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coding review

Question # 00673659
Subject: Business
Topic: Management
Due on: 04/16/2018
Posted On: 04/16/2018 03:35 PM

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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 two tables:

  • Variation Log by Type of Error
  • Variation Log by Coder

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. 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).

Questions:

  • Who is the best coder?
  • What is the largest area of error?
  • What is the second largest area of error?
  • What area has the least amount of error?
  • What should your plan be for the future?
  • Who will be in charge of scheduling education?
  • Will there be educational workshops for your coders? If so, what will it cover?
  • How will you reward your staff members who show great improvements?
  • How will you reward and/or recognize that your staff has made improvements overall?
  • Do you want to hire external auditors, or keep it internal?

Your Coding Team consists of:

Coding Manager (you)

1-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:

One audit was performed:

1. Coding quality review by MS-DRG

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%

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