Medical coding is a language unto its own. It’s the job of the 500 employees of Trust Healthcare Consulting Services LLC to fluently speak that language.
Based in Springfield, Trust HCS has amassed a team of coders in 48 states to handle the work for its 110 clients.
The local office houses the executive and administrative teams, which accounts for 15 people.
In other words, TrustHCS is almost an entirely remote company.
“Because it’s a remote company, it’s a pretty easily kept secret in Springfield,” says TrustHCS CEO Torrey Barnhouse.
Barnhouse started the company in 2010 by buying back a segment of business from Healthport, which had acquired his family’s document management business, Micro Innovations Inc.
He and partners ponied up for the initial, undisclosed investment, and today Cathy Brownfield remains a partner with Torrey Barnhouse. The two are minority owners of TrustHCS after electing in 2015 to bring on financial partners in Windrose Advisors LLC on the East Coast. Barnhouse says Windrose owns 70 percent equity in the company.
TrustHCS handles three services: health care coding, clinical documentation reviews and audits/education.
“It’s really all about the compliance and accuracy of the work that’s being done,” Barnhouse says.
The coding world
According to the AAPC, an association for health care coding and billing work, medical coders use universal alphanumeric codes to properly identify health care procedures, diagnoses, services and equipment. It’s a critical step in the medical billing process. Make a misstep here, and it could cost a health provider tens of thousands of dollars.
“The goal is zero mistakes,” Barnhouse says. “It is such a high-stakes game.”
For instance, in early September, The Topeka Capital-Journal reported on a four-year billing dispute with a Kansas doctor and Amerigroup, a state Medicaid contractor. After Amerigroup identified an excess claim of $750 from 30 audited medical charts by Dr. Kathy Cain, the company applied that error rate to say it’s owed $12,600.
“Every week there are headlines related to facilities that don’t have proper compliance oversight,” Barnhouse says. “Fraud that can result from that negligence or lack of oversight is top of mind for those hospital boards and certainly the C-suites that run those hospitals. They’re consistently worried that they’re being reimbursed properly.”
According to the AAPC, after reviewing patients’ clinical records and assigning the appropriate codes, the coders’ last step is creating a claim to be paid by insurance carriers. The organization counts over 105,000 certified professional coders as members.
Barnhouse says the medical billing process has become more complicated in recent years.
According to the U.S. Bureau of Labor Statistics, jobs for certified medical coders are expected to increase 22 percent through 2022. The AAPC’s 2017 Salary Survey indicates the average salary for a professional coder was $54,106.
At TrustHCS, spokesman Dalton Patterson says coder pay varies by position and experience between $36,000 and $76,000.
“Because it’s a unique job and it requires very specific skills, there’s not an abundance of staff to do that,” Barnhouse says. “They turn to us.”
The company claims an accuracy rating above 95 percent.
Barnhouse notes TrustHCS coders and other staff work on multiple platforms, based on the client’s preferred software. In that way, the company is technology agnostic, Barnhouse says.
“The challenge, of course, is making sure all of your staff is familiar and proficient in all different technologies,” Barnhouse says.
Among its national clients, TrustHCS performs projects and ongoing work for The Ohio State Medical Center, Banner Health in Phoenix and Adventist Health in California.
Local clients are CoxHealth, Citizens Memorial Hospital and individual physician’s offices, such as pediatrician Michael Hanks.
Staff, staff everywhere
In balancing the pros and cons of working with remote staff, TrustHCS has managed to garner recognition.
The company in June was named among “13 cool companies to apply to today” for remote work by Glassdoor, a jobs site where employees anonymously review their employers. TrustHCS received a 4.5 rating; others listed that nabbed a perfect 5 rating include Student Loan Hero, Aha! and Collage.com.
“It was a complete surprise to us. That was the best part,” Barnhouse says, noting Glassdoor has access to the data of 700,000 employers.
However, he recognizes working with a large volume of remote staff has its challenges.
“You do miss seeing people’s faces and having those casual interactions when you work in the same building,” he says.
To combat that, TrustHCS officials emphasize a culture of community in employee communication, such as newsletters, and on social media.
“It’s a widespread culture change,” Barnhouse says. “Although they are working from their home hundreds of miles away from their manager, I think we’ve been very fortunate to create a culture they feel they’re part of a work team.”
Barnhouse was credited for this work in another award by Glassdoor. He was named among the Top 50 CEOs of small and midsize businesses in the Glassdoor Employees’ Choice Award. The site ranked him No. 41 with a 96 percent approval rating.
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