Innovative Clinical Coding Service Set to Drive an Additional £15m in Annual Income for Trust

CEC Healthcare is currently working with a trust incorporating two acute hospitals to transform and optimise its clinical coding operations.

Challenge

The trust's existing clinical coding operations were sub-optimal. Some episodes of care were inaccurately coded or not coded at all, resulting in the trust foregoing a significant level of income.

Additionally, the trust was heavily reliant on contract coding staff, resulting in significant additional costs. The dependence on contract agency staff also led to the trust struggling to meet its target of 99% of cases coded by the Flex Date, causing cash flow problems.

How CEC Healthcare Helped

Initally CEC Healthcare supplemented the trust's in-house team with our own coders. Given the success of this, CEC Healthcare's innovative service bureau model was then introduced.

This enabled the trust to make use of CEC Healthcare's management structures as well as gain access to experienced remote coders who were able to commit the time and focus needed to ensure a consistent, accurate and in-depth level of coding. This improved the quality of the trust's coding operation as well as eliminating its dependency on contract agency staff.

Results

1.  Optimised Income

ClinicalCodingGraph

CEC Healthcare's quality approach to coding is currently enabling the trust to achieve an additional income of approximately £1.25m per month in just one area of focus.

This is a result of CEC Healthcare's experienced coders identifying and correcting episodes of care (outpatient procedures in this case) that have not been coded and therefore remain unpaid. CEC Healthcare introduced its service bureau to the trust in March 2015 and the dramatic increase in the number of outpatient forms being coded each week since then is shown in Figure 1.

This surge in the quantity of cases now being coded - approximately a 350% increase on the amount being coded at the start of March - is consequently providing the trust with a substantially increased income.

The trust's income is also being optimised through efficient coding ensuring PbR deadlines (Day 1, Flex and Freeze date) are no longer being missed. By making sure episodes of care are coded promptly, the trust is enjoying improved cash flows and no longer has to rely on external sources of stopgap funding.

2.  Cost Savings

By using CEC Healthcare's service bureau, cost savings of between 10 and 25 percent are being experienced. This is a result of the trust:

  • no longer engaging with and depending on contract coding staff, since it can now maintain a full complement of coders through using CEC Healthcare's remote coders
  • not needing to recruit and retain coding staff
  • having a more efficient clinical coding operation
  • being able to significantly free up valuable management time and office space

Current Situation

CEC Healthcare continues to work closely with the trust, through regular meetings and adjustments to SLA metrics, to identify further opportunities for efficiency gains and income generation.

 

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