hth iowa project workshop: monitoring coding productivity ... · healthcare coding and consulting...
TRANSCRIPT
1
1
HTH Iowa Project Workshop:
Monitoring Coding Productivity; Coding Efficiency
Process Mapping
Melissa Edenburn, RHIA, CCS, MS
AHIMA Approved ICD-10-CM/PCS Trainer
Senior Inpatient Auditor and Trainer
Healthcare Coding and Consulting Services (HCCS)
Angela Hartman, CCS, CPC
Outpatient Coding Manager
Healthcare Coding and Consulting Services (HCCS)
© 2015 Healthcare Coding & Consulting Services© 2015 Healthcare Coding & Consulting Services© 2015 Healthcare Coding & Consulting Services
AGENDA
Progress to date FY 17-18
Defining Productivity and Best Practices
Identification of Areas of Opportunity
Policies and Procedures
Identifying and Measuring Areas of Risk
Audits and Monitoring
Defining Best Practices
Process Mapping and Tips to optimize coding efficiency
2
2
© 2015 Healthcare Coding & Consulting Services3
Disclosures
The education offered by HCCS in this program is compensated by the Iowa Department of Public Health Small Hospital Improvement Program
(SHIP) under grant number 5887SH01.
HCCS does not have any proprietary interest in any product, instrument, device, or material discussed during this learning event. HCCS stands to benefit from the provision of services designed to address topics covered in this presentation.
MONITORING CODING PRODUCTIVITY; CODINGEFFICIENCY PROCESS MAPPING
© 2015 Healthcare Coding & Consulting Services
MONITORING CODING PRODUCTIVITY; CODINGEFFICIENCY PROCESS MAPPING
4
3
© 2015 Healthcare Coding & Consulting Services5
MONITORING CODING PRODUCTIVITY; CODINGEFFICIENCY PROCESS MAPPING
© 2015 Healthcare Coding & Consulting Services
MONITORING CODING PRODUCTIVITY; CODINGEFFICIENCY PROCESS MAPPING
6
• Steps
• Measures
• Analysis
• Tracking
Speed• Monitoring
• Benchmarking
• EducationQuality
• Standards
• Policies
Best
Practices
4
© 2015 Healthcare Coding & Consulting Services7
Part 1:
Defining Productivity and Best Practices
MONITORING CODING PRODUCTIVITY; CODINGEFFICIENCY PROCESS MAPPING
© 2015 Healthcare Coding & Consulting Services8
Take the Test to determine area for opportunity
Do you have productivity expectations currently?
Have you seen a decrease in productivity after ICD-10
Go Live, of which has not increased to date?
How do your coders stack up against each other or standards
industry wide?
Do you have a trackable way to measure productivity, or a data based
process to ensure you are optimizing resources?
MONITORING CODING PRODUCTIVITY; CODINGEFFICIENCY PROCESS MAPPING
5
© 2015 Healthcare Coding & Consulting Services
MONITORING CODING PRODUCTIVITY; CODINGEFFICIENCY PROCESS MAPPING
9
Asking the Questions…
What are Coding Productivity Standards?
Do you need Productivity Standards?
© 2015 Healthcare Coding & Consulting Services
MONITORING CODING PRODUCTIVITY; CODING EFFICIENCYPROCESS MAPPING
10
Audience Poll Question and Discussion #1
Do you have established
Productivity Standards for
your Coding Staff?
6
© 2015 Healthcare Coding & Consulting Services
MONITORING CODING PRODUCTIVITY; CODING EFFICIENCYPROCESS MAPPING
11
Step One:
Categorizing Coder Responsibilities
© 2015 Healthcare Coding & Consulting Services
MONITORING CODING PRODUCTIVITY; CODINGEFFICIENCY PROCESS MAPPING
12
Understanding the Process is Crucial
Understand the Process
Know the steps involved
Sources supplying the information
What problems are coders encountering during the process?
Have the coder record the time!
7
© 2015 Healthcare Coding & Consulting Services
MONITORING CODING PRODUCTIVITY; CODING EFFICIENCYPROCESS MAPPING
13
Look for areas of Opportunity…..
What redundant steps were observed?
