding metrics will remain consistent through period of change. This completely bypasses the need for hiring processes that are often costly, drawn-out, or simply unfeasible when an unexpected, immediate, or substantial need for manpower arises.

6.   Increased Patient Satisfaction

Perhaps the biggest and most important benefit of outsourcing your medical coding operations, is that it enhances patient satisfaction quite significantly. Outsourcing medical coding operations takes an additional responsibility off the hands of your clinical and support staff, thereby freeing them up to better focus on delivering a better patient experience. By focusing on addressing patient needs and smoothly carrying out support and clinical functions, patient satisfaction can be significantly increased – thus leading to higher patient retention and more growth for your organization.

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As mentioned earlier, these benefits aren’t rooted in assumptions but, rather, from our work with clients who are experiencing these benefits and more. If you’re ready to discover what outsourcing can do for you, please get in touch with us so that we can show you the Power of More – more benefits for your business than ever before.

Having contemplated the idea to outsource your healthcare business functions such as medical coding, billing management, compliance, and more, feeling slightly apprehensive is perfectly normal.

How does this work? What about your internal team? How will your responsibilities evolve? These are some of many valid questions you might have. As a high-quality service provider in this field, we at Red Road have answered some FAQs when it comes to outsourcing medical business functions to us.

Do I really need to outsource my medical business functions?

Recruiting high-quality staff in the United States has become immensely challenging over the last few years. This is only expected to worsen over time. The ever-decreasing margins faced by the home healthcare and hospice industry only add to this strain. This makes the decision to outsource not only essential, but eventually inevitable.

Outsourcing is a highly effective way to perform medical business functions while mitigating costs, by way of converting fixed expenses into variable costs that balance themselves out over time. While specifically working with Red Road, you will also have a direct line to monitor and manage the outcomes our teams produce for you, yet without needing to micromanage daily tasks.

How would my existing in-house team adapt to this change? What would this team look like in the future?

We do not recommend replacing your entire team from day one, or ever – if that is the desire of your organization. Red Road’s promise to to be an ‘extended team’ for our clients, so as to augment your organization’s existing team.

The transition to outsourcing is a step-by-step process. This enables our clients to become familiar with the process without delivering a major shock to your organizational structure. Even the manner in which we go about this process isn’t fixed, but rather tailored to your needs and the situation at hand. For instance:

Approach A

To start outsourcing on a trial basis when you lose an employee or have increased demands because of an upcoming clinical audit.

Approach B

While planning for future growth, we step in to expand your in-house compliance team – as opposed to you bearing the cost of hiring, onboarding, and managing new employees.

Your internal team will still play an important role in your organization. Typically, only tasks that have clearly defined processes and can be measured for quality are outsourced. Your internal team can monitor our quality assurance metrics through monthly or quarterly audits, and any issues identified can be brought up using the Service Level Agreement clause on these metrics.

In our experience thus far, most of our clients are working towards outsourcing a majority of tasks, but retain most of their experienced staff in order to monitor the productivity and quality of our services.

How does the process of outsourcing with Red Road work?

While the process works differently based on individual clients and their organizational needs, here are some key points that give you an indication of the Red Road experience.

• Red Road has managers who are qualified and well experienced with how the onboarding process works for different types of clients in the US healthcare industry. These managers will interface with your team to understand your business, and their KRAs.
• It usually takes about two or three video calls – prior to the pilot period – to set this up. Once our manager understands your needs and expectations, they select the right staff from our pool of expert staff for the pilot.
• This is followed by the training of the selected staff by the manager, following which the pilot goes live with the agreed upon number of initial staff.
• We organize bi-weekly check-ins with our manager and your team, in order to understand the progress of the pilot. These calls also present an opportunity to answer questions and address any issues, while also being used to design an internal QA process that’s specific to your needs. Specific QA metrics are identified and shared with you at regular intervals.
• At the end of the successful 4-6 week pilot period, both parties typically agree to go ‘live’ with the project on a more permanent basis.
• From the moment, the Red Road manager will be responsible for updating you at a frequency agreed between both parties. This manager will also train additional staff who might be required due to evolving requirements.

