Molly, the coding supervisor of Homer General Hospital, has a problem. Her Disch
ID: 123002 • Letter: M
Question
Molly, the coding supervisor of Homer General Hospital, has a problem. Her Discharged Not Final Billed (DNFB) report is staying significantly over the limit that administration desires. She is also behind in some of the compliance monitoring that needs to be completed. Molly has been given the mandate to determine what needs to be done to bring the DNFB down and still maintain quality, as well as keep current in the compliance monitoring. She pulled together the information shown in the table below. Analyze this situation from every aspect, including but not limited to quality, legal, and management, and answer the following questions:
1. What additional information should Molly gather?
2. What are Molly's options?
3. How can you ensure quality of coding while at the same time emphasizing volume?
4.What would you recommend to solve Molly's problems?
Data Table
Analysis for Discharged Not Final Billed (DNFB)
Number of current employees
Coding supervisor
1
Coders (all types of charts)
3
Number of vacant positions
Coders
1
Volume (average per day)
Inpatient
70
Outpatient
177
Emergency Room
122
Outpatient Surgery
90
Productivity Standards
(per 8-hour day)
Inpatient
25-28
Outpatient
170-185
ER
120-125
Outpatient Surgery
85-100
Amount of time currently spent on compliance issues
Hours per week
10
Amount of time that Molly feels should be dedicated to compliance to do it right
Hours per week
32
Current DNFB
$1.2 million
Desired DNFB level
$600,000
Aging
Current charts (3-day bill hold)
35%
4-10 days old
20%
11-21 days old
15%
22-30 days old
15%
More than 30 days old
10%
Number of current employees
Coding supervisor
1
Coders (all types of charts)
3
Number of vacant positions
Coders
1
Volume (average per day)
Inpatient
70
Outpatient
177
Emergency Room
122
Outpatient Surgery
90
Productivity Standards
(per 8-hour day)
Inpatient
25-28
Outpatient
170-185
ER
120-125
Outpatient Surgery
85-100
Amount of time currently spent on compliance issues
Hours per week
10
Amount of time that Molly feels should be dedicated to compliance to do it right
Hours per week
32
Current DNFB
$1.2 million
Desired DNFB level
$600,000
Aging
Current charts (3-day bill hold)
35%
4-10 days old
20%
11-21 days old
15%
22-30 days old
15%
More than 30 days old
10%
Explanation / Answer
1. What additional information should Molly gather?
Information about Not coded records.
Number of records processed daily
Track the records processed by:
Error reports and claim denials
2. What are Molly's options?
Ask the management to fill the vacant position of the coder.
Ask the coders to speed up coding cycle
Communicate with all departments and get records faster
Identify missing information before the process coding begins
Monitor error reports and claim denials
3. How can you ensure quality of coding while at the same time emphasizing volume?
Educate clinical and coding staff about recurring errors.
Ensure coders, clinicians, and administrative staff double-check their work. Reviewing a file for errors can save significant time and money in the long run.
Check every code in an invalid code denial claim to locate the culprit
Make a list of invalid code denials and share them with your coding staff
Check the codes in the drop-down menus of your database to ensure that they are complete, accurate, and up-to-date.
4. What would you recommend to solve Molly's problems?
Molly can strictly monitor and audit coders to prevent revenue loss
Molly can educate coders on the scope of the problem
Communicate with clinical staff and ask them to update on common inaccuracies in medical records, regularly omitted information and other clinical habits that can hinder coding efficiency and accuracy
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