- Examples include adding CPT’s in the encoder and in
B/AR side via charge (duplication). Is it needed?
- Are coders adding items in the encoder and in the system
duplicating efforts?
Example: Abstracting REV codes, or date of procedures
© 2015 Healthcare Coding & Consulting Services
MONITORING CODING PRODUCTIVITY; CODING EFFICIENCYPROCESS MAPPING
14
Coder’s don’t just code, they…..
Answer Questions from the Billing Office/ Patient Financial Services
Answer Calls/Questions from Physician Offices
Answer Questions from Case Management/UR
Querying Providers
Placing Deficiencies
Appealing Denials
8
© 2015 Healthcare Coding & Consulting Services
MONITORING CODING PRODUCTIVITY; CODING EFFICIENCYPROCESS MAPPING
15
Coder’s don’t just code, they…..
Obtaining Information to support medical necessity
Assisting with RAC requests
Back up Scanning
Assign working DRG’s (Concurrent coding)
Assisting with Release of Information (possibly)
Performing Clinical Documentation Improvement Functions
Peer to Peer questions
© 2015 Healthcare Coding & Consulting Services16
Action Items
List: Start to Categorize Coder Job Functions
Coding Time
Working Denials (i.e. LCD/NCD), continue…
Involve the coders
Ask where they are spending their time daily
Ask estimates of time they believe they are spending time on daily
Compile into one working list
MONITORING CODING PRODUCTIVITY; CODINGEFFICIENCY PROCESS MAPPING
9
© 2015 Healthcare Coding & Consulting Services17
Involvement of Coders Continued…
Why Coder involvement is key….
HIM responsibilities uncover diverse functions
Participant buy in by inclusion in the planning phase
MONITORING CODING PRODUCTIVITY; CODINGEFFICIENCY PROCESS MAPPING
© 2015 Healthcare Coding & Consulting Services
MONITORING CODING PRODUCTIVITY; CODING EFFICIENCYPROCESS MAPPING
18
Step Two:
Collect and Analyze Data
10
© 2015 Healthcare Coding & Consulting Services
MONITORING CODING PRODUCTIVITY; CODING EFFICIENCYPROCESS MAPPING
19
Audience Poll Question and Discussion #2
Do Systems (EHR) Impact
Coder Productivity?
© 2015 Healthcare Coding & Consulting Services
MONITORING CODING PRODUCTIVITY; CODING EFFICIENCYPROCESS MAPPING
20
Audience Poll Question and Discussion #3
Does having no
encoder Impact Coder
Productivity?
11
© 2015 Healthcare Coding & Consulting Services
MONITORING CODING PRODUCTIVITY; CODING EFFICIENCYPROCESS MAPPING
21
Additional Variables that Impact Productivity…
Type of Systems
Volume of Systems
Types of items abstracted
- Modifiers on hard applied items
- Hematocrit and Hemoglobin value codes
- Place of Occurrence Codes
Charge Entry
CPT’s on Inpatients or not
© 2015 Healthcare Coding & Consulting Services22
Defining “what” is involved
Is the coding only Diagnosis only?
Does the coding involve applying modifiers to soft and hard applied
codes?
- Defining what soft vs. hard applied is
Are E/M’s coded by coding?
Are Infusions and Injections coded?
What are your query rates?
Is there “auditing” of charges involved?
- Does this involve review, crediting, and/or working with the departments?
MONITORING CODING PRODUCTIVITY; CODINGEFFICIENCY PROCESS MAPPING
12
© 2015 Healthcare Coding & Consulting Services
MONITORING CODING PRODUCTIVITY; CODING EFFICIENCYPROCESS MAPPING
23
Observation Phase
Track time for 2 weeks
- By coder
- By category of function
- By Time spent
- By volume of charges coded, by chart type
What is a time study, and when is it beneficial?
How are you measuring (IP) longer Length of Stay accounts (LOS)
© 2015 Healthcare Coding & Consulting Services
MONITORING CODING PRODUCTIVITY; CODING EFFICIENCYPROCESS MAPPING
24
Question Everything for Opportunity
What functions can be streamlined?
What functions should coding not be involved in?
What is taking your coder away from coding?
What should be incorporated into their process that is not now?