 If these answers have assuaged your uncertainty, there might just be one more question on your mind – when do we start? Contact us for a consultation and let’s get you to experience the “Power of More” right away.

Here are the major changes you’ll notice once you start.

You’ve finally made the decision to outsource your medical coding & billing management operations. Perhaps you arrived at this decision due to inefficiencies in your organization. Or maybe you have been influenced by your peers and, sometimes, even your competition.

Whatever the reason is that you have now arrived at this decision, it is absolutely the right one to make – and it is a potentially exciting new era for your organization. Outsourcing is the present and the future of the healthcare industry when it comes to clinical business functions.

After you have made the decision to outsource your medical coding & billing, this decision will trigger changes to your organization that will present compounding benefits over time. But what exactly are these changes and how are you going to identify them and properly assess their benefits? As one of the high quality service providers in this field, we’re going to answer that for you – based on our experiences with our clients.

More Efficiency

Outsourcing your medical coding & billing operations eliminates several inefficiencies associated with hiring an in-house team. Once you outsource these operations to a high quality service provider, you’ll soon notice that your organization is less dependent on internal hires – while a dynamic team of experts with the utmost accountability delivers consistent results, without the need for you to continually follow up. It’s as efficient as putting these operations on autopilot, enabling your organization to focus on its core activities.

More Profit, Higher Margins

Hiring an in-house team is far more costly than it might seem. This is due to the fact that – over and above an employee’s salary – an organization also needs to account for recruitment costs, training costs, incentives, turnover, and additional overheads. Outsourcing turns these expenses into variable costs, which ebb and flow with your organization’s emerging needs. You’ll soon notice that this dynamism reflects positively on your organization’s financial statements, with significantly increased margins.

More Accountability

A high quality service provider isn’t just contractually obligated to deliver results, but also has a reputation in the industry to maintain. Working with these service providers will have you notice an uptick in accountability, and – perhaps more importantly – reliability. With designated coders and industry experts working as an extended team for your organization, you can be certain of working with a team that is as committed to your needs and goals as an in-house team would be. The best service providers also offer round-the-clock access that ensures industry-leading support on any day of the week.

More Flexibility

Hiring only an in-house team limits your organization’s flexibility to the specific skillsets of those individuals. On the other hand, outsourcing enables your organization to choose specific coders with varying levels of expertise to work as your extended team. With ever-evolving regulations and compliance norms, outsourcing will not just enable your organization to keep up with them – but also stay ahead of the curve. A high quality service provider ensures a steady supply of coders at every level of expertise, all of whom are required to keep up with the changing landscapes of compliance. You’ll soon notice that your organization is more agile and flexible than ever before.

More Accuracy

A high quality service provider can guarantee accuracy at scale, even when it comes to substantially increasing the numbers of records being audited. As your business grows, which means more records for your service provider to audit, a qualified outsource provider’s quality control and assurance systems are designed to withstand exponential growth, while maintaining accuracy with the same control levels. For instance, at RedRoad, all of our coders are certified medical coders who must maintain a minimum accuracy rate of 95% on a daily basis. Of all reviews conducted by our staff, 10% of these reviews are sent at random to an external quality control team for further assessment. With these assurances of accuracy, you’ll soon notice that your organization also has increased freedom to scale without worrying about an auditing team keeping up.

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All of these benefits are all based on our clients’ experiences working with us. And in case you haven’t noticed, the key operating term in all these benefits is ‘more.’

That is because Red Road is a high quality service provider delivering industry-leading healthcare business solutions, and our promise to our clients is the Power of More. From our very first interaction with our clients, our goal is to maximize value for them and ensure we make a significant difference to their organizations. We believe that our clients deserve more quality, efficiency, and affordability, without the need to choose one at the cost of the others.

If you’re contemplating outsourcing your medical coding & billing operations, do reach out to us for a free 4 week pilot program that enables us to truly understand your business needs – and have you truly experience the Power of More.

Leave the responsibility of compliance to an extended team of experts, so that yours can focus on saving lives.

