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Enhance coder performance

HIM Connection, February 8, 2005

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Coding has been a top focus for the past two decades since prospective payment was imposed upon healthcare facilities. The American Health Information Management Association reports a shortage of coding professionals nationwide-in some regions, vacancies for experienced credentialed coders exceed 70%. With such shortages and the need to have every encounter coded, enhance coder performance by establishing and communicating balanced work expectations to all employees. Ensure that employees understand the expectations, consider them fair, achievable, objective, and easily measurable. Monitor each expectation set and routinely share compliance goals with staff. These expectations can be expressed in the following ways:

• Number of records coded daily/weekly
• Unbilled accounts
• Number of discharge days uncoded

If more than one coder codes the same types of records, put provisions in place to ensure "cherry picking" does not occur. Cherry picking occurs when one coder chooses the easier cases and leaves behind the more difficult. This situation can happen with transcription, where one transcriptionist may skip a more difficult-to-understand dictator for the dictation of another physician who clearly enunciates his or her words. Avoid cherry picking by assigning records by terminal-digit or alphabetical order. By doing so, all coding personnel share difficult and easy records. It also allows a manager to assess visually who may be falling behind on their coding. This approach reduces time for the coders when picking up their records.

When a manager chooses to use the terminal-digit or alpha-split approaches, he or she must monitor the unbilled report to ensure that cases are not aging on the shelf. This can happen if a coder does not wish to tackle a particularly hard record, yet keeps it in his or her assigned category. Some managers establish a rule that there will be no uncoded record with a discharge date greater than a specified number or days. This is a better approach because it encourages teamwork among coders to ensure that everything within the designated time frame is coded. This approach works particularly well if there is a corresponding team incentive payment.

Many organizations place special emphasis on coding "high dollar" accounts. This requires staff to find the accounts, pull them out of the routine work flow, track their whereabouts, and then-once coded-move them back to where they belong. If staff are maintaining their coding within the "hold" period or the specified number of days category, this effort should be avoided. It takes staff away from doing other work. Based on our experience, processing these accounts may consume up to 19 minutes of clerical effort. This includes the time involved checking the list, determining where the record is, logging the record out to coding, getting it back from coding, logging it back into where it belongs in the process, and when folderization staff have finished their assembly and analysis that day, they must retrieve their log to check off this straggler record and then process it. Assigning the high dollar accounts to coders can slow down staff because of the frustration of having to do a group of high dollar charts before getting into their regular work.

Management's goal should always be to code within the hold period, which is established by the finance department as the time span following discharge that the account remains available for charges and services to be applied before it drops into the claim-submission queue. Some organizations call this the "suspense" period. Once this period passes, the account is deemed "unbilled," and this is when the fingers often point to HIM.

Never let accounts fall into the unbilled category to ensure harmony with the chief financial officer (CFO). Once you achieve this, approach the CFO and financial-services manager to create a daily report for those cases that require interim-billing. List these cases several days prior to the interim-billing date so you can assign a coding professional to visit the patient-care area to code the record in advance of the actual interim-billing date; otherwise, these may appear in the unbilled category.

Another asset that will enhance coding productivity is to have access to physician advisors interested in helping the coding professionals interpret some of the unique clinical aspects of a case. They also serve as champions for coding personnel with their colleagues. For example, a physician can remind another physician with poor documentation habits about the effects on the coding staff. This interaction is a powerful change agent.

This excerpt is adapted from the book More with Less: Best Practices for HIM Directors.

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