Revenue Cycle Managed Solution

The Challenge
A non-profit 500+ bed academic medical center in the Northeast requested coding and CDI assistance. Based on the quality of our performance, we were referred to one of the facility coding directors and started providing services to them. They were in the process of bringing all coding in-house and were dissatisfied with their current vendor, citing concerns around coding quality and account communication. They desired a managed coding solution with a more robust compliance component.

The Solution
Oxford initially provided coding and auditing resources. Upon review by our compliance team, quality and documentation issues were discovered during the coding audit process. The client asked us to craft a solution to resolve their documentation issues/trends and began to expand the scope of the project.

Key components of the solution included:

• Coding compliance oversight
• Feedback to the client on workflow with our recommendations to help streamline coding processes
• Successful reduction of DNFB with implementation of backlog plan
• Oversight/monitoring of accounts in work queues for the various specialty areas
• Consulting on new service lines and associated specialty software
• Development of an outpatient CDI program

The Result
Over the span of nine months, Oxford provided an additional 45 coding resources and a CDI team and increased the size of our compliance staff to oversee this work. We now provide support in over 15 key specialty areas with plans to increase staffing levels as they bring on more new service lines. Our flexible model allowed us to staff up as the work increased. Coding quality and documentation have improved, denials have significantly reduced, and revenue over these service lines has increased for the client.