BPO Service
Medical coding outsourcing with documented quality checks
Coders follow your coding rules, record the rationale, and route documentation gaps back to your providers.
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Actigy BPO, headquartered in Prague, Czech Republic, is a nearshore business process outsourcing (BPO) company offering medical coding outsourcing. A process audit and paid pilot test code assignment and review against approved records. Providers retain clinical attestation; clients keep coding policy and final approval.
Share chart volume and required hours. Review Actigy BPO's written scope before a paid pilot.
Actigy BPO: defined access · Client-owned procedures · Chart review before scale
Coding scope check: check credentials, specialty experience and chart reviews. Location alone does not prove skill or compliance.
Combined coding and billing results
- The telehealth case reports clean claims rising from 84.1% to 97.8% (Actigy BPO-reported). The engagement combined eligibility, coding, billing, denials and follow-up. This is not a coding-accuracy score.
Results come from anonymized client engagements, are reported by Actigy BPO and are not independently audited. Results depend on scope.
Key takeaways
- Actigy BPO delivers from teams in Bulgaria, Romania, Poland and Ukraine.
- Every Actigy BPO engagement starts with a process audit and a paid pilot.
- Clinical records support each code; missing details go back to the provider.
- Coding accuracy and clean-claim acceptance are different measures.
| Service | Medical coding, coding review and charge-capture support |
|---|---|
| Who it is for | Providers, hospitals, specialty groups and billing companies |
| Delivery locations | Bulgaria, Romania, Poland and Ukraine |
| Coverage | Business hours through 24/7, as agreed in scope |
| Pricing model | Usually per full-time equivalent (FTE) by role; written quote after audit |
| Typical start | Pilot usually 2 to 4 weeks after audit, subject to access, training and approvals |
What does medical coding outsourcing include?
Actigy BPO scopes diagnosis and procedure coding, review and charge-capture support by specialty and payer mix. Operators follow approved rules and note why each code fits. Gaps in chart records return to the clinical owner; coders do not infer diagnoses. Coding can run alone or with scoped billing work.
Diagnosis coding
International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes reflect diagnoses supported by the record.
Procedures and services
Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) Level II cover agreed procedures, services and supplies.
Visit levels and specialties
Evaluation and management (E/M) levels follow approved rules. Check skills for the specialty, such as surgery, radiology or cardiology.
What is the difference between coding and billing?
| Stage | Actigy BPO role | Client authority |
|---|---|---|
| Clinical documentation | Flags missing or conflicting chart details | Creates and attests clinical records |
| Coding | Assigns and reviews supported codes under approved rules | Owns coding policy and final approval |
| Billing | Handles scoped claims and follow-up | Owns payer contracts and financial decisions |
Medical transcription prepares clinical text. Charge-capture checks compare documented services with recorded charges. Medical billing outsourcing covers agreed claims and follow-up.
Actigy BPO's billing and coding guide includes an editable handoff matrix. Use it to name the documentation owner, coding reviewer and billing operator before a chart sample enters the pilot.
How Actigy BPO codes and checks charts
Actigy BPO runs every process on documented standard operating procedures (SOPs) with maker-checker quality assurance (QA) and QA sampling. Coding work includes pre-bill checks, reviews of past work and notes that explain each code. The team lead routes unresolved questions to the client's coding owner.
| Risk or measurement | Required review rule | Evidence to retain |
|---|---|---|
| Missing or conflicting records | Stop the coding step and ask the clinical owner. Do not infer a diagnosis. | Query, source record, response and owner |
| Automation suggestion | Check against approved records and rules. Send unclear cases to the named owner. | Suggested code, finding and approved change or rejection |
| QA score | Define the chart sample, error types, scoring and how to resolve disputed findings. | Sample basis, findings and approved fixes |
| Turnaround | Define receipt of full records, query pauses and when reviewed work is ready. | Receipt, query, response and finish times |
Artificial intelligence (AI) or automation needs written scope approval, with human review of every exception. An AI suggestion is not a clinical record. Denials follow payer adjudication; rejections occur before it. Track both and use approved fixes to update the SOP.
How Actigy BPO handles patient data in coding work
Actigy BPO works on protected health information (PHI) only in the systems the client approves. Coding uses the client's electronic health record (EHR) and coding tools. Agreed roles and access logs limit work. Health Insurance Portability and Accountability Act (HIPAA) terms need client review.
Data handling for US healthcare clients, including HIPAA requirements, is agreed in the written scope and data processing terms.