Do you coders frequently run out of work?
What does not “add up” when reviewing the information
13
© 2015 Healthcare Coding & Consulting Services
MONITORING CODING PRODUCTIVITY; CODING EFFICIENCYPROCESS MAPPING
25
Question Everything for Opportunity- Continued…
Ares that increase Productivity
Legibility and Consistency of Documentation
Availability of Chart Documentation
Encoder
EHR
Coder Education
© 2015 Healthcare Coding & Consulting Services
MONITORING CODING PRODUCTIVITY; CODINGEFFICIENCY PROCESS MAPPING
26
Question Everything for Opportunity- Continued…
Ares that increase Productivity
Remote vs. Onsite Coders
Right task performed by the right person
Standard forms in use
14
© 2015 Healthcare Coding & Consulting Services
MONITORING CODING PRODUCTIVITY; CODING EFFICIENCYPROCESS MAPPING
27
Question Everything for Opportunity- Continued…
Ares that decrease Productivity
IT issues and connectivity
Technology – Example: Dual Monitors
Missing Documentation – Timing is everything
- Example: Coding Emergency Charts – Questions to ask
- Example: Coding Inpatient Charts – Consider Scanning timeframes
Lack of complete, concise, and strong documentation
© 2015 Healthcare Coding & Consulting Services
MONITORING CODING PRODUCTIVITY; CODING EFFICIENCYPROCESS MAPPING
28
Question Everything for Opportunity- Continued…
Ares that decrease Productivity
Validating ABN’s
Analyzing Chart Documentation while coding
Auditing Departmental Charges
Let’s Look at an Example Together…
15
© 2015 Healthcare Coding & Consulting Services
MONITORING CODING PRODUCTIVITY; CODING EFFICIENCYPROCESS MAPPING
29
Auditing Departmental Charges
Coding Audits
Coding Reverses Charges
Coding Adds Charges
Coding Finalizes
Coding Audits
Coding Places on
Hold
Coding Notifies
Department for
Correction
Coding Finalizes
Code and Charge/Coding
Finalizes
Best Practice
© 2015 Healthcare Coding & Consulting Services
MONITORING CODING PRODUCTIVITY; CODING EFFICIENCYPROCESS MAPPING
30
Question Everything for Opportunity- Continued…
Areas that decrease Productivity
EHR – Chart Image Categorization
- All images placed into one running image (hundreds of pages)
vs. partitioned by image type
Example: Patient comes in and has an order for Lab services
System A: Images include one file of 89 pages of lab findings and on page 77
is the order
System B: The order is indexed under “order”, therefore the coder clicks on
one image to view
16
© 2015 Healthcare Coding & Consulting Services
MONITORING CODING PRODUCTIVITY; CODING EFFICIENCYPROCESS MAPPING
31
Step Four:
Develop Standards, Policies and Procedures
© 2015 Healthcare Coding & Consulting Services
MONITORING CODING PRODUCTIVITY; CODING EFFICIENCYPROCESS MAPPING
32
The Golden Question…
Is there a one size fits all productivity quota for coders by chart type?
17
© 2015 Healthcare Coding & Consulting Services
MONITORING CODING PRODUCTIVITY; CODING EFFICIENCYPROCESS MAPPING
33
Case Study Example Productivity:
Hospital A
Inpatient: 24
SDS: 48
OBS: 24
Emergency Room: 120
Rational….
© 2015 Healthcare Coding & Consulting Services
MONITORING CODING PRODUCTIVITY; CODING EFFICIENCYPROCESS MAPPING
34
Case Study Example Productivity:
Hospital B
Inpatient: 32
SDS: 56
OBS: 56
Emergency Room: 75
Rational….
18
© 2015 Healthcare Coding & Consulting Services
MONITORING CODING PRODUCTIVITY; CODING EFFICIENCYPROCESS MAPPING
35
Case Study Example Productivity:
Hospital C
Inpatient: 5
SDS: 4
OBS: 2
Emergency Room: 32
What does this scenario tell you about possible areas of
opportunity?
