The health information management team at Anywhere University Hospital (AUH) con
ID: 3068687 • Letter: T
Question
The health information management team at Anywhere University Hospital (AUH) contracted with an auditing firm to perform full assessment coding review. The results from this baseline assessment are provided in four tables:
Variation Log by Type of Error
Variation Log by Coder
Variation Log by MS-DRG
MS-DRG Relationship Assessment
You are the inpatient coding manager at AUH. Your director has asked you to develop an ongoing review and monitoring schedule for the next year based on the results from the outside review.
Include internal and external reviews, coding in-services, physician workshops, and external seminars/educational sessions that will be performed and or provided for your staff. The schedule should be specific (include volumes and/or percentages of charts to be reviewed). Keep in mind that on average it takes 18 minutes to review one inpatient chart. Budget provides for $15,000 for external reviews. The average cost for reviewing one inpatient record by an external review team is $55.00 (fully loaded).
There are 3 primary components I'm looking for in your response.
Review the results of the external audit (coder error rate, high volume/high error MS-DRGs, MS-DRG sets with greatest deviations, areas of concern identified in the audit), identify the risk areas, and determine an audit and training plan for the year. Include details on the frequency of charts to be audited by the external auditor, Coding Manager and Data Quality Auditor taking the $15,000 budget into consideration. Describe the frequency and type of education to be provided for the coders & physicians (i.e., monthly, annually, etc.).
(20 points)
Considerations:
Will the entire budget be used for external audits, split between education and audits, etc.?
How is the work to be divided between the external & internal auditors?
What MS-DRGs or focus areas are to be reviewed (refer to the external audit findings)? Possibly those identified by the external audit with greater error rates?
Will specific attention be given to the coders with higher error rates and/or new coders?
What is the plan for physician education?
What coding quality statistics (i.e., coder error rate, MS-DRG sets, etc.) should be monitored and reported to the HIM Director and Compliance? (6 points)
The data quality auditor could maintain coding quality logs similar to the ones produced by the external auditor. Monitor the same stats including coder error rate, error rate by DRG, reasons for DRG changes (Omission CC, etc.). This would make for easy comparison from month to month, quarter to quarter, and such.
The statistics should be easy for the data quality manager to maintain, perhaps in a database or spreadsheet format. The time it takes to maintain statistics should not be a significant amount of time per day.
What reward & incentive plan should be used for the coders who improve and/or consistently meet or exceed the standard of 95% compliance? (4 points)
There is not a right or wrong answer on this so be creative. Think of incentives you appreciate at current or previous positions.
Example: A coding team worked very hard to lower the “days from discharge to coding”. As a reward, the CEO/President of the hospital came to the department, shook each coder’s hand, and thanked them all for their hard work. He also expressed how important their position was to the hospital and to the patients.
Perhaps the coding manager could request that some of the budget be set aside for incentives. If the entire $15,000 is not used for external reviews, then could some of that be used for the employees?
