Importance of comprehensive compliance strategy

Importance of comprehensive compliance strategy

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

Cracking the code: Why You Should Be Outsourcing Your Medical Coding Operations in 2022.

Cracking the code: Why You Should Be Outsourcing Your Medical Coding Operations in 2022.

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.


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.

Uncertain about outsourcing your medical business functions?

Uncertain about outsourcing your medical business functions?

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.

Planning to outsource your medical coding & billing?

Planning to outsource your medical coding & billing?

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.


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.

Coping With Compliance: How Medical Compliance Services Can Help

Coping With Compliance: How Medical Compliance Services Can Help

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.

What is it like to revolutionize an industry every day?

What is it like to revolutionize an industry every day?

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.”

From 1 to 2: Our Red Road Journey

From 1 to 2: Our Red Road Journey

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.

It all started in 2018.

Red Road was started with a vision to provide medical coding & billing management services that are responsive, efficient, and reliable – and at a fraction of the typical cost. But it was also so much more. We aspired to create a solution that feels like an integrated, extended team and not an externally outsourced solution. Our teams have decades of experience in the healthcare service delivery worked as healthcare providers on the ground and in the field. They have leveraged that experience and worked tirelessly to formulate, refine, and perfect our range of offerings so that they support the backend operations of, home care and other ‘out-of-hospital’ care providers.

We are a high-quality service provider that’s driven by the interests of our clients, enabling them to focus on what they do best – saving lives. That required us to take the journey from 1 to 2, and the satisfaction of our clients makes it all worth it.

The Power of More

How much efficiency is too much efficiency? No matter how much of it already exists, a little ‘more’ can make a powerful difference.

We’ve harnessed that power and don’t offer it to our clients as a bonus, but as a promise.

Our Outsourcing 2.0 offerings promise more efficiency, more reliability, more expertise, and more results than any other offerings of their kind. We achieve this through less barriers to communication, lower turnaround times, higher accuracy rates, and a much lower cost to client. In eliminating all the typical barriers to interaction with your backend team, we have made healthcare organizations more efficient and transformed the way they work.

This makes us so much more than an external team, but rather a high-performing extended team for our clients.

A Team of Believers

Our mission to build Outsourcing 2.0 required more than a team of employees. We sought out the most dedicated, skilled, qualified, and future-minded specialists to build the future of outsourcing we wished to create. It required individuals with the bravery and expertise to push the boundaries of outsourcing to transform it in such a meaningful way.

It is these experts who envisioned our offerings, and brought them to life through a relentless, rigorous process of refinement – even when it meant going back to the drawing board at times. We opened for business only once our team was satisfied that our offerings could live up to our promise.

These are the very same individuals who continue to work with us, and handle the backend clinical management operations for all our clients. Their expertise and our approach as significantly improved our clients’ healthcare processes, compliance, and reimbursements, and that transformation forms new milestones in our journey.

Red Road is a working environment that challenges our team in meaningful ways, enabling them to achieve greatness and make a real difference to the industry. It’s no wonder that they absolutely love working here, which reflects in our excellent service as well.

Our clients have lots to say

We provide our services to a number of leading healthcare providers and home care providers, and the list constantly grows. Outsourcing 2.0 is a meaningful, sensible, and much needed transformation to the world of outsourcing – and if you’d like to take your organization into the future, we’d love to take the journey from 1 to 2 with you.

“Our Medicare Case Management department at BAYADA Home Health Care has had the pleasure of working with Red Road for over 2 years now. They have continued to demonstrate high quality, quick turnaround times, and effective communication with our team. They have worked very closely with us over the past 6 months increasing volumes month over month to meet the needs of our department through these challenging times. Red Road’s ability to be flexible and resilient through COVID has only helped to solidify the working relationship that we have. As Red Road continues to grow, their team strives to maintain high-quality services ensuring that our satisfaction is a top priority. I know I can always count on them when I need them.”


