Our client is a leading provider of advanced wound care with more than 600 clinics across over 30 states. They specialize in advanced treatments, including hyperbaric oxygen therapy, total contact casting, negative pressure wound therapy, and cellular tissue-based products.
They’ve treated 300,000 patients over the past 20 years, healing more than 4 million wounds. The client used their extensive reach to create one of the country’s largest wound care databases, enabling and partnering on research to advance the field.
Past Coding Partner Struggled With Compliance & Revenue Leakage
The group had previously engaged with another outsourced partner to support their coding but found they were unable to meet their coding compliance needs. The previous outsourcing partner had staffing issues, which resulted in increased coding denials. Denial causes included missing modifiers, incorrect ICD codes, unmet LCD guidelines, and missing CPT codes. There were also issues with frequent upcoding and downcoding office visit CPT codes, ultimately resulting in revenue leakage and increased A/R.
Infinx Chosen To Provide Coding Support Using Phased Transition
Realizing they needed a new coding partner, they signed on with Infinx’s coding support services for 18 of their clinics. The deciding factor was our reputation for high-quality and consistent outsourced support.
We proposed a phased transition approach to transition coding work by one or several clinics at a time, as each clinic was located in a different state, introducing a significant level of complexity. This allowed for a smoother process, in which old coding partners transitioned out while as our specialized wound care team began operations following our phased onboarding approach.
Wound Care Proficient Coders With Quality Controlled Execution
Our specialized wound care team was exclusively made up of coders that had wound care expertise with dedicated on-shore project and coding managers. Our project managers helped plan, execute, and report back on the transition weekly. Our coding managers monitor quality and hold feedback sessions with clients, coders, and auditors to ensure our team meets compliance standards and results in clean claims.
Prior to coding, our team review claims for medical necessity and ensures the documentation supports the codes. Once this is done, the appropriate CPT, ICD-10 CM, and HCPCS codes are selected, assigning and sequencing all codes.
Ongoing Audits & Coding Training Implemented To Help Optimize Workflow And Reimbursement
Our coding auditor meets with the client every week to discuss trend analysis and get updates. To help keep our specialists up to date on the latest coding changes and best practices, we employ a preventative action plan and monthly in-house training. The training shares healthcare and coding updates such as CPT and HCPCS changes and healthcare industry topics related to medical coding. They also review and discuss coding-related denials and how to avoid them.
We also identify and share clinical documentation notes, improvement areas, and limitations with physicians to optimize coding outcomes on an ongoing basis.
Physicians & Staff Pleased With Overall Increased Revenue And Successful Compliance
The client was able to realize additional revenue from compliant upcoded CPT codes and reduced coding-related denials. Both physicians and the revenue cycle teams were delighted to meet compliance standards and improve their bottom line.
Our coding teams were able to improve their quality score by 10% in comparison to their previous partner. We were also able to meet compliance standards in both upcoding and downcoding of office visits, as validated by the client’s compliance team, resolving one of the key issues in their previous coding workflow.
Our successful overhaul of the coding operations in their 18 clinics and consistent quality output over a year convinced the client to explore our further offerings in patient access and revenue cycle management.
Congratulations on a truly outstanding audit report. I calculate the quality rate at 97.7% with no coder below 95% and one coder almost perfect.
Thanks for your continued diligence and support of continuous coding quality improvement. Compliments to the team!
— Vice President of Billing Services