Improving productivity starts with education
Incentives also may help with performance
Who doesn’t want to do things better? Reducing errors and completing more charts means increasing both the speed and the amount of reimbursement. But improving productivity is easier said than done.
Productivity is most often measured by how many charts per day a coder can complete accurately. "A new coder with no experience should be able to code one outpatient chart every four to five minutes, or 120 charts per day. An experienced coder should be able to code one outpatient chart every two to three minutes, or 250 per day," says Steve Verno, CMBS, compliance director for the Las Vegas-based Medical Association of Billers and director of reimbursement for Emergency Medicine Specialists, which has locations in Miami and Boca Raton, FL.
It’s not the volume, however, that is important, says Verno; it’s accuracy. "You can have a coder processing 120 charts per day, but when 30% to 40% or more of your claims are denied due to coding issues, then you have an issue."
Measuring productivity can be a positive thing for HIM managers, providing benchmark data as well as information that can point to problems. It also can create problems if misused. "Measuring productivity has a huge impact on morale," says Verno. "I’ve seen coders end up in tears when they can’t meet the productivity deadline. I’ve seen them quit in less than a day on the job. Those that can take the challenge and make it will make excellent coders."
Verno offers tips on helping to increase productivity without scaring coders off:
- Pay coders based on the number of charts coded with 100% accuracy. "Paying a coder an hourly wage holds no incentives," he says. "With an hourly wage, it doesn’t matter if you code one chart or 5,000." The disadvantage, he points out, is coders picking up the pace but losing accuracy, which will result in lost reimbursement. The other disadvantage may be that coders use codes that pay less because the coder does not want to lose time tracking down documentation that supports a higher-paying code.
- Make sure charts are documented legibly and contain all the information needed to code the chart. This may entail reminding clinicians — or even teaching them how — to provide clear and detailed documentation.
- Keep interruptions to a minimum, which includes everything from meetings to personal phone calls. Verno also suggests providing flexible schedules. "A coder can code any time, not just from 9 a.m. to 5 p.m. Consider having most of your coders work from 3 p.m. to 11 p.m. or from 11 p.m. to 7 a.m.," Verno suggests. You can have one or two coders on hand during normal business hours to handle claims denials.
- Assign points to coding. "Let’s say a completed chart with 100% accuracy pays $4. This equals 100 points. Each point is worth four cents. If a code is incorrect, take away 30 points, or $1.20. If it took six minutes to code a chart and it should have taken three minutes, take away 30 points." At the end of a specified period, coders could be awarded a bonus based on the number of points earned.
Education and beyond
There are electronic tools that can be used not only to track the volume of work being completed but also to verify coding accuracy. "A company called The Coding Edge Inc. [based in Sanford, FL] developed coding auditing software called CodePlus. Coders use it to enter CPT and ICD-9 codes, and the software checks for accuracy," says Verno.
3M Health Information Systems’ Coder Productivity Reporter provides information on a coder’s volume, number and types of codes assigned, time it takes to code a chart, and reimbursements associated with the coder.
But if the coder doesn’t know what he or she needs to know, technology will not improve performance. That’s where education comes in. There are innumerable coding seminars and conferences available to get coders up to speed on everything from ICD-9 codes to the most recent CPT codes released by the American Medical Association.
The Alpharetta, GA-based Medical Management Institute offers certifications as a registered medical coding associate, registered medical coder, and registered medical manager, as does the American Health Information Management Association (AHIMA) in Chicago. AHIMA also has accredited the Michigan Health and Hospital Association’s corporate certificate program offered in partnership with Davenport University in Grand Rapids, MI. Going a step further is BJC Health System in St. Louis, which initiated a tuition reimbursement plan for coders pursuing the associate’s degree in health information technology at two local colleges.
Even physicians seem to be taking education more seriously. "More are taking the time for training," says Kristine Eckis, CMM, CPC, president of The Bottom Line Medical Administrative Consultants in Lake Wales, FL. In addition to complaining about working more and more while receiving less and less money, Eckis says doctors are hearing horror stories related to coding errors that resulted in charges of fraud and abuse. This aggressive enforcement climate is causing physicians to be more concerned about coding correctly.
If coders aren’t self-motivated to further their education, Verno suggests giving them an incentive: Assign a pay scale based on education and experience. "A new coder would be a Coding Technician 1, the next level would be Coding Technician 2, and so on. To attain the next-higher level, the coder would be required to code X number of charts per minute and per day. Each higher level requires a certain level of education and experience."
Regardless of how you measure productivity or what tools you use to improve it, the goal is reimbursement, says Verno. "The truest test of coding productivity improvement measures is when the claim is paid."
Who doesnt want to do things better? Reducing errors and completing more charts means increasing both the speed and the amount of reimbursement. But improving productivity is easier said than done.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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