The field of medical science is rapidly evolving. Such is the natural state of medicine, to evolve into better and better versions of itself over time. As medical science continues to evolve, so do your healthcare organizations’ infrastructure, expertise, and professionals.

Just as medical science evolves, so do the landscapes of regulatory frameworks and the compliance safeguards needed to navigate them. With constantly changing legislation on patient privacy, as well as the high-risks and cost implications associated with non-compliance, it is essential for healthcare enterprises to be dynamic in their approach to compliance.

Non-compliance can lead to poor clinical outcomes, divulgence of sensitive patient information, a waste of resources, financial fraud, legal action, high non-compliance penalty fees, and more. Additionally, compliance requirements can be incredibly challenging for healthcare institutions to keep pace with. Especially when their staff’s main focus is on saving lives.

Enter, outsourced medical compliance solutions. When sourced from a high-quality service provider of exceptional integrity, these services can shift the burdens and challenges often associated with compliance to a team of professionals that specialize in this very field.

There are numerous benefits associated with outsourced compliance solutions that every healthcare enterprise should know about:

 Independent Assessment of Existing Compliance Infrastructure

A high-quality external solutions provider doesn’t just bring their expertise to the table, but also their objectivity. Their first order of business is to evaluate how equipped your enterprise is to keep up with regulations and best practices, and suggest effective solutions to resolve shortcomings.

Successfully navigate The World of Compliance Tools – Without Actually Having To

Keeping up with regulations of the many different payors and accrediting agencies require the use of numerous compliance tools and solutions. While the choice of such tools on offer can seem overwhelming, a service provider will choose the best, most cost-effective tools for your organization depending on their assessment of the internal controls required.

Create Demonstrable Processes

A key aspect of compliance involves demonstrating to regulators that due processes are being effectively followed. If you select the right compliance solutions provider, they create a customized, bespoke solution that effectively maintains and organizes all your organization’s documentation. This makes the very same documentation available to regulators in an instant, once asked for.

More Efficiency, Even When It Comes To Costs

A service provider with the highest standards of efficiency and reliability will act as your organization’s extended team. This can help streamline your staffing and help reduce the need to hire additional full-time compliance team members whose salaries and benefits form an additional cost centre for your organization. Instead, a solutions provider remains committed to delivering results while being far more cost effective.

Improved Employee Engagement

While the objective of hiring an external solutions provider is to minimize the time spent by your employees on compliance, this doesn’t eliminate their responsibility altogether. Service providers establish customized compliance frameworks for your organization, in such a way that minimal employee contributions are solicited for the system to efficiently function. A single employee committing a major error, puts this system at risk. That’s why an external service provider will also educate and train your employees on basic compliance measures one must follow, especially with regard to data protection and documentation.

The RedRoad Advantage

All of these advantages do not come with just any compliance support provider, but are a distinct series of advantages that are exclusive to working with Red Road.

Red Road is a high-quality medical compliance solutions provider, delivering industry-leading solutions that take the burden of ensuring compliance off our clients’ shoulders. Despite being an outsourced team, our promise is to act as an extended team for your organization, one that comes with all the benefits of an in-house team – minus the high costs.

Our dedicated teams of qualified registered nurses and specialists boast of decades of industry experience, using their expertise to develop internal controls that your organization truly needs. Paired with our excellent customer support, this ensures that high-quality service is available to your organization 24/7.

At Red Road, we are on a mission to revolutionize outsourcing to deliver more efficiency, more results, more reliability, and more cost savings to our clients. Reach out to us if you’d like to experience the Power of More.

Red Road is an organization with a mission – to revolutionize the outsourcing of medical coding and deliver an unmatched level of efficiency and results to our clients. We believe in delivering services that are not just marginally better than the rest of the industry – we seek change the very expectations of the clients who look to our industry for support.

Our team of industry specialists turns this vision into action by bringing their expertise and commitment to the table every single day. Case in point, our medical coding team delivers industry-leading medical coding, best measured by our exceptional accuracy rates, minimal turnaround time, and customer support that reminds our clients that we’re always with them, at every step of the way. We think of finding simple solutions to not just solve complex problems, but exponentially increase beneficial results, so that our clients don’t have to.