© 2015 Healthcare Coding & Consulting Services
MONITORING CODING PRODUCTIVITY; CODINGEFFICIENCY PROCESS MAPPING
36
Sources for Productivity Benchmark Guides
AHIMA American Health Information Management Association (AHIMA)
http://campus.ahima.org/audio/fastfacts/FRB0602.pdf
AAPC (American Academy of Professional Coders) https://www.aapc.com/
19
© 2015 Healthcare Coding & Consulting Services
MONITORING CODING PRODUCTIVITY; CODINGEFFICIENCY PROCESS MAPPING
37
Formula Examples
Completed work = Total work output – Defective work
Labor productivity = ______Completed work_________ Hours worked to produce
total work output
Source: Miller and Waterstraat, 2004
© 2015 Healthcare Coding & Consulting Services
MONITORING CODING PRODUCTIVITY; CODINGEFFICIENCY PROCESS MAPPING
38
Example- Inpatient Coding Productivity Calculation for one Month
Definitions to Apply
• Percentage of work completed by auditCompleted work percentage
• Work output multiplied by completed work percentage Completed work Output
• Completed work output divided by total hours worked Completed work per hours
worked
• Number of work units recorded by the employee for the process Work Output
• Number of hours the coder worked of productive time, This does not include lunches, meetings, or coder breaks
Total Work Hours
• This is the work output divided by total hours workedAverage work output per Hour
20
© 2015 Healthcare Coding & Consulting Services
MONITORING CODING PRODUCTIVITY; CODING EFFICIENCYPROCESS MAPPING
39
Example Continued.. Inpatient Coding Productivity Calculation for one Month
Source: Health Information Technology: An Applied Approach
Coder Work Output (Coded records
Total Hours Worked
Average Work Output per Hour
Completed Work Percentage
Completed Work Output (records coded accurately)
Completed Work per hour worked
A 500 140 3.57 91% 455 3.25
B 475 140 3.39 96% 456 3.26
C 300 80 3.75 96% 240 3.00
D 375 80 4.69 64% 240 3.00
Department Average
3.69 3.13
© 2015 Healthcare Coding & Consulting Services
MONITORING CODING PRODUCTIVITY; CODINGEFFICIENCY PROCESS MAPPING
40
Example Capturing Data
21
© 2015 Healthcare Coding & Consulting Services
MONITORING CODING PRODUCTIVITY; CODING EFFICIENCYPROCESS MAPPING
41
AHIMA Survey Standards
Emergency Department – 120 a day
Ancillary Department – 240 a day
Ambulatory Surgery – 240 a day
Inpatient – 24 a day
© 2015 Healthcare Coding & Consulting Services
MONITORING CODING PRODUCTIVITY; CODING EFFICIENCYPROCESS MAPPING
42
Poll Question and Discussion #4
How do your Productivity Standards
compare to these previously published
by AHIMA?
22
© 2015 Healthcare Coding & Consulting Services
MONITORING CODING PRODUCTIVITY; CODINGEFFICIENCY PROCESS MAPPING
43
Differences Are Acceptable
Coding Responsibilities Vary
Degree of Automation/Systems
Documentation EHR
Type of Billing Requirements in compare to Acute PPS Facilities
Examples:
- CPT on Inpatients
- Coding the ED portion off a ED Admit as a discharge (Billing carve outs)
© 2015 Healthcare Coding & Consulting Services
MONITORING CODING PRODUCTIVITY; CODING EFFICIENCYPROCESS MAPPING
44
Define Standards by Chart Type
Inpatient __ per hour/day
Same Day Surgical __per day/hour
Ancillary OP __ per day/hour
Observation __ per day/hour
Emergency Room __ per day/hour
Clinic __ per day/hour
23
© 2015 Healthcare Coding & Consulting Services
MONITORING CODING PRODUCTIVITY; CODING EFFICIENCYPROCESS MAPPING
45
Step Five:
Develop Monitoring Processes
and
Assessing Actual Staffing Needs
© 2015 Healthcare Coding & Consulting Services
MONITORING CODING PRODUCTIVITY; CODING EFFICIENCYPROCESS MAPPING
46
Monitoring Timeframes
Daily, weekly, or monthly
Look for Red Flags
Too Fast?
Too Slow?
