Case Study: Coding Quality Improvement Plan for Healthcare Facility Acquisition
As healthcare organizations strive for continuous efficiency and sustainability, merging and acquiring (M&A) diverse medical facilities provides organizations with new opportunities to reduce costs and generate a larger footprint in current, and even new markets. As an HIM and Coding consulting company, YES has encountered several opportunities to implement auditing, coding, and education improvement plans in these specific scenarios. This case study summary provides an analysis on the unique challenges a medical facility faces when merging with independent practices (I.E. the impact on overall medical coding quality, turnover rate, and productivity), and the solutions we have crafted to be implemented for maximum results. In addition, an included overview of the impact of these solutions presented to a facility and practiced over a 21-month period.
The solution we’ve proposed is one that can be achieved through implementing the four key objectives of our Coding Quality Improvement Plan:
– Identifying the significant pain points impacting coding quality, resulting from a
healthcare facility acquiring a large physician group
– Creating and conducting a coding quality improvement program
– Capturing comparison data & analyzing the solution’s impact on overall coding quality
– Providing recommendations for future programs and addressing similar challenges
Overall, the implementation of a Coding Quality Improvement Plan for a merger and acquisition scenario for a period of 21 months, yielded the following results:
ProFee coding accuracy increase at a constantly growing rate: ProFee coders increased coding accuracy by 14.33% in a 21-month period for CPT (1Q17 vs. 3Q18). For DX coding, ProFee coders increased accuracy by 16.41% in the same period. Coder turnover decreased while constantly increasing coder accuracy.
Successful transition of complex encounters to YES team while maintaining a higher accuracy rate in CPT and DX: The YES team consistently performed with a higher accuracy rate in CPT and DX in regards to the overall ProFee coding program and the physician group ProFee coders.
Coder turnover decreased while constantly increasing coder accuracy: Quality Audits are performed per ProFee coder. As the first Quality Audit results were presented in 2Q17, coder retention decreased by over 30%, which resulted in a needed shift in physician group coding personnel in order to continuously increase accuracy and achieve a 100% retention rate by 3Q18.
To conclude, this case study highlights the best approach to address these challenges: assess and develop a plan, with a holistic approach that positively impacts coding quality on an enterprise level. This approach requires an objective team with higher accuracy rates, higher level of expertise in the ProFee field, and proven experience in coder mentoring.