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Tag Archives: vendors’

Beware of Medical Coding Vendors Not Dedicated to Coding

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The coding industry is chock full of companies offering a bevy of services, one of them being coding.

During our twenty five years in business, we have seen countless vendors in the healthcare revenue cycle industry add medical coding services to their service offerings. Their main focus is generally billing, scribe and documentation assistance, credentialing, or IT services.

They see coding as a natural extension of their business line and add a few generalist coders to help service the clients that ask for coding assistance. Coding isn’t their main focus and therefore doesn’t receive the high level of attention and scrutiny that is required to deliver an accurate and compliant coding service.

Coding is the key cognitive function within the billing cycle. Coding cannot be commodified like bandages or data entry services. Coding is a skill that requires a specialty specific knowledge of anatomy, physiology, and procedures that needs constant attention and updating.

Additionally, we have seen companies use generalist coders to provide their services. Just like a doctor selects a particular discipline and focuses on it exclusively to become an expert in their field, we likewise believe that a coder should target a particular area to specialize in. The code books are too vast for any one person to be an expert across multiple specialties and subspecialties.

If you’re using a company whose core business is not coding, there are some questions that you should ask to help decide if you should continue to utilize their coding service:

Who is doing your coding?

Is it outsourced to a coding company and if so, who?

Is your coding being sent offshore?

Are the coders you’re using specialty specific or generalists?

Do you test new coders in their specialty before they start working for you?

What does your coding QA program look like?

If you don’t like the answers to these questions it might be time to take your coding elsewhere!

The post Beware of Medical Coding Vendors Not Dedicated to Coding appeared first on The Coding Network.

The Coding Network

Split Model Service Providers (Medical Coding Vendors with Offshore and Onshore Operations)

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A troubling trend in the medical coding industry is a misleading split model where companies will have resources both onshore and abroad but not disclose which personnel are performing the services.  Some use their domestic resources almost exclusively for client facing interactions, such as sales and operations, but send all of the coding work to be performed offshore to reduce their costs.  This creates the illusion of a US based workforce, but it comes with the dangers of offshore medical coding.

The dangers of offshoring coding work are twofold: 1) accuracy, and 2) privacy.  Coding is a highly specialized cognitive function that cannot be commodified.  This isn’t bandages or simple repetitive tasks.  It is a service that requires a great deal of specialized knowledge and critical thinking that takes years of practice to hone and constant education to ensure that the coder is kept abreast of updates to their field.  As an external auditing provider, The Coding Network has audited a bevy of offshore coding vendors.  Our overwhelming experience is that offshore coding is suboptimal and greatly concerning for organizations that utilize their services.

Additionally, there are no HIPAA laws outside of the United States, raising privacy and security concerns.   A vendor might assure their clients that their overseas facility is secured, but if there is a breach of an organization’s PHI the only mechanism to protect themselves against the vendor would be a contractual claim, i.e. a breach of the terms of a BAA, not an enforcement action.  Trying to sue an entity that maintains most of its operations and assets offshore makes any recovery incredibly difficult and the likelihood of recompense murky at best.  You wouldn’t even know your information is leaked until it ends up in the wrong hands and since it would be impossible to trace without a candid engagement by the vendor, there is little that could be done.

Remember that the PHI in question is that of an organization’s patients.  What would the patients think if they discovered their personal information was being sent abroad for no other reason than to save the organization money.  This cost savings to an organization is nominal and more often than not the patients do not realize any of the savings in their billings.  From a public relations standpoint, this will likely not go over well with a practice’s patient base and could result in a loss of business and/or reputational harm.

Whenever dealing with a coding vendor it is important to make sure they are doing the work in the USA.  One tip is to ask for a clause in your contract that requires US-based coding.  Additionally, look out for pricing that seems too good to be true.  If you’re paying a bargain basement price for your coding work you will be getting bargain basement quality and security.

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The Coding Network

Prevalent Vendor Assess evaluates third-party vendors’ HIPAA compliance

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Product watch

Prevalent Vendor Assess evaluates third-party vendors’ HIPAA compliance

by Chris Apgar, CISSP

Much of today’s healthcare industry is reliant on third-party vendors. If you haven’t asked your vendors whether they are compliant with HIPAA and have implemented sound information privacy and security programs, you are likely facing unknown?and possibly significant?risks. Covered entities (CE) and business associates (BA) are required by HIPAA to exercise due diligence when it comes to their BAs and BA subcontractors. Assessing the risk of those vendors is necessary, especially if those vendors support critical functions in support of CE operations.

Prevalent offers Vendor Assess: a software as a service-based tool that can automate a large part of third-party vendor assessments. Its third-party risk management solution can help CEs and BAs manage the risks associated with BAs and BA subcontractors. And Vendor Assess provides the information and tools necessary to require vendors to address risks that could have an adverse impact on business and clinical operations.