24
© 2015 Healthcare Coding & Consulting Services
MONITORING CODING PRODUCTIVITY; CODING EFFICIENCYPROCESS MAPPING
47
Staffing Levels - Now is the time to assess!
Staffing and Productivity
Why is this important?
How is this calculated?
© 2015 Healthcare Coding & Consulting Services
MONITORING CODING PRODUCTIVITY; CODINGEFFICIENCY PROCESS MAPPING
48
How Many Coders do you actually need?
Determine FTE’s
Step 1: Defining what is a FTE by identification of approved hours per pay period
Step 2: Calculate and identify non worked paid hours
Step 3: Know the average volume of patient encounters
25
© 2015 Healthcare Coding & Consulting Services
MONITORING CODING PRODUCTIVITY; CODING EFFICIENCYPROCESS MAPPING
49
Formula to Calculate Staffing Levels for Coding
Example of Formula: Clinic Scenario
Number of FTE’s Needed= Patient Encounters Productivity
2.5 FTE’s = 250 Encounters100
© 2015 Healthcare Coding & Consulting Services50
Action Items
MONITORING CODING PRODUCTIVITY; CODINGEFFICIENCY PROCESS MAPPING
Collect Actionable Data weekly
Determine who is responsible for monitoring
Identification of Gaps
Assess Staffing Needs
Look for opportunities
26
© 2015 Healthcare Coding & Consulting Services
MONITORING CODING PRODUCTIVITY; CODING EFFICIENCYPROCESS MAPPING
51
Sharing of Best Practices
Ideas to Pass Along
© 2015 Healthcare Coding & Consulting Services52
MONITORING CODING PRODUCTIVITY; CODINGEFFICIENCY PROCESS MAPPING
27
© 2015 Healthcare Coding & Consulting Services
MONITORING CODING PRODUCTIVITY; CODINGEFFICIENCY PROCESS MAPPING
53
Poll Question and Discussion #5
What do you think Coding
Accuracy Standards
Industry wide are typically
set at?
© 2015 Healthcare Coding & Consulting Services
MONITORING CODING PRODUCTIVITY; CODINGEFFICIENCY PROCESS MAPPING
54
Nationwide 2nd Annual
ICD-10 testing challenges
the “all is fine theory”
Coder Credentials
Published results from Central Learning “contest”
550 coders tested
99% were certified o 59% AHIMA Certified o 28% AAPC Certified
1% not certified
28
© 2015 Healthcare Coding & Consulting Services
MONITORING CODING PRODUCTIVITY; CODINGEFFICIENCY PROCESS MAPPING
55
Nationwide 2nd Annual
Nationwide ICD-10 testing challenges
the “all is fine theory”
Experience Level of Participants
Inpatient Coders experience -14.3 years
Outpatient Coders experience- 9.9 years
© 2015 Healthcare Coding & Consulting Services
MONITORING CODING PRODUCTIVITY; CODINGEFFICIENCY PROCESS MAPPING
56
Nationwide 2nd Annual
Nationwide ICD-10 testing challenges
the “all is fine theory”
Scope of the Contest
1,636 medical record cases
Coders could “Choose” their area of Specialty for Test Purposes
All Questions/Answers were validated by industry certified experts
- Consultants
- Internal and External
29
© 2015 Healthcare Coding & Consulting Services
MONITORING CODING PRODUCTIVITY; CODINGEFFICIENCY PROCESS MAPPING
57
Nationwide 2nd Annual
Nationwide ICD-10 testing challenges
the “all is fine theory”
Inpatient 54%
SDS20%
ED26%
Chart Type Volumes
Inpatient
SDS
ED
© 2015 Healthcare Coding & Consulting Services
MONITORING CODING PRODUCTIVITY; CODINGEFFICIENCY PROCESS MAPPING
58
Nationwide 2nd Annual
Nationwide ICD-10 testing challenges
the “all is fine theory”
The results…….
Coders accuracy and proficiency in ICD-10 remains much lower than 95%
Sub-par findings with DRG Accuracy, significantly impacting revenue
Average inpatient coder accuracy: 61 percent
Average ambulatory surgery coder accuracy: 45 percent
Average emergency department coder accuracy: 36 percent
Study shows Increased Productivity and Grossly Sub Par Quality….
