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For other articles and previous issues click here. September 6, 2004 Morning
Glory Forget packing your lunch, traffic tie-ups—even brushing your teeth if you so choose. Remote coding has obvious benefits for coders, but hospitals can also relish in its advantages. Imagine waking up around 8:30 am, taking a quick shower, making your morning coffee, and sitting down to work by 9—without ever having to get into your car. Working at home is a pipe dream for millions of Americans and nearly everyone who works in a healthcare capacity. However, remote work is possible for more medical coders around the country as hospitals and healthcare systems factor in the practice’s drawbacks and benefits. “Employers realize that their geographic boundaries can be drastically expanded,” says Beth Friedman, RHIT, HIM, director of marketing and communications at ChartOne (formerly eWebHealth). “For years, it was difficult to get qualified coders because many women want a flexible lifestyle and the ability to telecommute.” In general, remote coding is becoming a much more acceptable practice, largely because the cost savings can be significant. The fines levied upon hospitals for inaccurate medical coding require the need for experienced coders who have a higher level of bargaining power. Thus, they can often bargain for the opportunity to work from home. Just a few years ago, many remote coding systems used nothing more than a fax machine to get documents back and forth to the medical facility. Today, highly functional and user-friendly computer software programs are available to ease the transition. In addition to these programs, online access can provide high-speed, real-time benefits that allow coders to submit their work to supervisors as fast as they would be able to on-site. “We are the transport mechanism,” says Friedman, whose company provides remote medical coding programs and solutions. “Records are scanned at the hospital and all that is needed is a scanner, PC, and high-speed connection. The coding supervisor can assign charts to specific coders from the hospital and the work is done at home.” Remote coding isn’t just a big-city or urban trend. The Utah Department of Community and Economic Development reported that remote medical coding over the Internet continues to emerge as a growing trend. By early 2004, 28% of statewide hospitals projected that their next information technology (IT) purchase will be the software to allow for remote coding. Remote coding programs have numerous benefits. For healthcare administrators, it has the potential to save money, clear facility space for clinical use, ease the burden of coder recruitment and retention, and provide for happier employees. Lifestyle flexibility and a potentially higher level of efficiency are the main benefits for employees who can work from the comforts of home at their own leisure. But there are challenges, both perceived and actual. Doug Weinberg, president and CEO of Cobius Healthcare Solutions in suburban Chicago, says a remote coding program requires a real commitment from hospital administrators and other key personnel. “You need to have the resources committed from the top level down and from the HIM and IT directors and CFOs of the organization,” says Weinberg. “We think of remote coding as part of an integrated system of remote coding in real time.” The process for selecting the best technology solution for a remote coding program is the same deliberate process a hospital would use for any new technology in the HIM department. The project team needs to gather information, define remote coding functionality requirements, meet with technology vendors, and select the remote coding technology that best fits its needs and circumstances. Weinberg says this detailed implementation plan is required to ensure the remote program is held to high standards. Piecemealing a solution without experienced, technical installations and education can limit the benefits associated with the remote coding system. For facilities interested in starting a remote coding program, Weinberg recommends outlining their vision one, three, five, and 10 years in advance. That way, the remote coding system will be part of a broader strategy that could include paperless document imaging. “In addition, some healthcare administrators feel if they can’t see the coders working, they aren’t getting their work done or aren’t earning their money,” he notes. Cedars-Sinai Medical Center has a partial solution for this concern. In May, the Los Angeles-based hospital went live with a remote coding system that requires new coders to work on-site for at least six months before they are allowed to work remotely from home. Existing coders who have been with the hospital for one year or more can begin to work remotely immediately, according to Coding Manager Berry Robertson, RHIT. This flexibility allows Robertson to employ some coders who would otherwise be unable to work at the medical center five days per week. “We have a long-time coder who is a new mother who was our beta test for running [the system live],” she says. “We didn’t want to lose this highly valued employee, and she is absolutely thrilled.” Friedman says some healthcare administrators are concerned they will lose control if the coder completes his or her work from home, but in reality, there is more control. Using the ChartOne system, coding supervisors can view the work that has been done online at the click of a mouse. Space limitations facilitated Cedars-Sinai’s move to remote coding, says Robertson. Most coders are uninterested in working during second or third shifts, and hospital administrators felt remote coding was the wave of the future, much like remote transcription services were a popular trend a decade ago. “I can see us having coders all over the country working for our hospital,” she says. “We might use [freelance] coders in the same way we use them for transcription services.” Patty Thierry, MBA, RHIA, CCS, vice president of Care Communications, has written about remote coding programs on numerous occasions. She says it is important to understand where a hospital’s philosophy is on electronic medical records (EMRs) and to understand the questions that need to be asked. “Knowing the planned path toward an EMR is critical because it identifies the immediately available access options and projects a timeline for when the options will change,” says Thierry. “For example, if a hospital already has a complete EMR, the technology discussions will center on how coders may directly access the EMR system, how work would be electronically routed to coders and supervisors, and reporting