The Indian Health Service is paying an Alaska firm to clear a coding backlog

At an Indian Health Service clinic, a patient visit that has not been coded cannot be billed. And the money that bill would have brought in is money the clinic keeps for itself, to pay for supplies, equipment and staff. IHS is paying an Anchorage contractor to help catch up.

The latest order is small: $110,693 to Koniag Advisory and Business Solutions for one medical records technician and coder at the Haskell Indian Health Center in Lawrence, Kansas, for a year starting Sept. 30. It follows a three-year, $1.26 million order in August to clear a patient-visit coding backlog at IHS facilities in what the agency calls its Northern and Southern Tiers.

The stakes are in the billing. IHS facilities can collect from Medicare, Medicaid and private insurers, and they keep what they collect on top of their federal appropriations. The Government Accountability Office found those collections at federal IHS facilities rose from about $943 million in 2015 to about $1.15 billion in 2019. IHS's own oversight treats a coding backlog of 30 days or more as a red flag, and its manual requires weekly review of the coding queue.

The Koniag subsidiary holds about two dozen IHS staffing orders, for clerks, guards, janitors, IT staff and coders, placed against standing contracts. It is certified in the federal 8(a) program, which Alaska Native corporation subsidiaries qualify for under rules written for them.