30
© 2015 Healthcare Coding & Consulting Services
MONITORING CODING PRODUCTIVITY; CODINGEFFICIENCY PROCESS MAPPING
59
Central Learning “Coding Test” Year Two results
Source: Journal of AHIMA 2017
© 2015 Healthcare Coding & Consulting Services
MONITORING CODING PRODUCTIVITY; CODINGEFFICIENCY PROCESS MAPPING
60
Central Learning “Coding Test” Year Two results
Source: Journal of AHIMA 2017
31
© 2015 Healthcare Coding & Consulting Services
MONITORING CODING PRODUCTIVITY; CODINGEFFICIENCY PROCESS MAPPING
61
Central Learning “Coding Test” Year Two results
Source: Journal of AHIMA 2017
© 2015 Healthcare Coding & Consulting Services
MONITORING CODING PRODUCTIVITY; CODINGEFFICIENCY PROCESS MAPPING
62
Central Learning “Coding Test” Year Two results
Source: Journal of AHIMA 2017
Productivity Findings….
Higher productivity decreased inpatient coding accuracy by -25.4
percent
Higher productivity decreased outpatient coding accuracy by -20.3
percent
32
© 2015 Healthcare Coding & Consulting Services63
ICD-10 challenges
Coders have questions, it’s ok.
Do you have an onsite ICD-10 expert?
Even in 2018 everyone has interpretations without source backing
Lack of coder feedback and education on their work
Bad habits were formed early on
Lack of adequate documentation Defining Coding Challenges
Understanding the importance of Source Guidance
MONITORING CODING PRODUCTIVITY; CODINGEFFICIENCY PROCESS MAPPING
© 2015 Healthcare Coding & Consulting Services64
Keys to Success
Partnering up with the experts
Proof of Continuing Education Participation
Assess your weaknesses
Open Environment is a must
Knowing the sources
Buyer beware
Knowing your resources
MONITORING CODING PRODUCTIVITY; CODINGEFFICIENCY PROCESS MAPPING
33
© 2015 Healthcare Coding & Consulting Services65
Coder Education
Know your sources!
Know your Code maintenance schedules
Provide education, don’t assume your coder is handling
Leveraging technology to provide cost-effective education,
especially those with limited time or resources
MONITORING CODING PRODUCTIVITY; CODINGEFFICIENCY PROCESS MAPPING
© 2015 Healthcare Coding & Consulting Services66
Best Practices
Monthly/ongoing training is imperative
Possible Areas to include: - Review of the OIG work Plan
- Current CPT Assistant reviews
- Current AHA Coding Clinic reviews
- Changes to the PPSs
- Annual CPT Changes (January)
- Annual ICD-10 Changes (October)
- Clinical Information related to coding (procedures, disease process etc.)
- Identifying your teams weaknesses, and providing group remedial
MONITORING CODING PRODUCTIVITY; CODINGEFFICIENCY PROCESS MAPPING
34
© 2015 Healthcare Coding & Consulting Services67
Take the Test to determine your risk
Do you offer mandatory education to your coders
currently?
Are your coders credentialed?
Do you validate your coders recertification and mandated CEU’s?
Do you have coders who code multiple specialties (i.e. inpatient/outpatient)?
Do you have access to and review the most current education, such as
Coding Clinics quarterly, CPT assistants?
MONITORING CODING PRODUCTIVITY; CODINGEFFICIENCY PROCESS MAPPING
© 2015 Healthcare Coding & Consulting Services
MONITORING CODING PRODUCTIVITY; CODING EFFICIENCYPROCESS MAPPING
68
Sharing of Best Practices
Ideas to Pass Along
35
© 2015 Healthcare Coding & Consulting Services69
Policies and Procedures
Take the Test to determine your risk
Do you have Coding Policies and Procedures in HIM
and available to your Coding staff?
Have your Policies and Procedures been reviewed for accuracy within the
last 12 months?
Do you have a expected coding accuracy rate documented within your
policy and procedures?
Do you have a expected coding productivity rate documented within your
policy and procedures?
