by Susan Chapman
Republished with permission: For The Record Vol. 30 No. 1 P. 10
Susan Chapman, a Los Angeles-based freelance writer, interviewed auditing firm leaders to share their thoughts on best practices in coding audits.
Given that quality is an important factor in helping health care facilities keep costs under control, accuracy is an important factor in the auditing process. Yet, productivity is also critical.
“I recommend auditing for accuracy,” says Sarah Humbert, coding and compliance manager at KIWI-TEK. “The productivity metric can be important for coders who are paid hourly, but there is no value to inaccurate records. Speed needs to be reasonable, but we’ve seen it over and over, one coder is achieving 98% accuracy but codes 10 records an hour. Another coder may be able to do the same thing with 12 records. Consequently, we place all of our weight on accuracy vs productivity. I don’t see the value otherwise.”
Jacqueline Thelian, CPC, CPC-I, CHCA, president of Medco Consultants, prefers to take a deep dive into the data. “Firstly, it is important to be sure the documentation supports the service being reported,” she says. “With regard to productivity, I always look to see whether the provider is overutilizing services without supporting medical necessity to gain a higher work relative value unit, or productivity. Medicare provides physician data so you can download the productivity of other providers of your same specialty in your geographic area to determine whether your utilization for certain services is in line with the industry.”
According to Lisa Marks, RHIT, CCS, director of client audits at nThrive, productivity and accuracy are two distinct measurements. “Coding accuracy is determined through coding auditing. Coding productivity is more operational. As a coding manager, I would review for both accuracy and productivity,” she says. “Your strongest coders will maintain high productivity with high accuracy. In identifying your strongest coders, you can call on them to help mentor and support others. With efforts to increase productivity without impacting quality, coding costs can then be better managed.”
When measuring the accuracy of a facility’s coding program, Gabe Stein, executive vice president of GeBBS Healthcare Solutions, recommends looking at facility type, the types of cases being coded, coder tenure, and production. “If the production is high but the quality is low, that is very telling,” he says.
Auditors must take into account that guidelines differ from facility to facility. “What Hospital A wants to capture and what Hospital B wants to capture are different,” Humbert explains. “You have to go back to the objectives. Get a gauge of the coder’s knowledge or money left on the table by the facility. We can be looking for other opportunities of the HIM function to improve coding.”
When measuring productivity, the complexity of a facility’s computer system should be taken into account, as well as the degree of clinical complexity. More complex clinical scenarios can result in lower productivity and make it more difficult for coders to achieve higher accuracy.
“The documentation itself is another issue,” Marks says. “If the documentation is weak, it can lead to poor quality in coding and necessitate multiple queries, which slow the revenue cycle and add burdensome steps to the workflow. For issues like computer complexity and documentation accuracy, education, training, and the current skill set of coders can drive accuracy and productivity goals.”
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