Case Study: Coding Quality Improvement Plan for Healthcare Facility Acquisition Process of a Large Physician Group
As healthcare organizations strive for continuous efficiency and sustainability, merging and acquiring (M&A) diverse medical facilities and developing an efficient facility acquisition process provide organizations new opportunities to reduce costs and generate a larger footprint in current, and even new markets. The Health Services sector has seen more than 1,000 deals per year since 2016. Excluding megadeals in both 2018 and 2019, total deal value increased by 77%, with Q4 2019 representing the largest quarter in at least five years. A new report from PricewaterhouseCoopers (PwC) US indicates in its Health Services Deals Insights: Year-end 2019 that even though deals are becoming more expensive, deal activity is likely to continue given capital availability, cross-industry alliances, and continuing trends. These continuing trends include regulatory uncertainty, reimbursement pressure, and increased focus on the consumer, impacting the market on a long-term basis.
We provide the full case study to clients, partners, and upon request. To request access to the full case study, please send your name, company, and contact information to email@example.com. Review our ProFee Coding Solutions page for information on how YES can help your facility. You can also review an Executive Summary of the Case Study Findings.
Challenges of Coding Quality Improvement
Healthcare facilities and independent practices face unique challenges when merging or facing acquisition. As an HIM and Coding consulting company, YES has encountered several opportunities to implement auditing, coding, and education improvement plans in similar scenarios. This case study provides a thorough analysis on the unique challenges a medical facility faces when merging with independent practices. Challenges impact overall medical coding quality, turnover rate, productivity and the bottom line. The analysis covers the solutions implemented, and an overview of the impact these presented to a facility, practiced over a 33-month period.
Implement these 4 key objectives of the Coding Quality Improvement Plan for a successful acquisition and transition:
- Identify significant pain points impacting coding quality, resulting from a healthcare facility acquiring a large physician group.
- Create and implement a coding quality improvement program.
- Capture comparison data and analyze solution’s impact on overall coding quality.
- Provide recommendations for future programs addressing similar challenges.
Results of the Coding Quality Improvement Plan
After 33 months, the Coding Quality Improvement Plan yielded the following results:
ProFee coding accuracy increased at a constantly growing rate. ProFee coders increased coding accuracy by 16.92% in a 33-month period for CPT (1Q17 vs. 3Q19). For DX coding, ProFee coders increased accuracy by 17.65% in the same period.
Successful transition of complex encounters to YES Team while maintaining a higher accuracy rate in CPT and DX. 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 1Q19-3Q19), reaching 100% accuracy rates (CPT) in 3Q18 and maintaining this level of accuracy for a full year.
Coder turnover reached 0% while coder accuracy continually increased. 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. A turnover rate of 0% has been maintained for a full year. No coders have left since 2Q18, and a new coder was added to the team in 3Q19.
To conclude, this case study highlights the best approach to address these challenges. That is: 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 firstname.lastname@example.org. Review our ProFee Coding Solutions page for information on how YES can help your facility. You can also review an Executive Summary of the Case Study Findings.