Director, Medicare Case Management – BAYADA Home Health Care


Still outsourcing your medical billing? It’s time for Outsourcing 2.0

Still outsourcing your medical billing? It’s time for Outsourcing 2.0

As a home health provider, you have a 76-year-old male patient, who needs substantial care at home. When it comes to his highly advanced COPD, the nursing care that your agency provides is of the essence. However, he also needs the services of Physical and Occupational Therapists to address his weakness and help him perform his day-to-day functions. You have outsourced your clinical services to a so-called ‘specialist’ agency, but their lack of coordination reflects on the patient’s rapidly deteriorating condition. Your entire home care operation is in the hands of third parties with no accountability, and the patient doesn’t receive care on time. How the rest of this scenario plays out, doesn’t leave much room for imagination. 

This is not how any healthcare facility runs when it comes to providing clinical services and saving lives. Most definitely not yours. However, it is how many billing departments function when their operations have been entirely outsourced. Why is this the case?

Conventional wisdom tells us that outsourcing billing operations and coding management reflects well on a healthcare centre’s revenue statements. However, this remains only conditionally true in 2021. Just as there are strong benefits associated with outsourcing, these are all but nullified by the presence of intermediaries between healthcare providers and service providers.

When considering outsourcing in current times, there’s a larger aspect to this decision that many tend to overlook – value. While your clinical expertise saves lives by delivering best-in-class healthcare, intermediaries must not hold other non-clinical operations behind. This calls for a revolutionary new way of outsourcing that we simply call Outsourcing 2.0, which focuses entirely on eliminating intermediaries and bridging the gap between healthcare institutions & service providers to create a system that’s as effective as a dedicated team, minus the overheads.

Here’s a closer look at how eliminating intermediaries can maximise value across all levels of your facility.
  • Complete Accountability: A team that reports directly to your organisation is a team that’s accountable, not just as a unit or as a consulting agency, but down to the most basic individual level. In Outsourcing 2.0, your billing team won’t just be a dedicated team for your facility, but also solely accountable to your organisation for all operations and results.
  • Consistency As A Norm: With established frameworks and processes that are specific to your healthcare facility and a specialised team that has mastered these processes, one can only expect consistent results and even more consistent successes. With your dedicated team of specialists, there’s no room for speculation on expected output and results. This makes a non-medical function turn so consistent, you could even call it clinical.
  • Cohesiveness That’s Smooth: Under Outsourcing 2.0, you have a dedicated team that’s oriented with your organisational culture and processes – and as a result, miscommunication becomes a relic of a bygone era. Experience seamless cohesiveness of thought and function, and nip any potential avenues for miscommunication before they even arise. A cohesive setup enables you and your team of clinicians to focus on what you do best – saving lives. Control That Works: Oversight is a powerful tool in any manager’s arsenal, and dedicated teams only strengthen its power. Dedicated teams allow for control at every stage of billing operations, facilitating more efficient resolution of queries and potential issues and a more hands-on approach to management that could ultimately yield greater revenue. This level of oversight isn’t a burden – it gives you a firsthand understanding of the exact state of your organisation, enabling more insightful decision-making.
  • Control That Works: Oversight is a powerful tool in any manager’s arsenal, and dedicated teams only strengthen its power. Dedicated teams allow for control at every stage of billing operations, facilitating more efficient resolution of queries and potential issues and a more hands-on approach to management that could ultimately yield greater revenue. This level of oversight isn’t a burden – it gives you a firsthand understanding of the exact state of your organisation, enabling more insightful decision-making.
  • Timeliness That’s Like Clockwork: With a team that’s based in the USA, comes the peace of mind of knowing that your team functions on the basis of the same time zone as your healthcare facility. The benefits that come with this are truly profound. Working together towards shared objectives at the same time, ensures that your organisation doesn’t just ahead with the times – but at the same time as all your departments. These cohesive efforts aren’t just a matter of convenience. They move your organisation forward.
  • Centralisation That’s Centred On You: Having dedicated billing operations doesn’t just make operational sense, but makes organisational sense too. A dedicated team lends itself to the strengthening of your organisational structure as a whole, setting a solid foundation for both the present and the future. Centralised setups bring together specialists that solely work towards the progress of your healthcare institution, eliminating any dependency on external organisations and bolstering your preparedness for the future. Your organisation becomes your team’s one and only professional priority.
  • Absolute Compliance: With ever-evolving compliance norms and regulations, a team that is rooted in the USA is inherently better equipped to ensure absolute compliance. Having a dedicated locally present team prevents potential breaches of HIPAA regulations, and more. This doesn’t just prevent operational challenges, but delivers the peace of mind that you need to focus on your clinical operations and deliver superior healthcare services without regulatory breaches.
  • It’s All In The Value: Across all spectrums, having dedicated billing operations under Outsourcing 2.0 clearly creates value at multiple levels in your organisation. Right from eliminating dependencies and facilitating efficiency, to the long term aspect of strengthening the very core of your organisational structure, Outsourcing 2.0 offers compelling solutions for both the present and the future. While some of these aspects can be measured in economic value, the rest only serve to enable your organisation to excel both as an institution as well as an experience for your patients.

