Coding Productivity & Audit. Laura Dornsife Director, Coding & Revenue Cycle Support

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1 Coding Productivity & Audit Laura Dornsife Director, Coding & Revenue Cycle Support

2 2

3 Ohio State University Wexner Medical Center University Hospital Ross Heart Hospital James University Hospital East Brain & Spine Hospital Opens Fall 2016 Ohio State University Physicians, Inc.

4 4 Medical Center Research

5 5 Ohio State College of Medicine

Improving People s Lives Through Innovation in Safety and Quality in Research, Education and Patient Care University Hospital The Ohio State University Ohio State s Wexner Medical Center Faculty

6 Improving People s Lives Through Innovation in Safety and Quality in Research, Education and Patient Care University Hospital The Ohio State University Ohio State s Wexner Medical Center Faculty Group Practice OSUCCC James Cancer Hospital University Hospital East Ohio State Harding Hospital Ross Heart Hospital College of Medicine Primary Care Network OSU Rehabilitation Services at Dodd Hall 6

7 Statistics (FY2016) o 58,211 patient admissions o 4,882 births o 1,664,152 outpatient visits o 125,327 emergency department visits o 15,951 inpatient surgeries / 25,000 outpatient surgeries o 1,600 physicians & providers o $1.1B annual professional charges 7

8 OSU Physicians FGP Background o OSUP Business Office Centralization 7/2013 o EPIC PB/SBO Conversion go-live (V2014) in 7/2014 o Plugged-in to existing Institutional Ambulatory, Inpatient, HB, Cadence, Prelude, etc. environment o Upgraded to EPIC V2015 in 5/2016 8

9 Integration Opportunities o Multiple coding areas, along with stand-alone Department Coders o Various practices and procedures among specialties o Workflows and policies varied across coding groups o ICD10 9

10 Organizational Chart: Pre- Integration 10 Department Administrator #1 Certified Coder Department Administrator #2 Certified Coder Department Administrator #3 Certified Coder Department Administrator #4 Certified Coder Department Administrator #5 Certified Coder Department Administrator #6 Certified Coder Department Administrator #7 Certified Coder Internal Medicine Coding Team Surgery Coding Team Corporate Coder Specialty Care Network Coding Team

11 Integrated Structure: Fall 2013 o Create consistent product & standardize support o Develop coding policies and processes o More effective resource alignment o Team approach to physician support with Compliance o Improve workflow & professional charging automation 11

12 Organizational Chart: Post Integration Sr. Director, Physician Compliance, Risk Mgmt. & Coding RCS Project Manager Director, Coding & Revenue Cycle Support Project Analyst(s) Coding Assistant(s) Coding Manager Coding Manager Coding Manager Coding Manager Lead Coder Certified Coders Lead Coder Certified Coders Lead Coder Certified Coders Lead Coder Certified Coders 12 *Director and Coding Managers have indirect reporting relationships to all respective Chairs and Department Administrators.

13 Timeline Coding Department Integration 7/1/13 EPIC PB Migration 7/1/14 Productivity & Audit Plan 7/1/ Jul Nov 2014 Jul Nov 2015 Jul Nov 2016 EPIC "Clinical Cutover" 4/1/14 PB Stabilization & Optimization 1/1/15 13

14 Productivity & Audit Plan o Electronic Productivity Measurement o Relevant and Random Audit Sampling o Implementation July 2015: 1 Year posttransition to EPIC Professional Billing (PB) o Preparation for ICD10 Transition & Impact 14

15 15 Operations Meets IT

16 The Productivity Project Team o Revenue Cycle Support Project Manager o Coding Manager(s) o IT Analyst(s) o Reporting Analyst(s) o EPIC Professional Technical Support (TS) 16

17 The Process o Determine how work effort will be measured o Consistent per User & System Action o Data analysis to consistently measure work effort o Equity among both like work & work type o Determine frequency to correlate hours worked and corresponding activity 17

