How to Evaluate Medical Coding Outsourcing Services for Home Health

Home health care coding is only getting more complicated, and scrutiny is increasing. With reimbursement rate cuts, how do you get all possible revenue for your business without leaving money on the table? 

The answer is by finding the right medical coding outsourcing services for home health to help you maximize your reimbursement, limit your risk exposure, and speed up the whole process so you can improve your cash flow and serve more members of your community. 

To do that, you need to know how to ask the right questions—which is exactly what we’ll be covering.

Why Agencies Use Medical Coding Outsourcing Services for Home Health 

Coding review consistently comes up as one of the biggest growth constraints when we speak with home health agencies. Slower turnaround doesn’t just slow your reimbursement; it limits the number of patients you can see and puts an invisible cap on your revenue. 

Outsourcing your coding review is one of the quickest steps you can take to relieve margin pressure, solve compliance concerns, and improve EBITDA. Here’s how:

Working with a coding service eliminates headaches. Put simply, finding good medical coders is hard. Coding is a critical, expert skill set that’s in high demand and short supply, making a good coding team exceedingly difficult to build in-house. 

Even if you do build an in-house coding function, supporting coders is a time-intensive and expensive process. When codes change every October 1st, it takes time and deep research to update your team. A vendor like Olli Health handles that for you. Our Director of Quality and Compliance, Tara Young, has over 20 years of experience and has spent years building teams of similarly highly qualified coders.

Expertise maximizes revenue. The specificity and sequencing of your home health coding can protect and maximize your revenue. Without the deep expertise of an experienced coder, you’re likely leaving money on the table. When it comes to more DIY AI services, most AI models simply aren’t complex enough to handle those nuances. 

Utilizing an AI-enabled managed service can also help you identify more comorbidities; AI-assisted coders can ingest and organize a huge amount of data that would take significantly longer alone. By identifying and documenting all comorbidities documented within the patient story, you improve reimbursement rates and care quality.

So often, we speak to agency owners who believe they’re compliant when they’re not. That’s the benefit of working with a managed service; this is all they’re focused on, freeing you from needing to track the shifting complexities of home health coding. By working with the right solution, you can ensure you’re maximizing reimbursement while audit-proofing yourself.

A unified workflow improves reimbursement and compliance. So far, we’ve been talking exclusively about coding review. However, in reality, you maximize your reimbursement rate and minimize compliance risk when coding, OASIS documentation, and plan of care review are all part of one workflow. By working with a solution that can handle all three, you ensure all of your documentation is consistent and thorough.

What to Ask When Evaluating a Coding Platform

Home health coding services—or any technology you use—should be a true partner in your business’ success. Don’t be afraid to ask direct questions when you’re evaluating a new solution to ensure you’ll be getting a service that truly meets your needs. If you’re not sure what to ask, here are some of the most common questions we hear (and those we wish were asked more often) and what to look out for.

Questions About Onboarding

When can we get started? This will vary between vendors, with no “right” answer. What you’re looking for is a clear timeline and onboarding process. A short delay can indicate that the vendor has customers and takes onboarding them seriously. A longer delay, however, may indicate process issues. Ensure you understand what to expect.

How heavy of a technical lift is onboarding? Get clarity on what will be required of your team and what the vendor does on their end. Is onboarding done for you, or is it more of a self-service model?

What are your integrations? You’ll want to ensure they integrate with your EHR or are willing to work with you.

What is your pricing structure? Am I getting the same price as everyone else? Is their pricing transparent, or does it vary between customers? Home health is experiencing ever-increasing margin pressure, meaning price and price transparency really matter. 

Questions About Security

Are you HIPAA compliant? Ensure the vendor has a clear training process and guardrails in place.

Do you have any other security certifications? Additional security measures are a plus. Rather than looking for one specific certification beyond HIPAA compliance, look for clear processes, prioritization of security, and transparency from any home health and home care coding companies you evaluate.

