Discharge-to-bill drop time is 24 to 48 hours
Coders visit nursing units to stay abreast of bills
Without a timely billing process, health care systems face a a faltering revenue stream. Yet days or even weeks after the patient is discharged often pass before the bill is sent. Not at Kosair Children's Hospital, part of the Alliant Health System in Louisville, KY, where six coders process an average of 10,000 charts a month. The 972-bed system outperformed its benchmarking peers with an average discharge-to-bill drop time of 24 to 48 hours, says Sharon Lau, consultant with Medical Management Planning in charge of BENCHmarking Effort for Networking Children's Hospitals, or BENCH. (See graphs comparing peer benchmarking results, pp. 78-79.)
"This drop time is less than half of the next best performer among our children's hospitals, and it even beats the best performer from our database of adult hospitals," Lau says. "Alliant's consistency on this measure is also notable - they've turned in this same performance for the past year."
Debby Ratterman, RRA, director of health information management at Alliant explains why it's critical for facilities to drop the bill as soon as possible. "The goal is to reduce your AR [accounts receivable] days, because the longer an account goes unbilled, the more it costs the hospital for every AR day on each account."
The secret, she explains, is to have as much documentation as possible accurately completed before the patient is discharged. But that demands accountability and teamwork, she says. For example, Alliant coders aren't isolated in their department but are "actively involved with case management to stay on top of the workload," says Ratterman.
Each coder, who is assigned a specific nursing unit, visits the unit within 24 hours of a new admission to review the chart and note the DRG on a special form in the chart, explains Jennifer Blackwell, RRA, health information manager. "Every 48 hours - more often if there is a drastic change in the patient's condition - the coder reevaluates the DRG and updates the form as needed," she says.
In addition to the coders, four RN specialists are assigned to review charts to make sure documentation is complete. "If there are any questions about the documentation, the specialists question the physician. By coordinating clinical experience with coding expertise, coders don't have to wait until the charts are in their department to second-guess physician documentation," Ratterman says.
Coders also track the DNFB, or the discharges not final billed. "Most hospitals monitor this information, but not always in a timely manner. We get it every day because it helps us to pinpoint where we need to concentrate our efforts and what charts we need to go after.
In the pressure to drop the bill, little things can add up. For example, in many other facilities, she points out, coders don't code if the chart is not assembled. "But here we do."
Accountability, teamwork needed
To perform consistently at such a high benchmark, efficiency is not the only requirement. "Accountability and teamwork are a must," Ratterman stresses. For example, the coders divide charts among themselves according to the terminal digits, rather than processing at random as the charts arrive. "This way, we can look immediately at those numbers and tell who is behind because we know who is responsible for terminal digits. Then we can go to that person and find out why he or she is behind. The process increases accountability."
Coders also work together to take ownership of the job. "If someone is out, all the other coders divide the terminal digits and help each other," she says. "It's not as if we say, `These are my numbers; when I'm finished, I can go home.' We have a feeling of ownership for our charts and our jobs."
The department has a weekly deadline. "By the time they leave on Friday, they must be caught up through at least the discharges from Wednesday," Blackwell says.
At Alliant, Ratterman says, coders are salaried rather than hourly employees. "This allows for flexible scheduling, which they set themselves. They know what must be done because of the system of terminal code assignments. And because they are salaried, they are allowed to do it when it is best for them. The accountably, together with the deadlines and the coders' job loyalty and ownership, makes the salaried option work."
For more information, contact Debby Ratterman, Alliant Health System, P.O. Box 35070, Louisville, KY 40232-5070. Telephone: (502) 629-7319.
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