Case Study: Coding Quality Improvement Plan for Healthcare Facility Acquisition of a Large Physician Group

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. YES has encountered several opportunities to implement auditing, coding, and education quality 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 impact overview of these solutions was presented to a facility and practiced over a 21-month period.

Our Solutions

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

The Plan in Action

Overall, the implementation of a Coding Quality Improvement Plan over 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 decreases while constantly increasing coder accuracy. We perform Quality Audits per ProFee coder. As the first Quality Audit results were presented in 2Q17, coder retention decreased by over 30%. Resulting 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.

If you’re ready to implement these strategies at your organization, or need help developing a custom plan, contact YES today! Our team of skilled coding and auditing consultants is ready to help you!

ProFee Coding

YES HIM Consulting

Coding Quality Improvement Plan

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