Establishing Coding Productivity Standards

Transcription

1 Establishing Coding Productivity Standards ANN BINA Objectives oreview published information for coding o Production o Quality ooutline items to consider when determining productivity standards o Total volume of work o Software functionality o Specialties o Other duties assigned oconsider ways to gain staff support odiscuss creating measurements to ensure success o Production o Quality 1

2 Disclaimer Information contained in this presentation, including all discussion, is not intended to be legal or business advice. The regulations regarding billing and coding are open to interpretation. It is your responsibility to ensure that compliant coding and billing guidelines are being followed and to seek assistance from outside experts on application of those guidelines specific to your circumstances Definitions oproductivity: The rate at which goods are produced or work is completed oefficiency: The ability to produce something without wasting time, materials or energy oeffectiveness: Producing a result that is wanted-having the intended effect oquality: How accurate or inaccurate something is ostandard: A level of quality or achievement that is considered 2

3 Goals oto determine if staff is completing their work in an efficient and accurate manner oto develop measurements to assist in setting annual performance goals oto allow issues with low performers to be recognized and addressed quickly oto assist in identifying when staff capacity is met oto meet your practice/organization s compliance requirements If you re not keeping score, how do you know if you re winning? Benchmarks Type of Record Inpatient Ambulatory Surgery Center Clinic Visits Observation Emergency Department Records Interventional Testing Non-interventional Testing Reported Expectation (highest percentage) records per hour 6-7 records per hour > 23 records per hour 5-6 records per hour 8-11 records per hour 4-5 reports per hour >37 reports per hour 2011 Coder Productivity Survey-HCPro 3

4 Benchmarks Type of Record Reported Expectation Inpatient 3 Outpatient (ambulatory, interventional, surgery and procedures Emergency Department 15 Ancillary Services (including testing and lab and radiology) 5 30 ICD10 Monitor October 25, 2015 Benchmarks Discussion: What are your quality expectations? o95% o90% oother 4

5 Considerations owork type owork hours owork location osoftware functionality o Other duties as assigned ocoding credentials Discussion: Are there other items that should be considered? Work Type What type of coding will the measurement apply to? o Inpatient Facility o Outpatient Facility o Clinic Visits o Professional Procedures/Surgery o Diagnostic Services o Interventional Will there be abstracting performed? 5

6 Work Hours ofte status oshift oextended hours Discussion: Should production expectations be altered during extended hours? Work Location ooffice oremote Office oremote Home Discussion: Does working from home change your productivity expectation? 6

7 Software Functionality ocomputer Assisted Coding oability to build payer specific edits ospeed ostreamlined processes Discussion: Does the software a coder uses change the production expectations? Other Duties As Assigned ois the staff member responsible for: oabstracting (CPT, ICD) oanswering questions oproviding analysis oworking denials oquerying providers/departments Discussion: Does ICD10 have an effect on productivity? 7

8 Coding Credentials ocpc (et al) occs, CCS-P orhit Discussion: Do coding credentials, or lack thereof, change productivity expectations? Other Considerations Identify how considerations identified in previous discussion affect coding productivity? 8

9 Gaining Support otrack current production over several weeks oask for input o i.e. daily, weekly or monthly averages ocreate an incentive plan o Payment o Conferences o Special projects oestablish annual goals based on performance odelay promotions and/or moves for under performers oallow overtime only for those meeting minimum production standards Gaining Support Discussion: What else can be done to help gain staff support? 9

10 Setting Measures Applying Average Current Production Measures omonitor production levels for all staff over a pre-designated period of time osort work by work type (specialty, inpatient, outpatient, abstracting, etc.) odetermine average (hourly, daily) othrow out the highest and lowest numbers oset performance standards o Minimum o Average o High oshare measures and data with staff Setting Measures Using Point Values to Measure Productivity odetermine a point value for each work type odetermine the average production you expect oset performance standards o Minimum o Average o High oshare measures and data with staff 10

11 Setting Measures Work Type Inpatient Emergency Room Professional and Facility ASC/Outpatient Procedure Clinic-Specialty Radiology Review Diagnosis Point Value 3 points 2.5 points 2 points 1 point.5 points Setting Measures Use published data as a benchmark odetermine production value for each work type (i.e. minutes, charts per day, charts per week) oreview published data oset performance standards o Minimum o Average o High oshare measures and data with staff 11

12 Setting Measures Work Type Minutes Per Chart Charts per Day Charts per Week Inpatient Observation Same Day Surgery Gastroenterology Other OP Charts UNMH HIM Coding Productivity and Quality Standards Setting Measures Discussion: How did you develop your production measures? 12

13 Production Measures ocoding staff is expected to meet expectations as follows: o Exceeds: o Average: o Minimum: o Not Meeting: Goal is met 90% or greater of the time Goal is met 70-89% of the time Goal is met 40-69% of the time Goal is met <40% of the time Discussion: How do you set expected productivity? Exceeds Average Minimum Quality Measures ocoding staff is expected to meet quality expectations as follows: o Meets: o Not Meeting: Achieves 95% or higher 90% or more of the time All others Discussion: How do you set expected quality? Meets Not Meeting 13

14 Review oreviewed published information for coding o Production o Quality ooutlined items to consider when determining productivity standards o Total volume of work o Software functionality o Specialties o Other duties assigned oconsidered ways to gain staff support odiscussed creating measurements to ensure success o Production o Quality Resources ohttp:// ohttp://weblogs.pbspaces.com/dyson/files/2010/10/baseball.jpg ohttp://hospitals.unm.edu/about/proposals/2015/p a-add1.pdf ohttp:// ohttp:// ohttp:// ohttp:// 14

15 Questions Ann Bina