With a mission that is focused on changing an industry-wide standard comes the need for a team that inherently aspires to push the limits. That is why a medical coder at Red Road needs to do more than just click a few technical boxes. They need to bring a passion for healthcare and a work ethic that gets us closer to our mission every day. Our mission requires us to recruit our coders in a way that is driven by this mission, seeking out those rare individuals who possess a unique blend of both technical expertise and our corporate values.

We don’t just believe in recruiting star coders, but in helping them improve every day. We have regular conversations with our medical coders to understand what skills they have learned in the organization, and how we can facilitate them achieving their goals and potential. ‘Communication’, ‘teamwork’, ‘problem-solving’, and ‘technical expertise’ are just some of many skills that our medical coders are proud to have mastered at Red Road, all to the benefit of all our clients.

At Red Road, we’re constantly pushing and redefining industry standards of excellence with our Outsourcing 2.0 efforts. We know that when our medical coding team is happy, it shows in the form of exponentially better results for our clients. That’s why we pride ourselves on maintaining a healthy work environment with a positive office culture, where talent is recognized and everyone can feel comfortable and welcomed – with an equal opportunity to shine. Our medical coding team has the confidence to give it their all, with high job security and leadership that encourages innovative thinking. We also reward ingenuity, with incentives, bonuses, quarterly & annual awards, and well-deserved promotions.

When our employees grow, our clients see the results in the work that we do for them and we get closer to fulfilling our mission. It is truly that simple. Our clients speak volumes about our unmatched accountability, transparency, reliability, and technical expertise – we owe this to the medical coding team that makes use of the opportunities they have in working with Red Road.

While many companies often view employees merely as resources, we treat them as stakeholders who have just as much of an investment in our future as our senior management does. We also acknowledge that everyone who works with Red Road is a person with a life outside of the office that is just as important as their work. Our work-life balance policies ensure that our coding team gets ample time to recharge and spend time with their loved ones, thereby keeping them invested in the company’s future.

In fact, we have noticed an incredible phenomenon in the office as a result of our investment in employee well-being. If you were to ask any member of the Red Road coding team at random what their goals are for our future, one would consistently hear the same response. It’s a response that’s a testament to the belief our teams have in our mission, and it both humbles us and drives us to succeed at fulfilling all our aspirations and delivering world-class service. For them. For us. For you.

As for that response itself?

“To make Red Road one of the top 3 medical coding agencies in the world.”

Two numbers that seem to be close enough to one another but, in reality, the gap could not be wider.

1.0 is the way outsourcing used to be, and is still the reality for healthcare organizations that haven’t shifted their outsourcing practices in line with the ever globalized economy of healthcare. This number stands for unnecessarily expensive, inefficient, cumbersome, unreliable, and ineffective outsourcing when it comes to your medical billing & coding management. This is the old way.

2.0 is more than just a new version of outsourcing. It stands for an idea. An idea that brings into question why an outsourced team can’t be as efficient as a dedicated in-house team, and why organizations need to settle for a ‘solution’ that seems to cause more problems than it solves and cost in both money and time than it otherwise should. In practice, Outsourcing 2.0 doesn’t just answer these questions, it sets new standards for what an outsourcing solution ought to be. It delivers on the Power of More, in producing outstanding efficiency, cost-effectiveness, reliability, and all the perks of having an in-house team minus the costs. It delivers the known benefits of outsourcing while mitigating the known drawbacks.

The gap between these two eras of outsourcing is nothing less than a quantum leap. It requires rewriting the rules, rooting out the inefficiencies, and working with the best in the business to change the old and herald the new. It’s more than a switch or an upgrade, but a journey.

To be more specific, our journey.

Red Road is a medical coding and billing management service, that has perfected the art, the process, and the science of outsourcing. We have meticulously refined our offerings to a level far superior to the market standard, redefining what outsourcing looks like for the healthcare organizations that work with us.

We’ve made the long, winding journey from 1 to 2. And this is how we did it.