Molly, the coding supervisor of Homer General Hospital, has a problem. Her Disch
ID: 371889 • Letter: M
Question
Molly, the coding supervisor of Homer General Hospital, has a problem. Her Discharged Not Final Billed (DNFB) report is staying significantly over the limit that administration desires. She is also behind in some of the compliance monitoring that needs to be completed. Molly has been given the mandate to determine what needs to be done to bring the DNFB down and still maintain quality, as well as to keep current in the compliance monitoring.
She pulls together the information shown in Table 7-2. Analyze this situation from every angle, including but not limited to quality, legal, and management, and answer the following questions:
1. What additional information should Molly gather?
2. What are Molly’s options?
3. How can you ensure quality of coding while at the same time emphasizing volume?
4. What solution would you recommend to Molly’s problems?
Table 7-2 Analysis for Discharged Not Final Billed (DNFB)
Number of current employees
Coding supervisor
Coders (all types of charts)
Coders
1
3
1
Number of vacant positions
Volume (average per day)
Inpatient
Outpatient
Emergency room
Outpatient surgery
70
177
122
90
Productivity standards (per 8 hour day)
Inpatient
Outpatient
Emergency room
Outpatient surgery
25-28
170-185
120-125
85-100
Time currently spent on compliance issues
Hours per week
10
Time that molly feels should be dedicated to compliance to do it right
Hours per week
32
Current DNFB
$1.2 million
Desired DNFB level
$600,000
Aging
Current charts (3 day bill hold)
4-10 days old
11-21 days old
22-30 days old
More than 30 days old
35%
20%
15%
15%
15%
Number of current employees
Coding supervisor
Coders (all types of charts)
Coders
1
3
1
Number of vacant positions
Volume (average per day)
Inpatient
Outpatient
Emergency room
Outpatient surgery
70
177
122
90
Productivity standards (per 8 hour day)
Inpatient
Outpatient
Emergency room
Outpatient surgery
25-28
170-185
120-125
85-100
Time currently spent on compliance issues
Hours per week
10
Time that molly feels should be dedicated to compliance to do it right
Hours per week
32
Current DNFB
$1.2 million
Desired DNFB level
$600,000
Aging
Current charts (3 day bill hold)
4-10 days old
11-21 days old
22-30 days old
More than 30 days old
35%
20%
15%
15%
15%
Explanation / Answer
1. The additional information that Molly should gather are as follows:
• Discharge to Home or Self Care
• Discharged/Transferred to a Short Term General Hospital for Inpatient Care
• Discharged/Transferred to an Intermediate Care Facility (ICF)
• Admitted as an Inpatient to this Hospital
• Expired
• Discharged/Transferred to a Federal Hospital
2. The above information from answer number 1 can be utilized for the purpose of adding options.
• Discharge to Home or Self Care
• Discharged/Transferred to a Short Term General Hospital for Inpatient Care
• Discharged/Transferred to an Intermediate Care Facility (ICF)
• Admitted as an Inpatient to this Hospital
• Expired
• Discharged/Transferred to a Federal Hospital
3. To ensure the quality and emphasize more volume it requires concentrating on the categories which need to be added to the list. More the service is added it needs to provide good service to the enlisted items, as a supervisor of the hospital Molly should undertake an analysis about the pros and cons before adding an item to the discharged item in the list.
4. Molly should focus on the areas which she wants to put in the discharge bill. As to import new listed item in the bill she first needs to focus on the areas which she can meet to avail the best standard facility in the hospital. The analysis is required to be done by Molly to ensure the best fit in the quality and then to add in the discharge bill.
Further Added Options for the discharge bill with codes
Discharge to Home or Self Care
discharge to home; jail or law enforcement; other residential care arrangements; outpatient programs
01
Discharged/Transferred to a Short Term General Hospital for Inpatient Care
patient is discharged or transferred to a short-term acute care hospital
02
Discharged/Transferred to an Intermediate Care Facility (ICF)
transferred to a nursing facility with neither Medicare nor Medicaid certification/ discharges/transfers to state-designated Assisted Living Facilities
04
Admitted as an Inpatient to this Hospital
use only on Medicare outpatient claims
09
Expired
used only when the patient dies
20
Discharged/Transferred to a Federal Hospital
applies to discharges and transfers to a government-operated health care facility
43
Discharge to Home or Self Care
discharge to home; jail or law enforcement; other residential care arrangements; outpatient programs
01
Discharged/Transferred to a Short Term General Hospital for Inpatient Care
patient is discharged or transferred to a short-term acute care hospital
02
Discharged/Transferred to an Intermediate Care Facility (ICF)
transferred to a nursing facility with neither Medicare nor Medicaid certification/ discharges/transfers to state-designated Assisted Living Facilities
04
Admitted as an Inpatient to this Hospital
use only on Medicare outpatient claims
09
Expired
used only when the patient dies
20
Discharged/Transferred to a Federal Hospital
applies to discharges and transfers to a government-operated health care facility
43
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