Vendor Assess is a subscription-based service which uses industry best practices to efficiently support CEs and BAs to conduct third-party assessments without the need for additional staff or resources. Prevalent Vendor Assess leverages Prevalent’s Vendor Risk Manager platform to generate focused third-party risk assessments and store the results in an easily accessible web portal. Also, Prevalent’s Vendor Threat Monitor is available to support the collection of real-time vendor threat intelligence information. THe subscription includes a single assessment, threat intelligence monitoring, reporting, and assessment recommendations by Prevalent.

Vendor Assess uses predeveloped third-party security questionnaires to identify CE and BA vendor risks. The questionnaires sent to vendors are customized to address areas of risk that are associated with each vendor versus a static set of questions that are not necessarily suited for each vendor. Because risks vary depending on the vendors and the services provided, the customization is an added bonus?especially when evaluating critical vendor information security risk to CEs and BAs.

The tool can be used to electronically generate questionnaires that can be distributed to vendors and takes a lot less time than manually generating, addressing, and sending questionnaires that are geared to identify risks that vendors pose to their CE and BA clients. The tool creates a centralized repository that can be used to track vendor risk management activities and questionnaire returns and create a baseline of vendor risk that can be used for future Vendor Assess assessments.

In addition to providing a sound solution to assess vendor risk, Prevalent’s offerings include the Prevalent Vendor Risk Maturity Assessment. The Vendor Risk Maturity Assessment was created to help CEs and BAs understand the maturity of their vendor risk management program, review specific actions for maturity improvement, and benchmark overall maturity with other Prevalent clients.

The Vendor Risk Maturity Assessment identifies CEs’ and BAs’ vendor risk management program maturity. The assessment involves a question and answer session with the staff responsible for vendor risk management. A Prevalent analyst reviews the data, identifies areas for improvement, develops a specific action plan for improving maturity across all the CE’s BAs and BA subcontractors and creates an executive presentation to show how an entity’s vendor risk assessment program compares to other Prevalent clients.

Pricing for Prevalent services fits the budget of most small and large CEs and BAs. Pricing is, for the most part, tiered by the number of vendors CEs and BAs will be sending questionnaires out to. Prevalent offers a concierge package of services that has, per Prevalent, appealed to smaller CEs and BAs. More information is available from Prevalent at www.prevalent.net.

 

Editor’s note

Apgar is president of Apgar & Associates, LLC, in Portland, Oregon. He is also a BOH editorial advisory board member. Opinions expressed are that of the author and do not represent HCPro or ACDIS. This information does not constitute legal advice. Consult legal counsel for answers to specific privacy and security questions. Email your HIPAA questions to Associate Editor Nicole Votta at [email protected].

HCPro.com – Briefings on HIPAA

Electronic Medical Records (EMR) Vendors – Points to Consider

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Selecting an EMR system for your medical practice is a very challenging task due to the rapid development in that field for last few years. According to a research, there are about 400 EMR vendors alone in the state of Los Angeles and California. Choosing the right EMR vendor is as important as choosing for the software itself. The element of reliability is very important because if it lacks that factor then there is no point of spending so much money on implementing EMR software for your medical practice.

So, if you are planning to have your own EMR system for practice, before buying the software the first thing that should be done is selection of the right EMR vendor. Following are the few points which will give you a guideline in carrying out the market research:

1. Checking the track record:

Evaluation of an EMR vendor can be done by reviewing their track record. Read the testimonials about their services and their success stories, this will help you in sorting out the right one for your requirements. Think of the EMR vendor as your partner and take a short interview before making up the final decision. Check the company history and their mission statement about the running business.

2. Evaluate your needs:

Before looking for an EMR vendor and getting confused with the services and features that they are offering, Make a clear list of what services and features that you actually require. This can be done by comparing it with the existing services you have implemented. This will save a lot your time once your clear with your depends or the type of system u want.

3. Consultation:

Before opting for EMR software, consult with different physicians who have been using the software for quite some time. Also, if you have any particular vendor in mind, check their clients and then compare and contrast with other vendors. Getting an opinion for complicated software like EMR is always beneficial in the long run.

4. Keep your questions ready:

Once you have evaluated your needs, and you are ready to go into the EMR market, make sure you have handful of important questions that are needed to ask. These questions can range from basic services to the more complicated ones including training procedures and the long term benefits. These Q/A sessions are extremely important because this would determine not only your commitment to your practice but also the efficiency of the vendor.

5. Training Issues:

Training is the backbone of the proper implementation of EMR system. Ask the vendor about their terms and conditions they are offering for training session. Learn about the onsite and online training manuals and demos. And also ask the vendor about the operating system and your requirements.

6. Manage your results:

After doing your market surveys write down your results. Don’t jump to any conclusions. It is wise to get back to your sales team or your staff, consult with them before making any final decision to proceed with a particular vendor. Also consider the differences very carefully because a physician with a newly established medical practice would be having different needs than the one who has been in business for a long time.

Daniel Ray MD Healthcare
EMR
EHR Systems