Outsourcing some HIM functions is common at many organizations. The decision might initially be spurred by staffing shortages or budgetary concerns, but many outsourcing arrangements become long-term projects.
Mrs. X, a 30-year-old pregnant mother of two with a supportive husband, is admitted to a Midwest rural hospital. She delivers the baby soon after, and the birth is uneventful.
Root cause analysis of edits and an understanding of the relationship between the chargemaster and HIM/coding must be supported by overarching principles and best practices for edit management. Processes should be built around the timing of edits, applying edits across payers, and denial management.
