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 33-month period.
Our Solutions Increase Coding Quality
The solution we’ve proposed is one that can be achieved through implementing the four key objectives of our Coding Quality Improvement Plan:
- Identify the significant pain points impacting coding quality, resulting from a healthcare facility acquiring a large physician group
- Create and conducting a coding quality improvement program
- Capture comparison data & analyzing the solution’s impact on overall coding quality
- Provide recommendations for future programs and addressing similar challenges
See Our Coding Quality Improvement Plan in Action
Overall, the implementation of a Coding Quality Improvement Plan over 33 months, yielded the following results:
ProFee coding accuracy increase at a constantly growing rate. ProFee coders increased coding accuracy by 16.92% in a 33-month period for CPT (1QY1 vs. 3QY3). For DX coding, ProFee coders increased accuracy by 17.65% 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. Physician group coders increased CPT accuracy rates by 16.54% and DX accuracy rates by 15.91% over 33 months. YES Coders remained the leaders in accuracy rates for CPT and DX (1.7% and 6% more accurate respectively, between 1QY1-3QY3), reaching 100% accuracy rates (CPT) in 3QY2 and maintaining this level of accuracy for a full year.
Coder turnover reached 0% while constantly increasing coder accuracy. We perform Quality Audits per ProFee coder. As the first Quality Audit results were presented in 2QY1, 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 3QY2. A turnover rate of 0% has been maintained for a full year. No coders have left since 2QY3, and a new coder was added to the team in 3QY3.
Ready to Try Our Coding Quality Improvement Plan at Your Facility?
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.
We provide the full case study on the facility acquisition process to clients, partners, and upon request. To request access to the full case study, please send your name, company, and contact information to info@yes-himconsulting.com. Review our ProFee Coding Solutions page for information on how YES can help your facility.
