Outsourced coding transition that restored cash-on-hand resilience
A 300-bed Eastern Washington hospital activated an outsourced coding operations within five business days, cleared backlogged queues to within 72 hours from DOS, and rebuilt cash on hand from three to 22 days of operating revenue.
96%
coding accuracy in first 30 days
5 business days
coding operations live in production
3 to 22 days
cash on hand recovered
Case study
5 min read
TL;DR
- Provider: A 300-bed hospital in Eastern Washington facing reimbursement change, lower patient volume, talent scarcity, and cash-on-hand pressure.
- Challenge: Commercial and federal payer volumes had decreased, local talent was limited, legacy methods slowed revenue cycle performance, low-SLA vendor contracts raised risk, and cash on hand fell to under 10 days of operating revenue.
- Solution: A hybrid US-India outsourced coding transition launched within 24 hours of contract execution, with a revenue-recognition steering committee, workflow mapping, coding operations support, training, QA, and active production within five business days.
- Impact: No loss of charge capture, 96% coding accuracy in the first 30 days, all backlogged queues brought within 72 hours from date of service, all hospital and professional coding outsourced, and cash on hand increased from three to 22 days of operating revenue.
A 300-bed hospital in Eastern Washington faced fiscal pressure as commercial and federal payer volumes declined. The operating environment included regional competition, limited talent, payer exclusivity clauses, legacy revenue cycle methods, and reduced agility during reimbursement-model shifts.
The provider needed a coding and revenue cycle operating response that could start immediately. We used a hybrid US-India model to close the resource and knowledge gap, transition coding work quickly, protect charge capture, and create a business rhythm for backlog clearance, service-level adherence, and steady-state operations.
The Challenge
The provider entered the engagement with constrained cash on hand and limited local talent. Prior vendor agreements carried low service levels and high operating risk, leaving leadership without quality guarantees to close the revenue gap. At its lowest point, cash on hand stood at three days of operating revenue.
The most urgent operational problem involved coding continuity and revenue recognition. The provider needed coding operations active within one week of contract execution, with little to no time for formal implementation planning or process-building.
The Solution
Rapid coding transition with revenue-recognition governance
We treated the transition as a production continuity and cash protection event. The approach was anchored in four mechanisms:
- Twenty-four-hour implementation launch: Started the coding implementation process within 24 hours, aligning to the provider's requirement that coding operations be active within one week.
- Revenue-recognition steering committee: Established a steering committee focused exclusively on revenue recognition, with US Operations, India coding operations, and hospital functional leaders coordinating the transition.
- Encounter workflow mapping: Sent experts onsite to assist with encounter workflow mapping, helping ensure patient visits were not lost during the partner transition.
- Training, QA, and production governance: Brought coding leadership into training and quality assurance for the internal coding department while coding operations moved into active production and backlog queues were stabilized.
The Impact
- Coding operations went live within five business days with no loss of charge capture during the transition to the new operating model.
- Coding accuracy reached 96% in the first 30 days supporting confidence in the quality of the outsourced coding operations model.
- All backlogged queues were brought within 72 hours from date of service creating a more current coding position and reducing revenue-recognition pressure.
- Cash on hand increased from 3 to 22 days of operating revenue over the next 11 months, as quality output from HIM supported significantly higher revenue return.
Why Us
The provider selected our team to close a resource and knowledge gap through a talent pool and a hybrid operating model. The decision reflected the need for immediate operational readiness, broad offshore delivery capability, coding depth, workflow transition support, and governance that could protect revenue recognition during fiscal pressure.
Transferable Insights
For CFOs, Chief Revenue Cycle Officers, HIM leaders, and coding leaders, the practical lesson is that outsourced transition succeeds when speed, governance, and workflow control move together. A rapid resource ramp needs encounter mapping, charge capture protection, production QA, executive steering, and measurable queue targets so cost pressure does not create downstream revenue risk.
Frequently Asked Questions
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