Briefing: Managing a Successful Coding Program
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Briefing: Managing a Successful Coding Program Date:20 March 2007 Time:1010 - 1100. Objectives. By the end of the class, the students will Learn what compliance plans contain Know how to develop methods of overseeing the coding Provide clinicians a feedback loop. Compliance Plan.

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Briefing: Managing a Successful Coding Program Date:20 March 2007 Time:1010 - 1100

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Briefing managing a successful coding program date 20 march 2007 time 1010 1100

Briefing: Managing a Successful Coding Program

Date:20 March 2007

Time:1010 - 1100


Objectives

Objectives

  • By the end of the class, the students will

    • Learn what compliance plans contain

    • Know how to develop methods of overseeing the coding

    • Provide clinicians a feedback loop


Compliance plan

Compliance Plan

  • Before you can manage a coding program, you need to insure that you have a compliance plan.

  • All staff should know the plan, what is required of them, and what assistance is available to them.


Questions

Questions

  • What?

  • When?

  • Where?

  • Why?

  • Who?

  • How?


Briefing managing a successful coding program date 20 march 2007 time 1010 1100

What?

All facility types

  • Facility

    • Inpatient

    • APV

    • Emergency Room *

  • Professional

    • Inpatient

    • APV

    • Outpatient


Briefing managing a successful coding program date 20 march 2007 time 1010 1100

When?

  • Daily

  • Weekly

  • Monthly

  • Quarterly

  • Constantly


Where

Where?

  • Coders

    • Onsite

    • Offsite

    • Remote

  • Clinicians and provider coders


Briefing managing a successful coding program date 20 march 2007 time 1010 1100

Why?

  • Coding accuracy

    • Workload reporting

    • RVU capture is optimized

  • Cost comparison with network providers

    • Are we providing services in-house cost effectively?

    • Can we provide services more effectively than the network providers can?


Briefing managing a successful coding program date 20 march 2007 time 1010 1100

Who?

  • Clinical staff

    • Independent licensed providers

    • Support staff

      • Registered nurses

      • Corpsmen

      • Techs

  • Coders

    • Non-certified

    • Certified


Briefing managing a successful coding program date 20 march 2007 time 1010 1100

How?

  • Baseline:

    • Audits

    • Reports

  • Ongoing

    • Education

    • Audits

    • Reports


Elements of compliance plan

Elements of Compliance Plan

  • Coding compliance policy statement

  • Ethical coding

    • Code of conduct

    • Confidentiality statement

  • References

  • Training and education

    • Clinical documentation training record

    • Schedule for each coder type

  • Coding audit plan

  • Data quality management control compliance

    • Corrective action

    • Command notification

  • Clinical documentation requirements

  • Personnel responsible for coding compliance


New patient bell curves

New Patient Bell Curves


Established patient bell curve

Established Patient Bell Curve


Briefing managing a successful coding program date 20 march 2007 time 1010 1100

Who?

  • GS Coders

  • Contract Coders


Briefing managing a successful coding program date 20 march 2007 time 1010 1100

What?

  • MEPRS

  • Location

  • Site of service

  • Provider


Briefing managing a successful coding program date 20 march 2007 time 1010 1100

When?

  • What time period?

    • Daily

    • Weekly

    • Monthly


Where1

Where?

  • Location

  • MEPRS

  • Site of Service


Briefing managing a successful coding program date 20 march 2007 time 1010 1100

Why?

  • ICD-9-CM Diagnoses

  • ICD-9 Procedures

  • E/M

  • HCPCS

  • What is the purpose of the audit?

    • Accuracy of codes?

    • Accuracy of provider documentation?


Briefing managing a successful coding program date 20 march 2007 time 1010 1100

How?

  • Audits using CCE data

  • Information from M2

  • Trends using bell curves

  • Trends using PEPPER

  • Information from productivity reports


Best practices

Best Practices?

  • What is your best practice?

  • Is there one single process that makes the accuracy better than before?


Briefing managing a successful coding program date 20 march 2007 time 1010 1100

QUIZ

  • 1 – Name two elements of a compliance plan

    a

    b

  • 2 – What computer program(s) can the coding program manager use to identify a provider who is overcoding?

  • 3 – What process or document is available to assist a staff member who has been identified as being out of compliance with coding standards?

  • 4 – The coding staff should always work out documentation and coding issues with the local command. T/F


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