Establishing Cding Prductivity Standards
Michelle Ann Richards BSHA, CPC, CPCO, CPPM-I Directr f Engagement, Cmpliance Services Michelle.Richards@aapc.cm
Objectives Review published infrmatin fr cding Prductin Quality Outline items t cnsider when determining prductivity standards Ttal vlume f wrk Sftware functinality Specialties Other duties assigned Cnsider ways t gain staff supprt Discuss creating measurements t ensure success Prductin Quality
Disclaimer Infrmatin cntained in this presentatin, including all discussin, is nt intended t be legal r business advice. The regulatins regarding billing and cding are pen t interpretatin. It is yur respnsibility t ensure that cmpliant cding and billing guidelines are being fllwed and t seek assistance frm utside experts n applicatin f thse guidelines specific t yur circumstances
Definitins Prductivity: The rate at which gds are prduced r wrk is cmpleted Efficiency: The ability t prduce smething withut wasting time, materials r energy Effectiveness: Prducing a result that is wanted-having the intended effect Quality: Hw accurate r inaccurate smething is Standard: A level f quality r achievement that is cnsidered
Gals T determine if staff is cmpleting their wrk in an efficient and accurate manner T develp measurements t assist in setting annual perfrmance gals T allw issues with lw perfrmers t be recgnized and addressed quickly T assist in identifying when staff capacity is met T meet yur practice/rganizatin s cmpliance requirements If yu re nt keeping scre, hw d yu knw if yu re winning?
Benchmarks Type f Recrd Inpatient Ambulatry Surgery Center Clinic Visits Observatin Emergency Department Recrds Interventinal Testing Nn-interventinal Testing Reprted Expectatin (highest percentage) 3-3.5 recrds per hur 6-7 recrds per hur > 23 recrds per hur 5-6 recrds per hur 8-11 recrds per hur 4-5 reprts per hur >37 reprts per hur 2011 Cder Prductivity Survey-HCPr
Benchmarks Type f Recrd Reprted Expectatin Inpatient 3 Outpatient (ambulatry, interventinal, surgery and prcedures Emergency Department 15 Ancillary Services (including testing and lab and radilgy) ICD10 Mnitr Octber 25, 2015 5 30
Benchmarks Discussin: What are yur quality expectatins? 95% 90% Other
Cnsideratins Wrk type Wrk hurs Wrk lcatin Sftware functinality Other duties as assigned Cding credentials Discussin: Are there ther items that shuld be cnsidered?
Wrk Type What type f cding will the measurement apply t? Inpatient Facility Outpatient Facility Clinic Visits Prfessinal Prcedures/Surgery Diagnstic Services Interventinal Will there be abstracting perfrmed?
Wrk Hurs FTE status Shift Extended hurs Discussin: Shuld prductin expectatins be altered during extended hurs?
Wrk Lcatin Office Remte Office Remte Hme Discussin: Des wrking frm hme change yur prductivity expectatin?
Sftware Functinality Cmputer Assisted Cding Ability t build payer specific edits Speed Streamlined prcesses Discussin: Des the sftware a cder uses change the prductin expectatins?
Other Duties As Assigned Is the staff member respnsible fr: Abstracting (CPT, ICD) Answering questins Prviding analysis Wrking denials Querying prviders/departments Discussin: Des ICD-10 have an effect n prductivity?
Cding Credentials CPC (et al) CCS, CCS-P RHIT Discussin: Des cding credentials, r lack theref, change prductivity expectatins?
Gaining Supprt Track current prductin ver several weeks Ask fr input i.e. daily, weekly r mnthly averages Create an incentive plan Payment Cnferences Special prjects Establish annual gals based n perfrmance Delay prmtins and/r mves fr under perfrmers Allw vertime nly fr thse meeting minimum prductin standards
Setting Measures Applying Average Current Prductin Measures Mnitr prductin levels fr all staff ver a pre-designated perid f time Srt wrk by wrk type (specialty, inpatient, utpatient, abstracting, etc.) Determine average (hurly, daily) Thrw ut the highest and lwest numbers Set perfrmance standards Minimum Average High Share measures and data with staff
Setting Measures Using Pint Values t Measure Prductivity Determine a pint value fr each wrk type Determine the average prductin yu expect Set perfrmance standards Minimum Average High Share measures and data with staff
Setting Measures Wrk Type Inpatient Emergency Rm Prfessinal and Facility ASC/Outpatient Prcedure Clinic-Specialty Radilgy Review Diagnsis Pint Value 3 pints 2.5 pints 2 pints 1 pint.5 pints
Setting Measures Use published data as a benchmark Determine prductin value fr each wrk type (i.e. minutes, charts per day, charts per week) Review published data Set perfrmance standards Minimum Average High Share measures and data with staff
Setting Measures Wrk Type Minutes Per Chart Charts per Day Charts per Week Inpatient 30 15 75 Observatin 20 21 105 Same Day Surgery 12 35 175 Gastrenterlgy 10 42 210 Other OP Charts 4 105 525 UNMH HIM Cding Prductivity and Quality Standards
Daily Cder Prductivity Expectatins CHART TYPE PER DAY PER HOUR TIME PER RECORD Ancillary Testing Cding 240 30 2 Inpatient/Observatin 24 3 20 Same Day Surgery 48 6 10 Emergency Rm 96 12 5 Outpatients 240 30 2 Radilgy - n ther duties 400 50 1 Radilgy - ther duties 240 30 2 Urlgy 144 18 3.3 Ambulatry Multi-Specialty Clinic (125 prviders 7 FTEs) 136 17 3.5 E&M 160 20 3 Orthpedic Surgeries 60 7.5 8
Prductin Measures Cding staff is expected t meet expectatins as fllws: Exceeds: Gal is met 90% r greater f the time Average: Gal is met 70-89% f the time Minimum: Gal is met 40-69% f the time Nt Meeting:Gal is met <40% f the time Discussin: Hw d yu set expected prductivity? Exceeds Average Minimum
Quality Measures Cding staff is expected t meet quality expectatins as fllws: Meets: Achieves 95% r higher 90% r mre f the time Nt Meeting:All thers Discussin: Hw d yu set expected quality? Meets Nt Meeting
Review Reviewed published infrmatin fr cding Prductin Quality Outlined items t cnsider when determining prductivity standards Ttal vlume f wrk Sftware functinality Specialties Other duties assigned Cnsidered ways t gain staff supprt Discussed creating measurements t ensure success Prductin Quality
Resurces http://www.merriam-webster.cm/dictinary http://weblgs.pbspaces.cm/dysn/files/2010/10/baseball.jpg http://hspitals.unm.edu/abut/prpsals/2015/p312-15-a-add1.pdf http://www.hcpr.cm/cntent/267408.pdf http://www.hcpr.cm/cntent/238552.pdfhttp://www.hcpr.cm/him- 238989-3288/Use-benchmarks-t-set-cding-prductivity-standards.html http://www.frtherecrdmag.cm/archives/080210p6.shtml http://www.hcpr.cm/him-66492-865/institute-an-incentive-plan-tincrease-cding-prductivity.html
Questins
Michelle Ann Richards BSHA, CPC, CPCO, CPPM-I Directr f Engagement, Cmpliance Services Michelle.Richards@aapc.cm