 Outsourcing 2.0 – how do I get started?

Just as there is no room for needless dependencies in clinical operations, there is no longer any when it comes to billing operations as well. Red Road is an American medical billing management company headquartered in the United States, that doesn’t just act as a consulting agency but works as a dedicated team for your healthcare institution with no intermediaries. Our team of world-class specialists delivers superior services at half the market rate for outsourced operations, ushering in an era of what we call Outsourcing 2.0. And with that, comes the consistency and operational ease that can truly transform your healthcare facility.

Come down this road with Red Road, and experience efficiency, consistency, and convenience in your billing operations and coding management:

Home Health and Hospice in 2021

Home Health and Hospice in 2021

As we take on 2021 and the third wave of the Coronavirus pandemic, this is a time that will drive change, test capabilities, and possibly, transform the home care and hospice industry. Professionals must come together to navigate the future. It’s time to identify challenges, innovate, and exceed expectations.

There is a greater role to play for home-based care and health workers, and alongside them for the clinical back-end support agencies – in dealing with the pandemic in a robust way. Now more than ever, home-based care is the innovative forefront of providing care as a way to keep those most vulnerable to the virus at home, while receiving the care that they need under the compassionate, qualified, and watchful eye of a home care professionals.

The need for home-based care is at an all-time high, and it will only grow. Here are a few major trends that we will see in home health and hospice in 2021.

More people opting for care at home

Consumers who have not previously considered hospice and home health care services are making the shift to home-based support, as it reduces burden on caregivers, provides immediate access to their care team, and helps them maintain independence while healing in the comfort of their home.

Higher quality, reduced costs

The value of care delivered at home will be on full display in 2021 and beyond. As the shifting of health care services into the home setting continues to rise, it will facilitate and accelerate the ongoing effort to reduce health care costs while still delivering quality outcomes.

Efficient and effective care

Physicians are starting to introduce the delivery of hospital-level, skilled nursing care right at home. Given the increased risks of receiving care in the hospital or facility setting , more patients are being referred into home-based models. Home visits, virtual care, and remote-monitoring technology are significant factors in delivering safe and effective care.

Investment in human capital

In order to succeed, the most significant investment to be made lies in people –including recruitment, talent management, clinical education, and professional development. There is a ever-increasing need to help clinicians and staff prepare for and cope with the challenges that will arise while they are engaged in providing care for their patients.

A new generation of medical and nursing professionals

People recognized the role of healthcare professionals as we watched them in action during the pandemic. This is going to result in increased enrollment in doctoral, therapeutic, and nursing programs everywhere.

Even though we may not see these new recruits on the front lines immediately, they’re sure to bring a fresh perspective to home health care after living through a global pandemic.

Back to basics

As we look to 2021, clear communication and adaptability at every level of care delivery will become the key to success. It’s important to be able to gauge the environment, adjust quickly, and expand capabilities. The ability to address a multitude of patients’ needs will be of prime significance.


Booming growth in the technology sector focused on tools like wearables and Internet of Things will permanently transform the delivery of care to patients. These developments will allow real-time patient and provider access and the ability to provide care solutions that respond to patients’ conditions in a way that closely resembles a “hospital at home.”

