Seven Steps to Optimized Medical Coding Health Solutions – A Checklist Guide

By Cindy Doyon, RHIA | Posted: 11/13/2018

Seven Steps

The increased scrutiny on accurate health care reporting and reimbursement means greater exposure and possible consequences to health care providers. Medical coding and process performance affect outcomes and can mean the difference between a provider with strong reporting, patient satisfaction and reimbursements and those with coding performance and health information management process issues that result in reimbursement loss.

There is pressure on providers to optimize medical coder performance and shorten the path to reimbursements and hit revenue cycle goals. This list has been developed to help you keep your coders productive and their output accurate and efficient. It points out the distraction that take coders away from their role, and reminds the provider to keep implementing current resources, and to ensure coders are credentialed, educated and can forge ahead in the face of constant change.

The following is a seven-sectioned guide filled with questions and considerations to factor in when measuring medical coding productivity. It’s a resource to help you streamline coding in your health care organization and optimize productivity.

Medical Coding Productivity Evaluation Guide

1 - Answer these Yes/No questions

If you answer no, factor in extra time allowance.

  1. Is all relevant documentation available to the coder? Yes or no?
    Missing dictated reports and key documents should be present and legible at time of coding. If no, the coder must locate them prior to coding to ensure quality coding occurs.
  2. Do your coders code a balanced mix of records? Yes or no?
    A change in the balance of record types that your coders code affects productivity.
  3. Do your coders use encoding and grouping software? Yes or no?
    Lack of these health information technology resources impacts coding completion time and coding accuracy.
  4. Do your coders code a maximum of 50 data elements? Yes or no?
    Coders identify additional data elements – for example, did the patient discharge and go home? Discharge and go to a nursing facility? Up to fifty data elements are a rule of thumb for coding teams – more than 50 requires additional abstracting time.
  5. Are ADT interfaces installed? Yes or no?
    If your organization does not have ADT interface for patient demographic information, add more coding time.

2 - Factor these considerations for your metrics

  1. Number of diagnoses coded per patient record type. The sicker the patient, the more coding required. Some organizations set limits.
  2. External cause codes – are they required? Certain states/providers require these. Providers usually can decide whether to include them.
  3. PCS codes on outpatient records. Some hospitals require using ICD-10 PCS codes in addition to CPT codes which results in needing more time to code.
  4. Non-surgical Procedure Codes can be applied through the Charge Description Master. If not, they must be applied by the coder. Make sure your Chargemaster is up to date or more back-end edits will occur.
  5. If coders are tasked with reviewing medical denial codes and appeals, take the non-coding time into consideration.
  6. Validation of Patient Access collected demographic data and/or Nursing data accuracy and corrections, such as patient information or insurance, requires non-coding time.
  7. Factor in time if your coders must consider risk of mortality (ROM)/severity of illness (SOI) for APR-DRG’s. Some payors, including Medicaid, use the scores to determine payment.
  8. Problem list maintenance – sometimes when a coder is coding quickly, they may carry resolved/inactive ICD codes forward. Views on coding from problem lists vary from provider to provider. Whichever your hospital prefers, ensure it’s an effective medical coding solution.

3 - Coder responsibilities – Answer these questions

  1. Which of these scenarios fits your coders’ functional responsibilities? Factor in the additional responsibilities when measuring coding time: Coding, Coding and abstracting, Coding with abstracting and analysis
  2. Does the abstracting system have a demographic interface with the mainframe? No means more time to code is required.
  3. Are the coders collecting an excessive number of data elements in accordance with the requirements of your organization? Yes means more time is required.
  4. Identify the types of records coded – Tertiary care, trauma, specialty units such as rehab, skilled, transplant, burn, high risk obstetrical, NICU. Different types require different time allowances.
  5. Do your coders deal with ancillary departments for outpatient related issues? Do they have to wait for charges to be finalized before they code? Yes means more time is required.
  6. Are coders required to track down their own records and/or missing documents, or do they have clerical support dedicated to helping them? No support means more time is required.
  7. Are coders responsible for generating routine and/or special reports? Yes means more time is required.
  8. Do coders handle edits? Yes means more time is required.

4 - The Right Tools for the Job

  1. Coding books – are your medical coders utilizing online book resources or are they still using hard copy books to research issues such as Medicare guidelines, medications, coding clinic, ICD-10 codes, etc.? The more health care coding resources available to coders online, such as Stedman’s, MedLearn and CPT Assistant and Coding Clinic, the more efficient.
  2. More on encoders … which encoder do your coders use? Encoders vary in effectiveness.
  3. If your encoder is interfaced with the abstracting system, are the codes are automatically entered in the abstract? If not, coders input codes manually, which is a risk for errors in addition to taking extra time.

5 - About your medical coders

Coding staff must be credentialed, regardless of credential type.

Identify your provider’s credential requirements:

  • Any apprentices or coders in training
  • Experience – how long and what kind

To maintain credentials, minimum amounts of credentials are required. Quality of output suffers when coders are not allowed to maintain their education requirements or enhance their medical coding training. Credentials may falter. Answer these questions to evaluate your commitment to ongoing education for your team:

  • Does the coding staff receive routine education?
  • By whom?
  • How frequently?
  • Is attendance mandatory?
  • Are there coding round tables/huddles?
  • How are code updates addressed and communicated?
  • Is there an active auditing program and what is its focus?
  • Are there documented medical coding guidelines and are they easily accessible and kept up-to-date?
  • Is there a resource for answering difficult coding scenarios?

6 - Coder tenure

A longer tenure may mean more skilled staff … BUT, if the average tenure is high, and there is little to no continuing education available or required, it could indicate that the staff is not up-to-date on current health care coding guidelines.

7 - Coder location

  • Where the coding is performed affects productivity.
  • Coding completed onsite at the organization – the ideal spot is a quiet, secluded area
  • Coding completed remotely – ensure it’s a dedicated work area free of distractions

It’s no coincidence that today's best-performing coding organizations are found in the top performing health care provider organizations. Those providers know that a coding program built on a foundation of knowledgeable staff, current tools, supportive health information technology, access to education, knowledge of what the coder faces daily and their collaborative relationships with other departments impacts organizational success.

nThrive offers a comprehensive range of proven medical coding services, outsourcing and education solutions to positively impact your revenue cycle. With nThrive’s proven health information management solutions, you’ll raise the performance level of your coding organization to deliver outstanding quality and productivity. Many nThrive coding clients experience coding accuracy percentages in the high 90s. Our coders are familiar with many coding technologies. For many providers, partnering with nThrive ensures:

  • Reduced DNFB (discharged not final billed) levels
  • Easier coder recruiting and retention challenges
  • Reduced lost reimbursements, coding backlogs and noncompliance risk
  • Improved accounts receivable days and cash flow
  • Optimal quality with ongoing coding audits

nThrive is the comprehensive Patient-to-Payment resource in health care. We integrate our knowledge and expertise of the entire revenue cycle in a way that provides unmatched benefits for health care. We are accountable to our clients, not payor or provider owners. As a result, our health solutions are unbiased and focus on what's best for our clients. nThrive empowers health care for every one in every community by transforming financial and operational performance, enabling health care organizations to thrive.

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