HINM271Week5AssignmentSP24

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Montgomery College *

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271

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Mechanical Engineering

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Apr 3, 2024

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Assignment #5 Developing a Coding Quality Plan DUE: 2/25/24 You have just been promoted to coding supervisor at a 300-physician clinic. The previous supervisor was terminated for incompetence. The coding section is a disaster. There are two full-time coders. One has one year of experience and is a recent graduate of a local college. Additionally, she has her RHIT certification. The other coder has four years of coding experience, but no formal coding or HIM experience. There is no coding quality program in place. There are no coding standards for quality or productivity. There is a high denial rate (33% of your Medicare claims) due to the coding problems. The accuracy level is currently at 72%. Your job is to resolve the coding section deficiencies. Since you have been promoted from within the facility, you are already aware of many of the problems. Your facility is in serious trouble with the Quality Improvement Organization (QIO), and you fear that the Office of the Inspector General (OIG) will show up on your doorstep soon. Although not all of the financial difficulties the physician practice is having can be related to coding, many can, as the facility is not receiving proper reimbursement. Helpful links: https://www.fortherecordmag.com/archives/0219p22.shtml https://www.impact-advisors.com/revenue-cycle/tips-coding-quality/ https://www.icd10monitor.com/icd-10-coding-three-ways-to-improve-quality- consistency-collaboration-and-education 1. Identify what needs to be done to resolve the problems with the quality of coding. 2. Identify what needs to be done to reduce the denial rate. 3. Recommend a coding quality standard. 4. Recommend standards for productivity of all types of coding (inpatient, emergency room, etc.).

To resolve the problems with the quality of coding and reduce the denial rate, as well as establish coding quality and productivity standards, several actions can be taken:  First, the quality of coding must take place, meaning that: the implementation of a comprehensive coding quality program that includes regular coding audits and feedback sessions must be done. Assign experienced coders or external auditors to review a sample of coded records for accuracy and compliance with coding guidelines. Also, I can provide ongoing training and education for coders to ensure they are up to date with coding guidelines and best practices. This can include attending workshops, webinars, and pursuing additional certifications such as Certified Coding Specialist (CCS) or Certified Professional Coder (CPC). To add, I must establish a mentoring program where the more experienced coder can mentor the recent graduate to improve their coding skills and knowledge. In sum, I can develop coding guidelines and procedures manuals that outline coding conventions, documentation requirements, and best practices. Ensure that all coders have access to and follow these guidelines consistently.  Next, action is to do a denial rate reduction here, I must conduct a root cause analysis to identify the specific reasons for claim denials. This can involve reviewing denial reports, analyzing coding errors, and interviewing staff involved in the coding and billing process. Also, addressing coding errors and deficiencies identified during the root cause analysis by providing targeted training and education to coders. Implement a coding review process prior to claim submission to ensure accuracy and completeness of coded data. This can involve a second level review by a senior coder or coding manager. In sum, I.

must collaborate with the billing department to ensure that claims are submitted accurately and timely. Improve communication and coordination between coding and billing staff to address any coding-related issues that may contribute to claim denials.  Furthermore, to recommend a coding quality standard, I must Establish a coding quality standard that outlines expectations for accuracy, completeness, and compliance with coding guidelines. Also, define metrics and benchmarks for coding quality, such as accuracy rate, coding compliance rate, and coding turnaround time. And last, I can regularly monitor and measure coding quality performance against established standards. Provide feedback to coders and recognize and reward high-performing individuals.  Last, productivity standards that I would recommend are: o Develop productivity standards for different types of coding (e.g., inpatient, outpatient, emergency room) based on industry benchmarks and organizational goals. o Consider factors such as complexity of cases, volume of records, and required documentation when setting productivity targets. o Monitor productivity performance regularly and provide support and resources to help coders meet productivity goals. Adjust productivity standards as needed to ensure they are achievable and realistic.

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In conclusion, by implementing these recommendations, the coding section can improve its quality of coding, reduce denial rates, establish coding quality and productivity standards, and ultimately enhance reimbursement and compliance with regulatory requirements.