capabilities. Will coding staff access the EMR through dial-up or the Internet? For coders working on-site, will there be any problems accessing the EMR from hospitals in the system? Does the hospital have a virtual private network [VPN]?” Thierry says it is also important to understand the functionality requirements, such as the differences between Web-based and Web-enabled products. Web-based products require only a Web browser and are written in the latest languages (ie, XML, HTML, Java). Web-based products can work in a thin-client environment, which means software is not needed on the user’s desktop, moving away from client/server technology where software resides on a PC and the server. “This also means it can be deployed to more people at once because many of the barriers to access are removed and the cost per user is lower than client/server technology,” says Thierry. Web-enabled products use older programming code with a Web viewer as its front end. They are client-/server-based, which is becoming an outdated approach to deploying software. Web-enabled products do not have the same degree of flexibility when it comes to customizing views, reports, etc. And Web-enabled products cannot take full advantage of Internet technologies and are more costly to implement, says Thierry. MC Strategies has developed Coders.com, a suite of secure remote coding and consulting services designed to help healthcare organizations efficiently and cost-effectively manage their HIM needs. This remote service includes quality management, coding validations, denial reviews, coding mentoring, and backlog coding assistance, all designed to facilitate maximum coding/billing accuracy and regulatory compliance. Hospitals that purchase the Coders.com solution receive a flat-screen monitor, central processing unit with preloaded software, and scanner for transmitting medical records to remote coders. Using this technology, the client can scan and send all the medical records to be coded. These records are sent over a secure server using HIPAAGUARD. According to MC Strategies, it is the first and only network fully guaranteed to exceed all federal requirements for sending secure electronic healthcare transactions. A staff of highly trained professionals then reviews the records. Once the coding review is complete, another coding expert reviews the findings to double-check for accuracy. The findings will then be sent to the hospital electronically. Web-based training is available for hospital coders. The reviews of this unique system have been positive. “This service allows us to securely scan and send records from each facility to the consultants for DRG [diagnosis-related group] validation, which saves us time and money,” says Pam Smith, HIM corporate director for LifeCare Management Services in Plano, Tex. “The [Coders.com] consultants have improved the accuracy of our coding, enhanced our reimbursements, and helped me ensure we’re in compliance.” Security issues were prevalent with remote programs years ago, but those fears have been put to rest since virtually every software vendor provides master servers that are kept locked and even guarded in a secured, climate-controlled room 24 hours a day, seven days a week. Any system worth its weight will offer at least 128-bit encryption. For the most part, the means of sending documentation to and from a healthcare system is as secure as the systems used by financial institutions. In general, healthcare administrators and coding managers are more comfortable with electronic records as a whole, says Weinberg. Friedman agrees that security is no longer an issue for most clients. “These concerns are a dying breed,” she says. “There is little concern anymore about sending out information over the Internet because of the improved technology.” There are a few lingering security concerns at Cedars-Sinai, according to Robertson. The majority of these obstacles were overcome with various software interfaces used to allow the “outside world to safely interact with our network,” she says. In addition, there was some hesitation on the part of the hospital’s IT staff to utilize a remote coding system because of the large number of Internet viruses. But at the end of the day, those worries were all put to rest and the remote system was put into place eight months after it was initiated. Robertson says during the planning process, it was decided that coders who worked remotely would need to have some ability to maneuver technically through applications with which they were unfamiliar, which required coders to be computer-savvy. “Coders like their work to be consistent and don’t like a lot of change, so I did have to do some hand-holding to prepare our coders for this,” she says. “It’s been a challenge, but it has been well worth the effort.” As for the cost savings, Weinberg says it can be significant but it depends on the coding system. The move to a remote system is often made more out of convenience than for any other reason, he says. And while the technology can be installed and used within two to three weeks, most hospitals take anywhere from two to six months to get a remote coding system running live because of the need to establish an updated telecommunications policy. “Getting the software installed is actually very quick, but it’s making sure everyone from the IT department to the administrators on down is on the same page [that takes time],” Weinberg said. Hospitals can save a significant amount of money compared with other options, such as outsourcing coding work in the United States or offshore. Most off-site coding vendors price their services in different ways to meet the needs of customers. PHNS provides a remote coding program that allows hospitals to purchase remote coding on a hospital-by-hospital basis or charge using a transmission cost per chart. The pricing can be customized in other ways to make it more affordable up front. In essence, Robertson felt it was important to convince upper administration that to meet rising demands, the department had no choice but to institute a remote coding system. And it is likely that many other coding supervisors around the country are in a similar position. “Really, we had no other options because there is just no space left and we don’t have the ability at this time to expand our facility,” she says. That’s good news for coders who prefer that their mornings be filled with pastry swirls rather than traffic jams. — Mike Scott is a freelance writer who has contributed to more than 70 magazines, newspapers, and Web sites on numerous topics—from business to healthcare to technology. He lives in Waterford, Mich. |
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