General Data Protection Regulation (GDPR)-compliant delivery uses client-agreed locations and data-processing terms. Ukraine is outside the EU. The written scope names work locations, subprocessors and any transfer terms.
ISO 9001-aligned quality management. Aligned, not certified. SOC 2-aligned controls: role-based access, logging and segregation of duties. Aligned, not audited.
Client legal review must check state law, payer rules and contract terms before live charts. Some payer or government contracts restrict offshore access. Review the security controls and data-processing terms.
What are the risks of outsourcing medical coding?
Before giving Actigy BPO access, agree how staff handle unsupported codes and exceptions. Check credentials, screening, access limits, audit rights and exit duties in the contract. Published controls support this review. Routine quality checks do not replace a required independent compliance audit.
| Risk | Published operating control | Contract item to confirm |
|---|---|---|
| Unsupported coding | Notes, maker-checker QA and clinical queries | Coding rules, sample scores and final approval owner |
| Staff suitability | Training and readiness checks for scoped work | Current credentials, specialty experience and Medicare exclusion screening where required |
| Patient-data exposure | Client-approved systems, role-based access and logs | Permitted locations, incident duties and breach responsibility |
| Limited oversight | Coder notes, QA samples and monthly review | Audit rights, required records and dispute handling |
| Exit or enforcement risk | Client-owned SOPs and handover records | Data return, access removal, exit support and legal review of offshore enforcement |
Check each proposed coder. Internal training is not external certification. Location alone does not prove coding skill or patient-data access rights.
How does a medical coding pilot work?
A pilot with Actigy BPO usually starts 2 to 4 weeks after the process audit. Access, training and client approvals set the start date. Test a chart sample before adding volume. Agree coding rules, review steps, clinical-query owners and written acceptance thresholds.
- Audit and scope. Map chart volume, specialties, payer rules, chart quality and retained approvals.
- Select and train. Review coders' credentials and experience. Test skills on approved rules and sample charts.
- Paid pilot with Actigy BPO. Code and review the sample. Record reasons, queries, errors and time against the baseline.
- Review and scale. Expand only after the pilot meets agreed SOP thresholds. Continue sampling and monthly root-cause reviews.
With Actigy BPO, clients own SOPs and approve coding-policy changes. Specialties need training and checks. Read the pilot process.
How do you measure outsourced coding accuracy?
Actigy BPO reports sampled coding accuracy, turnaround and coding-related denial trends. Agree the chart sample, error types and who settles disputed findings before work starts. Separate missing-record delays from coding delays. Routine QA does not replace an independent audit required by the client's compliance team.
- Sampled accuracy: checked codes scored against the approved rules and sample basis.
- Turnaround: time from complete records to reviewed work, with query pauses defined.
- Chart queries: missing details, response time and unresolved clinical questions.
- Rework and denials: coding-related corrections and adjudicated denials, separated from front-end rejections.
- Workload: chart volume, backlog and exceptions reviewed with the team lead each month.
Allow for payer delays when reading denial trends from a short pilot. Clean claims also depend on eligibility, prior approval and billing data.
How is medical coding outsourcing priced?
Actigy BPO prices coding per FTE by role, with chart volume, specialty and review needs shaping the quote. The fee is not a share of reimbursement. Compare cost per reviewed chart with accuracy and query rates. Include retained clinical-query and final approval costs.
| Decision | Actigy BPO managed team | In-house team | Staffing agency |
|---|---|---|---|
| Daily work | Manages agreed coding queues | Client directs staff | Confirm who directs placed staff |
| SOP ownership | Client owns SOPs | Client owns procedures | Confirm documentation ownership |
| QA | Maker-checker review and sampling | Client supplies reviewers | Confirm who checks work |
| Coverage | Agreed hours and query handoffs | Client arranges absence cover | Confirm staffing hours |
| Start | Audit, then paid pilot | Recruitment and training | Selection and onboarding |
| Pricing | Per FTE by role | Pay plus operating costs | Contracted staffing fee |
| Exit | Client-owned SOPs support transfer | Internal handover | Confirm records and handover |
For in-house hiring, include pay, employer costs, hiring, training, a team lead, QA and clinical-query cover. The medical coding salary report gives staffing context. Match role, credential and source year; pay data is not a reviewed-coding quote.
A managed team runs agreed workflows. Outstaffing supplies operators directed by the client. Compare cost and review quality, not price alone.
When does a medical coding team fit?