A bigger force

As the pressure on home health and hospice rises, doctors and agencies need to gear up by partnering with clinical back-end solutions to provide support with high quality clinician documentation, coding and billing, and RCM – thereby giving service providers room to focus on providing compassionate care for clients.

If you’re looking to strengthen your care with expert clinical back-end, we can help you discover the power of more. Give us a ring!


The Benefits of Outsourcing in the COVID and post COVID world

The Benefits of Outsourcing in the COVID and post COVID world

2020 was one of the most challenging years in memory. This year saw the world grappling with a deadly virus while trying to adapt to the new normal of masks, sanitizers and quarantine, besides the economic and health challenges posed by COVID-19.

The pandemic has undoubtedly caused serious implications to people’s lives and health, while adversely impacting the business environment, industrial sector, small businesses and big corporations alike; and the healthcare sector has been right at the centre of all the action.

Many different measures were implemented to stem the spread of the virus and to keep businesses afloat. While some were temporary, others have long term implications. Outsourcing is one such measure. With the increased demand for health care, especially in the home health and hospice sector, and the corresponding increase in clinical back-end processes, more and more healthcare businesses are now partnering with external support to strengthen and expand their capabilities.

Now, more than ever, the healthcare sector needs to stand up and deliver. We believe that outsourcing will play a huge role in this extraordinary time. Here’s why:

Focus on Core Business
Outsourcing can provide businesses with expert clinical back-end services to improve efficiency and grow profitability. By outsourcing non-core functions, nurses can focus on what’s most important – the recovery journey of patients.

Cost Optimization
Running a business entails heavy costs – operational expenses, employee salaries, costs associated with training and development, employee benefits, and other charges. Outsourcing can offer a reliable and affordable medicare-compliant avenue of support while optimizing operational costs, helping it reduce by at least 20% to 30%.

Latest Technology
Businesses need to be up to speed technologically and be flexible in common times, much more so during a crisis like COVID-19. Digitally mature companies are 26% more profitable than those who are not. By outsourcing tasks, businesses can get access to the technology the outsourcing company is using. With access to their digital resources, businesses can adjust and adapt to the changing needs during the pandemic.

With outsourcing, business capabilities are bolstered with highly experienced professionals who are proficient in providing top-quality support needed in these times. Quality hires are assured as candidates undergo a rigid selection process to provide high standards of services continuously.

Reduced Risk
Outsourcing helps take care of the complexities of compliance so that healthcare providers can stay focused on providing quality services to their clients. By outsourcing the task of comprehensive documents to a team of highly experienced clinicians, providers can ensure a thorough and accurate end-to-end check. It helps mitigate the threat of non-compliance and reduces any potential risks in audits.

Continuity in Business
Due to COVID- 19, organizations have faced unforeseen challenges. Coronavirus has disrupted the smooth functioning of business processes. Outsourcing enables a business to cope, even in the light of challenges and periods of instability. The COVID-19 pandemic may have impacted the budget and resources of management, but outsourcing can help overcome these hurdles and ensure business continuity.

Walk with Giants
Despite a low budget and capital, small businesses can compete both with other small businesses and large corporations. Outsourcing ensures access to the latest tools, technology, and highly trained professionals. It allows them to compete with large corporations by providing the same knowledge, resources, and services to their potential clients.

Data Security
Outsourcing, contrary to popular belief, is very safe. All valuable hospital and patient information and sensitive information are safe and secure when hiring a reputable medical coding company. Keep an eye out for companies that are HIPAA and GDPR compliant, as they are more suited to keeping valuable patient information secure. Look for companies that exhibit transparency while rendering high-quality medical coding services. Lastly, identify companies with client testimonials, as they are also testimony of safety and security.

COVID-19 has proved to be a considerable disruption, but it has also accelerated change, and caused a major shift in paradigm. In the current context, outsourcing can provide extensive support in effectively dealing with the pandemic, helping businesses stay afloat and continue to grow well beyond expectations in the years to come.

Home health coding services, medical billing, and clinical compliance review are significant services of any medical organization. Managing to complete these tasks consistently, successfully, and to a high standard ensures success in the industry.

If you are a healthcare provider exploring outsourcing options, contact us.