When comparing productivity it is often best to average the performance of a coder over a period of time. It could be one week or a month but determining the definition for a time period is
We have reviewed coding and CDI and now we will look at coding productivity to get an idea of a coder’s day.
Fill in the blanks below after calculating the answers.
Bed Size: 300-bed facility, with a variety of services
Downtime: 1 hour per day (two 15 minute breaks and one 30 minute non coding period)
Time Standard: 4 records per hour (or one every 15 minutes) excluding obstetrics and newborns which take less time
Work Day: Coder works an 8-hour shift with 30 minutes for lunch or 8.5 hours total
1) Total productive hours available: ____ hours per day or ____ hours per week
2) Total records to be coded: ____ x _____ = ______ records per day or ______ records a week
3) Actual records coded: 135
4) Coder individual productivity: 135/_______ = ______ % (percent) – productivity rate for the week
(135 records divided by expected hours XXX equals a percentage rate for the week)
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Averaging
When comparing productivity it is often best to average the performance of a coder over a period of time. It could be one week or a month but determining the definition for a time period is important when striving for consistency in applying standards. Everyone has good days in which they seem to be very productive and can accomplish many things, and everyone has days in which they can’t seem to accomplish anything. The coding manager/supervisor should determine a standard time frame and remain consistent.
It is also important to communicate the time period to the coding professional. If a coding professional knows that at the end of each week they should be coding a specific number of charts, it may not be overwhelming if they do not meet the production rate on a specific day of the week.
If a coding supervisor or manager has reviewed a coder’s productivity weekly for a month and the coder has not met the predefined productivity standard it may trigger a face to face meeting with the coder to determine what the issues are. Was the coder out of the office on vacation? Did a new coding change contribute to the decrease? Was the coder training or mentoring a new coder? Was the coder burdened with all of the high dollar/longer stay charts? It is important for a supervisor or manager to recognize these variances in productivity and address them as necessary.
Part 2 – Improper Payment Review Analysis (8pts)
Visit the Medicare CERT homepage (link below). Locate the most recent CERT annual report. Locate the section titled: Projected Improper Payments and Type of Error by Type of Service for Each Claim Type.
Make a Word document, cite references.
Identify the top issue for the following claim types: Part B, DMEPOS, Part A excluding Inpatient Hospital PPS and Part A Inpatient Hospital PPS.
For each claim type, identify the top issue (for Part A Inpatient Hospital PPS identify the top clinical area).
For each top issue identify the payment implication, the error rate, and the most significant error type.
After reviewing the statistics, discuss what providers and facilities should do to improve their performance.
Additionally, use the CERT annual report to define the five major error categories and explain each and what can be done to resolve these.
2.1 – No Documentation
2.2 – Insufficient Documentation
2.3 – Medical Necessity
2.4 – Incorrect Coding
2.5 – Other
The CERT homepage can be found at:
https://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Medicare-FFS-Compliance-Programs/CERT/index.html?redirect=/certLinks to an external site.
Directions on the CMS cite: The link takes you to CMS, next in the left menu click on CERT Reports. Next click on the 2019 Medicare Fee for Service Supplemental Improper Payments Data and download that report. In the report, go to page 4 and see Appendix D. Click to open it and use each table in Appendix D that applies to an answer for the questions above.
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