Wiki Setting Compliance & Productivity Standards

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lisashernandez

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Local Chapter Officer
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Gainesville, Georgia
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We are in the process of writing a complaince plan and I'm needing some help on setting standards.

We have about 90 providers - some do their own coding, some circle E/M levels on a fee ticket and write the dx and the coder applies the correct ICD-9 and some providers have coders that do all of their coding. So we have several standards that we need to set and we are looking to split the coders up into several different groups based on some accuracy, productivity, ambition, attitude measures (beginner, intermediate, expert).

#1. Provider Coding Audits: What are the standards that you use to grade providers? I know the OIG says 95% but everyone would be on 100% review so we are looking to take some toddler steps.

Example: 50% coding error or more = 100% audit
49% - 40% = Monthly audit
39% - 20% = Quarterly audit
19% - 10% = Bi-annual audit
9% - 0% = Annual audit

Believe me I don't like the idea that 10 out of a 100 charts have some error but again....toddler steps...... :)


#2. Coder Audits: We want three different levels of accuracy rates. (I just don't want to be too harsh so I'm soliciting advice) Obviously we want 100% accuracy but what is actually fair to expect for 100 charts. Do you look at procedure and ICD-9 error together or do you separate them out?

#3. Productivity:
a. Someone who codes almost strictly from fee tickets for a family med/internal med practice
b. Someone who codes 100% of office visits for a general surgery group

And finally #4. Has anyone done a workflow analysis on their coding staff to see how long it takes to code for the average provider? We are trying to make this as easy on the coders to keep track so it doesn't disrupt their daily workflow. Do you just ask for the time it takes to code a batch of tickets for a couple of weeks and average it out?

Any and all answers are appreciated!!!!!

Thanks,
Lisa
 
I just have to say something here regarding the coders coding off of a fee ticket. A fee ticket (superbill) is NOT a part of the medical record and coding off of one can lead to MANY problems. I, personally, would NEVER code off of a fee ticket. Besides, that is data entry and not coding.
 
Yes, I would agree with you 100% but we are just starting the process of certifying staff to start taking over coding everything completely by dictation. We still call them coders even if some of them technically do mostly charge entry because they do handle some providers that are coded strictly by dictation.

There are many facilities that make their providers 100% responsible for coding their office E/M's and diagnosis and then they are audited and educated based on their audit results. These tickets are then entered by a charge poster.

That being said we have 80% of providers who have been doing things a certain way so we cannot shell-shock all of them at once.....even though I'd rather just rip the band-aid off, it's not the popular way to do things.

Thanks,
Lisa
 
At the HCCA COmpliance Academy in Orlando this year it was pointed out that the 'acceptable' error rate used to be 10% as published in guidance by the OIG, but now they are saying 5%. The percentage applies to either coding or revenue.

Pretty strict, but compatable with their stated goal in reducing error rates.

We have a requirement that providers with 79% or less on the review (coding only) then the provider has to undergo documented coding/documentation education by a certified coder.

We will change the percentages next year to be more compatable with the OIG guidance.
 
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