Coding Productivity & Audit Laura Dornsife Director, Coding & Revenue Cycle Support
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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 Medical Center Research
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 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
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
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
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
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
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
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.
Timeline Coding Department Integration 7/1/13 EPIC PB Migration 7/1/14 Productivity & Audit Plan 7/1/15 2013 Jul Nov 2014 Jul Nov 2015 Jul Nov 2016 EPIC "Clinical Cutover" 4/1/14 PB Stabilization & Optimization 1/1/15 13
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 Operations Meets IT
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
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
Data Analysis o Workflows o Coding Type o Complexity differences in work assignments 18
Payroll Worked Hours Coder Actions Data Analysis Productivity Outcome 19
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 170.7 136.6 2% 2.7 66 24.4 78% 106.5 3337 31.3 20% 27.3 50 1.8 Coder, Tom KW 168.2 134.6 1% 1.3 21 16.2 79% 106.3 4209 39.6 20% 26.9 87 3.2 Coder, Bob BM 89.7 71.8 10% 7.2 10 1.4 75% 53.8 1879 34.9 15% 10.8 98 9.1 Coder, Sue LD 87.8 70.2 5% 3.5 26 7.4 80% 56.2 1072 19.1 15% 10.5 34 3.2 Coder, Millie KM 170 136.0 25% 34 840 24.7 65% 88.4 2801 31.7 10% 13.6 74 5.4 Coder, Jason LM 156.2 125.0 0% 0 103 95% 118.7 5245 44.2 5% 6.2 46 7.4 Coder, Suzie KM 157 125.6 50% 62.8 1229 19.6 40% 50.2 5563 110.8 10% 12.6 170 13.5 20
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 170.7 136.6 2% 2.7 66 24.4 Coder, Tom KW 168.2 134.6 1% 1.3 21 16.2 Coder, Bob BM 89.7 71.8 10% 7.2 10 1.4 Coder, Sue LD 87.8 70.2 5% 3.5 26 7.4 Coder, Millie KM 170 136.0 25% 34 840 24.7 Coder, Jason LM 156.2 125.0 0% 0 103 Coder, Suzie KM 157 125.6 50% 62.8 1229 19.6 21
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 170.7 136.6 78% 106.5 3337 31.3 Coder, Tom KW 168.2 134.6 79% 106.3 4209 39.6 Coder, Bob BM 89.7 71.8 75% 53.8 1879 34.9 Coder, Sue LD 87.8 70.2 80% 56.2 1072 19.1 Coder, Millie KM 170 136.0 65% 88.4 2801 31.7 Coder, Jason LM 156.2 125.0 95% 118.7 5245 44.2 Coder, Suzie KM 157 125.6 40% 50.2 5563 110.8 22
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 170.7 136.6 20% 27.3 50 1.8 Coder, Tom KW 168.2 134.6 20% 26.9 87 3.2 Coder, Bob BM 89.7 71.8 15% 10.8 98 9.1 Coder, Sue LD 87.8 70.2 15% 10.5 34 3.2 Coder, Millie KM 170 136.0 10% 13.6 74 5.4 Coder, Jason LM 156.2 125.0 5% 6.2 46 7.4 Coder, Suzie KM 157 125.6 10% 12.6 170 13.5 23
24 Fast is fine, but accuracy is everything. Wyatt Earp
Creating the Audit 1 2 3 Audit Sample Timeframe Determine Quantity & Database Define Randomization Method 4 Develop Audit Tool & Scoring 25
The Audit Plan Team o Revenue Cycle Support Project Manager o Coding Manager(s) o Reporting Analyst(s) o Coding Assistant(s) 26
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
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
RCS Team Support o Manage Audit Calendar o Blind data pulls o Audit form preparation o Additional data request as needed 29
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
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% 10 10 Coder, Bob B 20% 2 80% 8 10 Coder, Sue C 70% 7 30% 3 10 Coder, Millie D 80% 8 20% 2 10 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% 10 10 Coder, Bob B 20% 2 80% 8 10 Coder, Sue C 70% 7 30% 3 10 Coder, Millie D 80% 8 20% 2 10 32
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 170.7 136.6 2% 2.7 66 24.4 78% 106.5 3337 31.3 20% 27.3 50 1.8 Coder, Tom KW 168.2 134.6 1% 1.3 21 16.2 79% 106.3 4209 39.6 20% 26.9 87 3.2 Coder, Bob BM 89.7 71.8 10% 7.2 10 1.4 75% 53.8 1879 34.9 15% 10.8 98 9.1 Coder, Sue LD 87.8 70.2 5% 3.5 26 7.4 80% 56.2 1072 19.1 15% 10.5 34 3.2 Coder, Millie KM 170 136.0 25% 34 840 24.7 65% 88.4 2801 31.7 10% 13.6 74 5.4 Coder, Jason LM 156.2 125.0 0% 0 103 95% 118.7 5245 44.2 5% 6.2 46 7.4 Coder, Suzie KM 157 125.6 50% 62.8 1229 19.6 40% 50.2 5563 110.8 10% 12.6 170 13.5 33
Develop Audit Tool & Scoring o Developed based on policy o Effort between Coding & Compliance 34
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 12345678A Patient, Public A 6/18/16 37994XXX N/A Provider A 10 Muse 12345678B Patient, Public B 6/14/16 37893XXX 8052157XXX Provider B 10 Muse 12345678C Patient, Public C 6/9/16 38378XXX 8052524XXX Provider C 10 Radiant 12345678D Patient, Public D 6/28/16 38666XXX 8053079XXX Provider D 10 Inpatient 12345678E Patient, Public E 6/12/16 37615XXX 8052524XXX Provider E 10 Cardiology 12345678F Patient, Public F 5/27/16 36723XXX 8050703XXX Provider F 10 CRCE 12345678G Patient, Public G 4/21/16 38852XXX 8047495XXX Provider G 10 CRCE 12345678H Patient, Public H 4/28/16 37779XXX 8051723XXX Provider H 10 Muse 12345678I Patient, Public I 6/10/16 37714XXX 8051835XXX Provider I 10 Cardiology 12345678J Patient, Public J 6/8/16 37939XXX 8051999XXX Provider J 10 TOTALS 100 AUDIT SCORE: Manager Signature Date Coder Signature Date 35
Productivity Raw Data Randomization Data Analysis Quality Outcomes 36
Timeline Productivity & Audit Plan 7/1/15 Coding Department Integration 7/1/13 EPIC PB Migration 7/1/14 2013 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
Outcome Remote Work Program o RETENTION/ RECRUITMENT o Staff Satisfaction Productivity Maintained Post ICD10 38
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 2016 7/1/15 Remote Work Program 1/1/16 EPIC "Clinical Cutover" 4/1/14 PB Stabilization & Optimization 1/1/15 ICD10 10/1/15 39
In the End. o Consistent Measurement o Improved Communication & Education o Staffing: Assignment & Coverage o Improved Accountability o Remote Work Program 40
Laura Dornsife Director, Coding & Revenue Cycle Support (614) 685-1511 laura.dornsife@osumc.edu