18 Data Analysis o Workflows o Coding Type o Complexity differences in work assignments 18

19 Payroll Worked Hours Coder Actions Data Analysis Productivity Outcome 19

20 Productivity Summary Coder Productivity Reporting Period May-16 Staff/ Hours Charge Entry (Includes Surgeon Coding WQ) Charge Review Follow-Up (Includes PAU, Claim Edit, RTP) Coding Staff Manager Hours Worked Productive Time (80%) Chg Entry Work % Chg Entry Hours Session Review Total Prod/Hour Charge Review Work % Chg Review Hours Session Review Total Prod/Hour Follow Up Work % Follow- Up Hours Session Review Total Prod/Hour Coder, Sally KW % % % Coder, Tom KW % % % Coder, Bob BM % % % Coder, Sue LD % % % Coder, Millie KM % % % Coder, Jason LM % % % Coder, Suzie KM % % %

21 Summary: Surgical & Procedural Activity Coder Productivity Reporting Period May-16 Staff/ Hours Charge Entry (Includes Surgeon Coding WQ) Coding Staff Manager Hours Worked Productive Time (80%) Chg Entry Work % Chg Entry Hours Session Review Total Prod/Hour Coder, Sally KW % Coder, Tom KW % Coder, Bob BM % Coder, Sue LD % Coder, Millie KM % Coder, Jason LM % Coder, Suzie KM %

22 Summary: Charge Review Coder Productivity Reporting Period May-16 Staff/ Hours Charge Review Coding Staff Manager Hours Worked Productive Time (80%) Charge Review Work % Chg Review Hours Session Review Total Prod/Hour Coder, Sally KW % Coder, Tom KW % Coder, Bob BM % Coder, Sue LD % Coder, Millie KM % Coder, Jason LM % Coder, Suzie KM %

23 Summary: Follow Up Activity Coder Productivity Reporting Period May-16 Staff/ Hours Follow-Up (Includes PAU, Claim Edit, RTP) Coding Staff Manager Hours Worked Productive Time (80%) Follow Up Work % Follow- Up Hours Session Review Total Prod/Hour Coder, Sally KW % Coder, Tom KW % Coder, Bob BM % Coder, Sue LD % Coder, Millie KM % Coder, Jason LM % Coder, Suzie KM %

24 24 Fast is fine, but accuracy is everything. Wyatt Earp

25 Creating the Audit Audit Sample Timeframe Determine Quantity & Database Define Randomization Method 4 Develop Audit Tool & Scoring 25

26 The Audit Plan Team o Revenue Cycle Support Project Manager o Coding Manager(s) o Reporting Analyst(s) o Coding Assistant(s) 26

27 Audit Sample Timeframe o Determined in Coding Audit policy o Revenue implications o Timing of complete data from charge inception to claim generation o Retrospective review 10 sessions quarterly 27

28 Determine Quantity & Database o Determined in Coding Audit policy o 10 Services per quarter o Audits pulled from productivity raw data file o Percentages based on work type 28

29 RCS Team Support o Manage Audit Calendar o Blind data pulls o Audit form preparation o Additional data request as needed 29

30 Audit Tracking Tool Audit tracking: Coders/Manager/Month for FY2017 Coding Staff Manager Qtr 1 July/Aug/Sept Qtr 2 Oct/Nov/Dec Qtr 3 Jan/Feb/Mar Qtr 4 Apr/May/June Coding Staff Manager Provided to Manager (Date- Qtr 1) Month Provided to Manager (Date- Qtr 2) Month Provided to Manager (Date- Qtr 3) Month Provided to Manager (Date- Qtr 4) Month Coder, Sally A 12-Jul July Dec Feb Apr Coder, Tom A N/A N/A ** newly hired staff Oct Jan June Coder, Bob B 8-Jul July Dec Feb Apr Coder, Sue C 7-Jul July Dec Feb Apr Coder, Millie D 11-Jul Aug Dec Mar June 30

31 Audit Randomization Charge Entry Sources are CRCE, OpTime and Provation Pull # for audit Charge Review Sources all- excluding CRCE, OpTime and Provation (includes Paper Billing) Pull # for audit Totals Coding Staff Manager Chg Entry Work % Charge Review Work % Coder, Sally A Anesthesia- separate spreadsheet data extraction 10 Coder, Tom A 0% 0 100% Coder, Bob B 20% 2 80% 8 10 Coder, Sue C 70% 7 30% 3 10 Coder, Millie D 80% 8 20%