Where will my data be stored? Data being stored in the United States improves security. Look for clarity and transparency in their answer.

Questions About Workflow

What is your turnaround time? As long as results are accurate and detailed, clearly faster is better here. Traditional coding review can take several days; Olli’s turnaround time is within 24 hours.

How much of the workflow will be handled by the vendor? One of the benefits of using a managed service for coding review is that the vendor should handle a majority of the process. At Olli, we ingest all of the documentation and put the codes into your EHR in the correct places on your behalf. With a more DIY solution, you’ll likely need to do this yourself.

How will our clinical field know when you make edits in our system? If the vendor handles inputting edits to the EMR on clinicians’ behalf, how will they be notified? This is dependent on your EMR. Some require rationale for any changes, which Olli will input. Others have communication notes, which clinicians can review. 

How will this improve our clinicians’ lives? At the end of the day, any cost savings created by switching to a solution your clinicians don’t like will be eaten up by turnover costs. Make sure any vendor you consider can clearly share how their solution benefits the end users. At Olli, we provide our clients with the top areas of opportunity for improvement we see in their documentation. This allows you to provide targeted, relevant education to clinicians to reduce the amount of back and forth in the future.

Questions About Accuracy

What is your accuracy rate? Look for human-level accuracy or better, and ensure you understand how they define accuracy. Many AI vendors will add an asterisk - “*Sometimes AI can get things wrong.” We believe that asterisk is reckless; our COO Joe Freudenthal, a former home health care agency owner himself, is fond of saying “60% accurate coding is 0% useful.” It either biases your clinicians to accept a potentially inaccurate code and opens you up to risk or means your clinicians need to spend more time reviewing outputs. 

Is your solution 100% AI, or is a human involved? We’re not yet in the age of autonomous medical coding, with AI that can consistently produce human-level accuracy without oversight. If a human isn’t involved in the process, you’ll likely need to do more manual review on your end.

Are your coders certified? It is time consuming and expensive to keep coders up to date with each year’s changes. Make sure there are certified coders on board and learn how they’re keeping their training current.

What is your internal QA (Quality Assurance) process? Can you see the reasoning behind the AI’s recommendations? AI shouldn’t be a black box; you need to be able to understand how it came to certain conclusions. At Olli, we give the precise reasoning behind any changes, including the citation for specific guidelines. We’ll show what was documented, what the CMS guidance is, and what needs to change. This helps strengthen your clinicians’ knowledge so they can focus on their patients, not paperwork.

Do you have a post-completion process? You may want to follow up with questions after coding is complete. Make sure that’s available and covered as part of their fee.

The Big Question: Reimbursement Rates 

One of the most common questions we hear is, “Will this improve my reimbursement rate?” 

The honest answer is, it depends on the quality of your coding before we get started. We do often see reimbursement rates improve as much as 8-10% as a result of our services. When clients don’t see rates improve, it’s often because their coding was less compliant and we’ve significantly improved their risk position instead. This is especially important for larger and/or hospital system-affiliated home health agencies who are a larger target for CMS.

If anyone promises you a reimbursement rate improvement without seeing your information first, run for the hills. Some vendors will try to ensure there is a reimbursement rate improvement with new customers during a pilot to win business, even if it can open you up to significant risk. If it sounds too good to be true, it usually is.

Find a True Partner

Asking these questions does more than get you technical specifications; it helps you evaluate whether you’ve found a vendor who is ethical, transparent, and easy to work with. 

If you’re looking for a true solution to your coding review needs, Olli is here to help. We bring decades of home health experience combined with expert AI-enabled coders to handle your coding faster, more accurately, and at half the cost of a traditional vendor. Try Olli and learn why 96% of customers continue with us after a pilot.

Want to know how Olli has worked for other home health agencies? Learn how we helped First Choice Home Health & Hospice cut coding and quality review costs by 75% without sacrificing quality.