Health Information Management

Use benchmarks to set coding productivity standards

JustCoding News: Inpatient, September 16, 2009

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Editor’s note: This article was adapted from an HCPro audio conference, which focused on a coder productivity benchmarking survey. Out of 213 responses, the highest number of respondents came from acute care non-teaching community hospitals, with 94 responses, and acute care teaching community hospitals with 54 responses.

Recovery audit contractors are scrutinizing coding accuracy, and the transition to ICD-10 is only a few years away. These are just two of the reasons why coder productivity is more important now than ever, yet 27% of respondents in an HCPro survey said they have not established standards.

Measuring coder productivity helps determine whether staff members are coding as efficiently as possible. Accurate standards also help to justify the addition—or retention—of full-time employees.

During an August 18 HCPro audio conference, “Benchmarking Coder Productivity to Improve Efficiency and Justify FTEs,” Rose T. Dunn, MBA, RHIA, CPA, FACHE, chief operating officer of First Class Solutions in St. Louis, MO, spoke about the factors that affect productivity and provided tips for how to assess standards in light of non-coding duties. She also discussed the results of HCPro’s 2009 coding productivity benchmarking survey.

Understand productivity statistics
In the survey, 213 individuals responded from nine different types of facilities. The respondents answered 55 questions, providing information such as:

  • Number of beds
  • Average number of encounters
  • Whether there are designated inpatient coders, designated outpatient coders, or whether coders code all record types
  • Coder duties and responsibilities
  • Specific productivity expectations based on record type

According to the results, respondents reported the following productivity standards based on record type (records per hour):

  • Inpatient records:
    • Fewer than three records: 12%
    • Three: 30%
    • Three and a half to three and three-quarters: 14%
    • Four: 10%
    • Greater than four: 6%
    • Not applicable (we don’t have a standard or performance expectation): 15%
    • Not applicable (we don’t code this record type): 14%
  • Ambulatory surgery records:
    • Fewer than four: 5%
    • Four: 6%
    • Five: 16%
    • Six: 18%
    • Seven: 9%
    • Eight: 6%
    • Greater than eight: 7%
    • Not applicable (we don’t have a standard or performance expectation): 16%
    • Not applicable (we don’t code this record type): 17%
  • ED encounters:
    • Fewer than six: 2%
    • Six: 2%
    • Seven: 2%
    • Eight: 3%
    • Nine: 2%
    • 10: 13%
    • 11: 1%
    • 12: 7%
    • Greater than 12: 29%
    • Not applicable (we don’t have a standard or performance expectation): 16%
    • Not applicable (we don’t code this record type): 23%
  • Outpatient testing (non-interventional):
    • Fewer than 20: 8%
    • 20 to 25: 19%
    • 26 to 31: 12%
    • Greater than 31: 13%
    • Not applicable (we don’t have a standard or performance expectation): 20%
    • Not applicable (we don’t code this record type): 27%
  • Invasive/interventional outpatient testing: 
    • Fewer than four: 4%
    • Four: 6%
    • Five: 12%
    • Six: 8%
    • Seven: 6%
    • Eight: 4%
    • Nine: 1%
    • 10: 5%
    • Greater than 10: 9%
    • Not applicable (we don’t have a standard or performance expectation): 19%
    • Not applicable (we don’t code this record type): 28%
  • Clinic visits
    • Fewer than eight: 3%
    • Eight: 5%
    • Nine: 1%
    • 10: 6%
    • 11: 1%
    • 12: 3%
    • Greater than 12: 17%
    • Not applicable (we don’t have a standard or performance expectation): 20%
    • Not applicable (we don’t code this record type): 44%
  • Observation
    • Fewer than four: 9%
    • Four: 10%
    • Five: 16%
    • Six: 9%
    • Seven: 3%
    • Eight: 4%
    • Greater than eight: 6%
    • Not applicable (we don’t have a standard or performance expectation): 21%
    • Not applicable (we don’t code this record type): 21%

Dunn noted that the American Health Information Management Association (AHIMA) and the Healthcare Financial Management Association (HFMA) released benchmarking data in 2007 and 2004, respectively. Many of the standards set forth by these organizations were similar to those of HCPro’s survey, she adds. However, Dunn points out two areas that differ significantly: ED and ancillary. AHIMA expects 15 ED records per hour, while the HFMA data listed 24 ED records per hour. For ancillary records, AHIMA advocates for 30 records per hour, while HFMA specifies 55.

HFMA’s expectation for ancillary records requires coders to complete nearly one record per minute, Dunn said.

“I’m not quite sure how someone can code, access the account, and enter the data in less than one minute,” she said.

Nonetheless, this type of data helps coding managers determine what their expectations should be based on the characteristics of their facility, she said.

Tackle productivity challenges
At a time when coder accuracy and efficiency is especially important, healthcare providers need to consider setting standards. Understanding what challenges affect productivity will help coding managers set appropriate standards and determine what they can do to lessen the effects of those challenges.

Coder clinical knowledge. Every coder has a different level of clinical knowledge that affects his or her ability to understand terminology and code efficiently. Managers should assess each coder’s knowledge to determine what additional education or materials, if any, are necessary, Dunn said.

Access, content, and format of the record. Some facilities may use a complete electronic health record. Others may use a hybrid record that includes both paper and electronic documents. Ask these questions to determine how the record format might affect coder productivity:

  • How long does it take for coders to access a record?
  • How long does it take for coders to look through the record?
  • Can coders easily find the information they need?
  • How easy is it for coders to read the documentation?

“Probably the one issue I often hear from coding professionals is that the scanned record is completely black and white,” Dunn said. “They were so accustomed to working with a paper record with certain colors to help identify a certain part of the record.”

Remote coding. Some facilities allow coders to work from home, which presents several benefits as well as challenges. For example, one challenge is that productivity may decrease due to technical difficulties. According to the survey, 50% of respondents who employ remote coders said the coders experienced disconnects and connectivity issues. Also, some coders prefer to work on-site because they enjoy the camaraderie. Thirty-eight percent of respondents with remote coders said they complained about the lack of coworker interaction, particularly when they have coding-related questions.

One of the benefits of a remote coding program is that many coders actually experience increased productivity when working remotely. Forty-three percent of survey respondents said coders are more productive than when they worked in the office. It’s important to decide what works best for your facility and what maximizes productivity. To do this, keep an open dialogue with coders, Dunn said.

View a case study of how one hospital implemented a remote coding program to improve productivity.

Technology. There are two ways in which directors can use technology to increase coder productivity. One way is to provide a dedicated printer for each coder. Another is to provide dual computer screens. Sixty-five percent of survey respondents said they do not have dedicated printers; however, 48% said their coders worked with dual screens.

“We need to offer those coders that dual screen capability,” Dunn said. “It makes it much easier for them to view several pages at the same time or to have two applications open simultaneously.”

Providing each coder with a dedicated printer also helps keep him or her seated and at work, she said. “Make that technology work for you and help improve the productivity of your staff,” she added.

Editor’s note: E-mail Dunn at rose@firstclasssolutions.com.

To learn more about coder productivity standards, purchase a copy of HCPro’s August 18 audio conference “Benchmark Coder Productivity to Improve Efficiency and Justify FTEs.”



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