Your Coding Team consists of:
Coding Manager (you)
Data Quality Auditor (1 FTE)
8 – Inpatient Coders (8 FTE)
2-RHIA, CCS
3-CCS
3-RHIT
Results of the full assessment coding review for AUH
Two audits were performed:
1. Coding quality review by MS-DRG
2. MS-DRG Relationship Analysis
Variation Log by Type of Error
% of errors
Inaccurate sequencing or specificity principal diagnosis, affect MS-DRG
17%
Inaccurate sequencing or specificity principal diagnosis, non affect MS-DRG
16%
Omission CC, affect MS-DRG
33%
Omission CC, non affect MS-DRG
2%
Inaccurate principal procedure, affect MS-DRG
3%
Omission procedure, affect MS-DRG
4%
More specific coding of diagnosis or procedure, non affect MS-DRG
12%
Inaccurate coding
5%
Missed diagnosis or procedure code
8%
Variation Log by Coder
Coder
Error Rate
Standard
Coder 1
3%
5%
Coder 2
9%
5%
Coder 3
8%
5%
Coder 4
2%
5%
Coder 5
4%
5%
Coder 6
16%
5%
Coder 7
12%
5%
Coder 8
3%
5%
Variation Log by MS-DRG*
MS-DRG
Volume
Error Rate
470
420
2%
313
233
14%
392
232
1%
291
232
17%
247
220
3%
292
216
5%
871
213
12%
641
209
0%
194
195
3%
293
193
1%
885
188
3%
312
177
0%
191
175
7%
287
173
2%
310
171
15%
689
157
11%
603
143
2%
379
137
3%
192
131
9%
683
116
11%
189
114
1%
069
110
2%
190
92
12%
193
87
10%
690
76
4%
065
76
5%
195
72
2%
066
52
2%
064
41
5%
906
35
2%
*MS-DRG descriptions provided below
Variation Log by MS-DRG* Set
MS-DRG Set
Hospital %
Nation %
064
24.3%
21.4%
065
45.0%
43.8%
066
30.8%
34.8%
190
23.1%
15.2%
191
44.0%
33.5%
192
32.9%
51.3%
193
24.6%
17.5%
194
55.1%
54.2%
195
20.3%
28.3%
291
34.6%
29.2%
292
36.7%
38.8%
293
28.8%
31.9%
689
67.4%
21.7%
690
32.6%
78.3%
*MS-DRG descriptions provided below
MS-DRG
MS-DRG Title (FY 2008)
064
Intracranial hemorrhage or cerebral infarction w MCC
065
Intracranial hemorrhage or cerebral infarction w CC
066
Intracranial hemorrhage or cerebral infarction w/o CC/MCC
069
Transient ischemia
189
Pulmonary edema & respiratory failure
190
Chronic obstructive pulmonary disease w MCC
191
Chronic obstructive pulmonary disease w CC
192
Chronic obstructive pulmonary disease w/o CC/MCC
193
Simple pneumonia & pleurisy w MCC
194
Simple pneumonia & pleurisy w CC
195
Simple pneumonia & pleurisy w/o CC/MCC
247
Perc cardiovasc proc w drug-eluting stent w/o MCC
287
Circulatory disorders except AMI, w card cath w/o MCC
291
Heart failure & shock w MCC
292
Heart failure & shock w CC
293
Heart failure & shock w/o CC/MCC
310
Cardiac arrhythmia & conduction disorders w/o CC/MCC
312
Syncope & collapse
313
Chest pain
379
G.I. hemorrhage w/o CC/MCC
392
Esophagitis, gastroent & misc digest disorders w/o MCC
470
Major joint replacement or reattachment of lower extremity w/o MCC
603
Cellulitis w/o MCC
641
Nutritional & misc metabolic disorders w/o MCC
683
Renal failure w CC
689
Kidney & urinary tract infections w/ MCC
690
Kidney & urinary tract infections w/o MCC
871
Septicemia w/o MV 96+ hours w MCC
885
Psychoses
906
Hand procedures for injuries
Variation Log by Type of Error
% of errors
Inaccurate sequencing or specificity principal diagnosis, affect MS-DRG
17%
Inaccurate sequencing or specificity principal diagnosis, non affect MS-DRG
16%
Omission CC, affect MS-DRG
33%
Omission CC, non affect MS-DRG
2%
Inaccurate principal procedure, affect MS-DRG
3%
Omission procedure, affect MS-DRG
4%
More specific coding of diagnosis or procedure, non affect MS-DRG
12%
Inaccurate coding
5%
Missed diagnosis or procedure code
8%
Explanation / Answer
a) The staff members who show great improvements shall be rewarded as per they deserve. They will be given some bonus and incentives. Some of them who perform extraordinarily would be given promotion in order to encourage them.
b) The quality of their work will be checked thoroughly throughout the entire project in order to recognize the improvements in their work and they will be compensated depending on their level of improvement.
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