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
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