32 Audit Randomization Charge Entry Sources are CRCE, OpTime and Provation Pull # for audit Charge Review Sources all- excluding CRCE, OpTime and Provation (includes Paper Billing) Pull # for audit Totals Coding Staff Manager Chg Entry Work % Charge Review Work % Coder, Sally A Anesthesia- separate spreadsheet data extraction 10 Coder, Tom A 0% 0 100% Coder, Bob B 20% 2 80% 8 10 Coder, Sue C 70% 7 30% 3 10 Coder, Millie D 80% 8 20%

33 Productivity Summary Coder Productivity Reporting Period May-16 Staff/ Hours Charge Entry (Includes Surgeon Coding WQ) Charge Review Follow-Up (Includes PAU, Claim Edit, RTP) Coding Staff Manager Hours Worked Productive Time (80%) Chg Entry Work % Chg Entry Hours Session Review Total Prod/Hour Charge Review Work % Chg Review Hours Session Review Total Prod/Hour Follow Up Work % Follow- Up Hours Session Review Total Prod/Hour Coder, Sally KW % % % Coder, Tom KW % % % Coder, Bob BM % % % Coder, Sue LD % % % Coder, Millie KM % % % Coder, Jason LM % % % Coder, Suzie KM % % %

34 Develop Audit Tool & Scoring o Developed based on policy o Effort between Coding & Compliance 34

35 Audit Template Coder: Coder, Sally Qtr: 1st Month: July Manager: A Source MRN/ Patient Name DOS TAR/Invoice* (*Print HCFA) Billing Provider Errors assigned (Detail) Starting Value True/Total Error(s) Value Assigned/ Max Error (s) Value Total New Point Value / % Paceart A Patient, Public A 6/18/ XXX N/A Provider A 10 Muse B Patient, Public B 6/14/ XXX XXX Provider B 10 Muse C Patient, Public C 6/9/ XXX XXX Provider C 10 Radiant D Patient, Public D 6/28/ XXX XXX Provider D 10 Inpatient E Patient, Public E 6/12/ XXX XXX Provider E 10 Cardiology F Patient, Public F 5/27/ XXX XXX Provider F 10 CRCE G Patient, Public G 4/21/ XXX XXX Provider G 10 CRCE H Patient, Public H 4/28/ XXX XXX Provider H 10 Muse I Patient, Public I 6/10/ XXX XXX Provider I 10 Cardiology J Patient, Public J 6/8/ XXX XXX Provider J 10 TOTALS 100 AUDIT SCORE: Manager Signature Date Coder Signature Date 35

36 Productivity Raw Data Randomization Data Analysis Quality Outcomes 36

37 Timeline Productivity & Audit Plan 7/1/15 Coding Department Integration 7/1/13 EPIC PB Migration 7/1/ Jul Nov 2014 Jul Nov 2015 Jul Nov 2016 EPIC "Clinical Cutover" 4/1/14 PB Stabilization & Optimization 1/1/15 10/1/15 ICD10 37

38 Outcome Remote Work Program o RETENTION/ RECRUITMENT o Staff Satisfaction Productivity Maintained Post ICD10 38

39 Timeline Coding Department Integration 7/1/13 EPIC PB Migration 7/1/14 Productivity & Audit Plan 2013 Jul Nov 2014 Jul Nov 2015 Jul Nov /1/15 Remote Work Program 1/1/16 EPIC "Clinical Cutover" 4/1/14 PB Stabilization & Optimization 1/1/15 ICD10 10/1/15 39

40 In the End. o Consistent Measurement o Improved Communication & Education o Staffing: Assignment & Coverage o Improved Accountability o Remote Work Program 40

41 Laura Dornsife Director, Coding & Revenue Cycle Support (614)

Library. Summary Report

Library. Summary Report Library Summary Report 215-216 Prepared by: Library Staff March 217 Table of Contents Introduction..1 New Books.2 Print Circulation.3 Interlibrary Loan 4 Information Literacy 5-6 Reference Statistics.7