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Never before has coding has been so crucial to the financial stability of an organization. As the Office of the Inspector General in Washington, DC, focuses on certain coding practices, health information management professionals are feeling the need to institute coding compliance and education programs.
Ray Pinder, MS, RHIA, has worked with several such programs in his 25 years of being a medical records director. Now, as director of medical records services at Holy Redeemer Hospital and Medical Center in Meadowbrook, PA, he has made it a priority to enhance the coding compliance and education program at his new facility.
"It’s important that as a manager, I know the coding quality of my department in case I am questioned by my chief financial officer or chief executive officer on why our case mix index may be going up or down," he says. He needs to know, for example, if any changes in the case mix are significant or just due to a different patient volume that month.
Pinder began setting up the health information management program at Holy Redeemer with the blessing of Don Friel, Holy Redeemer’s senior vice president and chief information officer, to whom Pinder reports. First of all, Pinder knew the program needed the assistance of a coding specialist. "I have a strong background in reimbursement methodologies, but coding is not my daily function," he says.
At the end of April, Pinder hired a coding manager to run and enhance the coding compliance and education program and to support the coding staff at Holy Redeemer. The manager, Margaret Giancaterino, RHIT, has more than 20 years of coding experience.
As a new director coming into the facility, Pinder had already discussed with Friel the need to have a baseline study conducted by an external auditing company. "We needed to evaluate the quality of our coding in comparison with external regional and national data," Pinder explains.
Friel had wanted to do such an audit for some time, Pinder says. "Prior to my coming on board, we started talking about the vendors we would [consider]."
To decide among vendors for the baseline review, Pinder pulled from resources that he had used at his previous organization. He then asked for price quotes from the vendors, which he and Friel reviewed. "I made recommendations based on my knowledge of the companies," Pinder says.
The vendor chosen for the audit reviewed three months’ data covering all inpatient admissions and outpatient visits. The data were provided by Holy Redeemer’s information systems department. When the vendor ran the data through its system, it made a random selection of 100 records on each side. "We used that as our sample size, and it was above 5%. It was a good sample size for the study," Pinder says.
This first review took place within three months of Pinder’s employment at Holy Redeemer. The final report, which was submitted to senior management as well as to Pinder, demonstrated that the coding at the facility was well within the national average, Pinder says. "We were informed that the ranges go anywhere from 92% to about 98% for accuracy in coding. We were in a 95% to 96% range."
When Holy Redeemer received the results of the audit report, Pinder and Friel sat down with their coders — three full-time and three part-time employees — and reviewed the results with them. "We wanted them to know that they did well in the external review," Pinder says.
The report offered recommendations, because the audit looked at documentation as well as coding. The reviewers broke their comments about documentation into two categories of problems: The coders made errors because they missed documentation that was present, or the documentation was lacking in the first place.
"If the coders missed documentation that was present, we alerted them and put a reminder notice in each of their mailboxes, telling them to look for a certain report [in the record]," Pinder says. "Our coding staff reviewed the audited results and were given the opportunity to dispute cases based on coding guidelines."
If documentation was lacking, Pinder worked with Holy Redeemer’s medical director to provide feedback to the medical staff. This feedback was provided either through a newsletter or by the medical director or Pinder going to the medical staff’s monthly departmental meetings and giving a documentation update.
Pinder and his coding manager then developed their own coding quality review. On a monthly basis, Giancaterino will review a sample of each coder’s work for accuracy and complete the chart review to determine whether all the codes were properly identified. "If any were not, our work tool for both inpatient and outpatient [coding] would document the variances," Pinder says. These tools handle the different types of questions related to diagnosis-related groups and ambulatory classification payments.
Those worksheets are then tabulated, and the coders have an individual monthly review of their coding quality. If problems are found that seem to happen across the board, Pinder and Giancaterino have a general discussion during their monthly coders’ meeting about how these patterns can be corrected.
Pinder presents a quarterly summary of this report to the hospital quality performance committee. He will also use the monthly and quarterly reports to supplement the department’s annual evaluation for coding accuracy, quality, and productivity. Although the department does have a productivity standard, it is not the most important indicator, he says. "Quality is first and foremost over productivity."
(Editor’s note: Next month, Pinder addresses the education component of his coding compliance and education program and how his program will affect the entire Holy Redeemer Health System.)