Actigy BPO fits when providers or billing companies have repeatable coding work, approved rules and full chart access. Backlogs, staffing gaps or review needs can justify a pilot. The client must still answer clinical queries and approve policy. Test actual chart types before adding more staff.
Actigy BPO is not the right fit when a client expects outsourced clinical attestation or final compliance accountability. Resolve gaps in records before coding. Billing companies need client-specific access and rules.
Medical coding outsourcing FAQ
What is medical coding outsourcing?
Medical coding outsourcing assigns diagnosis and procedure coding to an external team.
Actigy BPO provides coding and review from approved clinical records in client-approved tools. Scope covers agreed code sets, specialties and payer rules. Providers retain clinical attestation, and client owners retain coding policy and final approval. The process audit and paid pilot test chart readiness, coding rationale, review coverage and documentation queries.
What is the difference between medical coding and medical billing?
Medical coding assigns supported diagnosis, procedure and service codes from clinical documentation. Medical billing uses coded encounters to prepare claims, submit them and follow up on balances. The two stages need separate procedures and decision owners.
Coding can be outsourced alone or alongside billing. Clean claims depend on eligibility, authorization and billing data as well as codes, so acceptance is not a standalone coding-accuracy measure.
How does Actigy BPO handle patient data in coding work?
Actigy BPO works on PHI only in client-approved systems, with agreed access roles, logging and segregation of duties. The client approves permitted tasks and work locations before live charts enter scope.
Data handling for US healthcare clients, including HIPAA requirements, is agreed in the written scope and data processing terms. Review transfer terms, retention, subprocessors and incident responsibilities with client legal and compliance owners.
Which code sets and specialties can the team code?
Actigy BPO scopes ICD-10-CM diagnosis coding, CPT and HCPCS Level II coding, and E/M visit levels. Specialty work can include surgery, radiology or cardiology when the proposed team passes scope-specific readiness checks.
Review current credentials, specialty experience and payer rules before approving staff. Internal training is not external certification. New specialties require their own documentation, review and training assessment before charts enter scope.
How do you check coding accuracy?
Actigy BPO uses maker-checker QA and sampled review against approved coding rules. Define the chart sample, error categories, scoring method and reviewer-disagreement process before the pilot. Retain the coding rationale and relevant documentation queries.
Monthly reviews track sampled accuracy, turnaround and coding-related denial trends. Clean-claim acceptance is a separate measure. An operational sample review does not replace an independent compliance audit when one is required.
What should a medical coding outsourcing contract include?
An Actigy BPO coding contract needs defined tasks, retained decision owners, access limits, review rules and acceptance criteria. Check staff credentials, required exclusion screening, audit rights and access to work records. Separate these duties from published controls.
Client legal review also needs work locations, transfer terms, incident and breach duties, data return and exit support. Check enforcement in the proposed locations before granting live access.
Can coders outside the US work on US charts?
Only after client legal and compliance owners confirm that applicable requirements and contracts permit the proposed access. State, payer and government-contract restrictions need review before live work. A delivery location does not establish permission or coding quality.
The written scope must identify approved systems, work locations, subprocessors and transfer terms. Verify proposed coders' credentials and readiness separately, using the actual specialty and payer rules.
How is medical coding outsourcing priced?
Actigy BPO prices coding per FTE by role after the process audit. Chart volume, specialty, documentation quality and review coverage inform staffing. The fee is not a percentage of collections or reimbursement.
Compare the written scope with internal salary plus recruitment, training, supervision, QA and absence cover. Retain clinical-query and final-approval costs in both models. Cost per reviewed chart needs the same complexity and review assumptions.
Should you hire a medical coder or outsource medical coding?
Hire internally when recurring volume supports an employee and the client can provide supervision, review and absence cover. Outsourcing can fit a defined backlog or ongoing queue with complete documentation and clear approval owners.
Compare the proposed coders' credentials and specialty readiness in either model. A managed team handles agreed operations; outstaffing leaves daily direction with the client. Clinical attestation and final coding approval remain client responsibilities.
Related healthcare workflows and cost resources
Compare medical coding providers.
Test coding work on a defined chart sample
The RCM workflow map explains coding handoffs to billing.
Share chart volume, specialties, payer mix and approved coding rules. Use the audit to define staffing, review coverage and acceptance criteria.
Review Actigy BPO's written scope before a paid pilot.
Scope a pilot
What happens next
The team reviews the workflow before proposing a written scope. You decide whether to start a paid pilot after reviewing it.