MONITORING CODING PRODUCTIVITY; CODINGEFFICIENCY PROCESS MAPPING
© 2015 Healthcare Coding & Consulting Services70
Example Policies and Procedures:
Audit and Monitoring System
- Audit/Monitoring Schedule
- Concurrent Audit
- Targeted Audits
Quality Management and Assurance Reporting
Remote Coding
Job Descriptions (Coder I, II, III, etc.)
Performance Management (Performance Reviews)
MONITORING CODING PRODUCTIVITY; CODINGEFFICIENCY PROCESS MAPPING
36
© 2015 Healthcare Coding & Consulting Services71
Example Policies and Procedures Continued:
Rebills Process (APC/DRG Changes)
Ambiguous or deficient documentation
Explanation of Source Guidance (Official)
Process when no Source guidance is available
Coding TAT expectations
MONITORING CODING PRODUCTIVITY; CODINGEFFICIENCY PROCESS MAPPING
© 2015 Healthcare Coding & Consulting Services72
Code of Conduct
Every HIM should develop a code of conduct
AHIMA’s Standards of Ethical Coding
AAPC’s Standards of Ethical Coding
http://bok.ahima.org/doc?oid=106344#.V3-yeRYebIU
https://www.aapc.com/aboutus/code-of-ethics.aspx
MONITORING CODING PRODUCTIVITY; CODINGEFFICIENCY PROCESS MAPPING
37
© 2015 Healthcare Coding & Consulting Services73
Identifying and Measuring Areas of Risk
Take the Test to determine your risk
Do you concurrent audit certain DRG’s,
pre-bill?
Do you target certain DRG’s retrospectively?
Are you familiar with target areas from OIG, CMS, RAC and
incorporate them into your internal monitoring?
MONITORING CODING PRODUCTIVITY; CODINGEFFICIENCY PROCESS MAPPING
© 2015 Healthcare Coding & Consulting Services74
Current CMS Audit Environment
• Recovery Auditor Program (RAs)
• Medicare Administrative Contractors (MACs)
• Medicaid RACs
• Quality Improvement Organizations (QIO)
• Medicaid Integrity Contractors (MICs)
• Zone Program Integrity Contractors (ZPICs)
• State Medicaid Fraud Control Units (MFCUs)
• Comprehensive Error Rate Testing (CERT)
• Payment Error Rate Measurement (PERM)
MONITORING CODING PRODUCTIVITY; CODINGEFFICIENCY PROCESS MAPPING
38
© 2015 Healthcare Coding & Consulting Services75
Action Items
Become Familiar with the “Hot Topics”
• Auditing and monitoring Systems in place
• Effective communication mechanisms in place
• Take a good look at denials
MONITORING CODING PRODUCTIVITY; CODINGEFFICIENCY PROCESS MAPPING
© 2015 Healthcare Coding & Consulting Services76
Action Items
Writing Policies and Procedures
Ensure Education needs are met
Importance of credentialed Coders
Ensure the right tools are available
Review where your facility's area of risk is, take action!
MONITORING CODING PRODUCTIVITY; CODINGEFFICIENCY PROCESS MAPPING
39
© 2015 Healthcare Coding & Consulting Services77
Action Items
Validate if your Productivity Standards are
Correctly set, and look for areas of opportunity
Identify a Productivity tracking measuring mechanism.
MONITORING CODING PRODUCTIVITY; CODINGEFFICIENCY PROCESS MAPPING
© 2015 Healthcare Coding & Consulting Services78
Learning Outcomes
Progress to date FY 17-18
Defining Productivity and Best Practices
Identification of Areas of Opportunity
Policies and Procedures
Identifying and Measuring Areas of Risk
Audits and Monitoring
Defining Best Practices
Process Mapping and Tips to optimize coding efficiency
MONITORING CODING PRODUCTIVITY; CODINGEFFICIENCY PROCESS MAPPING
40
© 2015 Healthcare Coding & Consulting Services
MONITORING CODING PRODUCTIVITY; CODINGEFFICIENCY PROCESS MAPPING
79
References
Journal of AHIMA November 2017
Journal of AHIMA October 2017
Central Learning
AHIMA
AAPC
© 2015 Healthcare Coding & Consulting Services80
THANK YOU FOR YOUR TIME
We welcome all questions!
Quality
Valu
e