Wiki Practice Standards

[rhirst28]

Hi,
Is anyone aware of any available research on standards for the ratio of coders to providers? We are a growing specialty hospital and we have abstract coders who code E/M, family medicine, radiology, and outpatient and inpatient surgeries for a variety of specialties. Any advice would be much appreciated!

 

[csperoni]

In my opinion, there are a lot of factors that could impact that ratio. Some of them include:
1) Productivity levels of the providers involved. Some providers see 65+ patients per day. Others max out at 20.
2) Specialty. For example, coding 20 chest xrays would be expected to be much faster than coding 20 complex orthopedic surgeries.
3) Level of coding required. Are the coders coding CPT and ICD10 from scratch? Or are they just scrubbing what the provider coded?
4) Computer systems and integration. Do the coders have to search for the op note in one system, the pathology in another, then enter the charges into a third? Expect that to take longer than one fully integrated system.
5) Other work. What other work do your coders perform? Provider education? Given continuing education time? Is your organization very meeting centric? Any billing responsibilities?
6) Work hours. I have seen full time in organizations range from 35-40 hours. Particularly once you extrapolate that to dozens of coders, 5 hours less or more per week of work per coder makes a difference.
7) Experience level. An entry level CPC-A would not be expected to be as productive as a lead coder with 10 years experience in that specialty.

To me, more than a ratio of coders to providers is to have some type of productivity expectations for your coders. For E&M services, I would expect ballpark of 10-12 per hour. In my organization for hospital E&M, I expect abut 8/hr since they need to maneuver several computer systems to do this. Surgeries about 5-6 per hour. Keeping in mind other responsibilities, allot time each day for emails, meetings, etc. I also like to keep my coders assigned to a specific specialty and/or group of providers. You can definitely build up speed when you are more familiar with common codes in a particular specialty.

I would run productivity reports on your current coding employees and then set the expectation somewhere near the middle.

 

[amyjph]

That is great advice above. I would also suggest doing a search in the forums for words like benchmark, production, ratio, etc.

There was a discussion here which was somewhat related. However, the links would probably help.

https://www.aapc.com/discuss/threads/coding-benchmarks.189988/?view=date#post-520157

 

[TThivierge]

Hi Rhirst28,
Please read the advice of those coding expert above from amyjph and csperoni...those folks ROCK in medical coding knowledge !! However worked as coder many places due to relocation and military marriage. In one hospital each coder assigned 8 providers then coded each inpatient, and outpatient claims for them, sent a weekly email if noticed errors or auditing mistakes to providers, then once a week did catchup on training & aiding billing clerks questions on notations. Plus answering pt. phone calls every 2 weeks for one day. Once a year had luncheon met providers and their staff to aid communication. We were expected to do 70-100 claims per day .The OP claims were easy to abstract cause documentation was great. Inpatient coding took bit more time. Coders got audited every 90 -180 days by inside auditor to ensure high 90-95% accuracy. Another work site each coder assigned certain medical specialty & their providers,(coded ancillary OP & IP records associated with these docs) then traded with other coders every 3 years. Also this helped keep line of communication opened as team between coders. The monthly meetings every month with department head and coding supervisor.
I hope this data helped you! Have a great day!
Lady T

 

[rhirst28]

Thank you everyone for your replies! Currently we run productivity, and audits, and assign coders based on need/ skill. I'm just researching to see if there is another standard, or another recommendation- to keep up with deadlines, and to measure the amount of full time staff needed. Almost all of our staff is full time. Great advice! If there's more- keep it coming!