hsmithleade Web viewOBjective. 5. current. Team Member Model. 6. Team Member job descriptions, Coder. 7. Metrics

Running Head: BUSINESS PLAN 1

Business Plan for Restructuring the Billing Department

Heather Smith

Siena Heights University

October 30, 2013

Running Head: BUSINESS PLAN2

Table of Contents

EXECUTIVE SUMMARY……………………………………………………………………….3

CASE FOR ACTION……………………………………………………………………………..4

MISSION AND VISION

OBJECTIVE5

CURRENT TEAM MEMBER MODEL6

TEAM MEMBER JOB DESCRIPTIONS, CODER7

METRICS…………………………………………………………………………………………8

STRATEGIES.9

GAP ANALYSIS

FINANCIAL ANALYSIS

ORGANIZATIONAL ALIGNMENT13

TEAM MEMBER JOB DESCRIPTIONS,AUDITOR14

AUDITOR ROLES DEFINED6

MONITORING AND REVIEW7

REASSESSMENT AND REVISION…………………………………………………………...18


Executive Summary

The Department of Health and Human Services (HHS) released the final regulation on January 15, 2009 to move from the current ICD-9-CM coding system to the ICD-10-CM coding system on October 1, 2013 (HHS, 2009). On August 24, 2012, the HHS announced changes to the final rule that changed the deadline for compliance to October 1, 2014 (AHIMA, 2012). WMU School of Medicine must be prepared for this transition to ensure that our cash flow is not disrupted or delayed. Quality improvements to chart documentation will be essential in obtaining reimbursement from insurance carriers once ICD-10 is implemented. ICD-10 requires more detail and a clearer clinical description to justify the medical necessity for services provided. Provider readiness assessments must occur to evaluate their documentation and educate them on deficiencies found to prepare for this transition. A steering committee must be established to meet the challenges we face in preparing for ICD-10 implementation. Due to past issues with provider compliance audits and to effectively prepare for this transition, we are recommending the addition of a second full time auditor, and a change to the structure and set up of the billing department. In addition, we will internally prepare to train and educate our organization on ICD-10’s code structure, conventions, and guidelines.


Case for Action

On January 15, 2009, the Department of Health and Human Services (HHS) released the final regulation to move from the current ICD-9-CM coding system to the ICD-10-CM coding system in October 1, 2013 (HHS, 2009). Due to the importance of this transition, administrative burdens on physicians, and the need for more time to prepare and test, the HHS announced the final rule changes that changed the deadline for compliance to October 1, 2014 (AHIMA, 2012). In order for WMU School of Medicine to be prepared for this transition it is imperative to change the structure of our billing department to meet the standards set within this regulation and to meet the compliance and documentation standards at WMU School of Medicine.

Quality improvements to chart documentation will be essential in obtaining reimbursement from insurance carriers once ICD-10 is implemented. ICD-10 will significantly expand current diagnostic code sets, requiring more detail and a clearer clinical description to justify the medical necessity for services provided. We need to evaluate where our providers are at now with documentation and educate on deficiencies found to prepare for this transition. To make this happen and to ensure an efficient transition, we are recommending the addition of a 2nd full time auditor and a structure change to the billing department.

The initial function of both auditors will be to provide us with a Gap Analysis on documentation now and the documentation required for coding in 2014. The auditor’s will be part of the core training team that will then educate the organization by department on the new coding convention and guidelines that will impact their selection process. The second function of this new auditor would be to provide support to our 1st internal auditor by performing FOCUSED based audits in areas that have been determined to be problems for providers in previous audits and areas deemed high risk by the OIG. Finally, we would like this auditor to support the billing department’s functionality by performing chart audits on clinic notes missing E&M services. This would allow an increase of correct code selection and take away the need for providers to go back and re-review their documentation to provide us with a level of service or diagnosis codes that can be abstracted from the chart by a qualified auditor.

Western Michigan University School of Medicine’s Mission Statement

To advance the health of humanity through excellence in medical education, clinical care, research, and service. These pursuits are interdependent and together assure optimal care for today and hope for tomorrow.

Western Michigan University School of Medicine’s Vision

The medical school is distinguished as learner centered, discovery driven, globally engaged, and patient and family focused.


Objective

The transition to ICD-10-CM could present significant challenges to WMU School of Medicine, and if not properly implemented, could have an adverse impact on clinical and financial performance. With the October 1, 2014 deadline, it is important that to WMU School of Medicine begin planning an implementation strategy that will ensure a smooth transition. Planning is the key to success; our key objectives are outlined below:

Create a steering committee that will provide strategic guidance for the implementation of ICD-10-CM

Define each person’s role and responsibility in achieving a successful transition Set deadlines to achieve results including changes in process, procedures, policies, as

well as budget, education and communication needs Plan the Budget Hire a second auditor and define the roles for each Reorganize the billing department to perform prospective billing reviews to

o Support medical necessityo Code to the highest level of specificityo Ensure claim accuracy for proper reimbursement

Identify the systems that will be affected within the entire organization Discuss with vendors as to when software updates will occur and when we will be able

to begin testing Perform chart reviews to determine current areas where documentation must be

improved Review the impact and expectations on documentation Review and update coding support tools Begin to communicate the transition to providers, coders, and billers Create a training module to perform in-house training Train practitioners, coders, billing staff, and other identified staff affected by this

transition Coders will be required to pass an ICD-10-CM proficiency test to maintain AAPC

certification Identify weaknesses where additional education would be beneficial Test Transition operation October 1, 2014 Communicate and provide feedback Monitor, review, re-assess, and re-train if necessary


Current Team Model

Manager: Heather Smith

Coding Team: Mary Beronja-Bunch In-patient All departments except belowLori Meier In-patient Psychiatry & Infectious Disease

Deb Erickson 1st Floor clinic Rebecca Leep 2nd Floor Clinic

Billing Team: Kara Srackengast Medicare & Straight Medicaid billerKathy Thomas Blue Cross Blue Shield & West Michigan

Air CareKelly Longest PsychiatryLowyn Cantrell Patient Financial Counselor, Workman’s

Compensation & Automobile AccidentMelissa Houseman Medicaid HMOPeggy Meier CommercialKelli Presley Payment Poster & ERA resolution specialist


Team Member Job Description, Coder

Coding Specialist: Reviews, analyzes, and codes diagnostic and procedural information for all clinic encounters, inpatient and outpatient hospital services.

EDUCATION AND/OR EXPERIENCE: High school diploma plus knowledge of electronic billing. Associates degree preferred. Three years experience in medical coding. Minimum of one year of Orthopedic/Surgical experience is desired. Coding certification is required. Advance knowledge of medical terminology, surgical procedures, anatomy and physiology. CPC or CCS-P certification required.

OTHER SKILLS AND ABILITIES: 1. Knowledge and proficiency of eClinicalWorks and Gateway EDI.2. Knowledge of insurance/billing rules and regulations.3. Advanced knowledge and proficiency of medical terminology, anatomy and physiology.4. Advance knowledge and proficiency of medical codes involving the selection of the most accurate and

descriptive CPT/ICD-9or ICD-10/HCPCS code for billing third party resources.5. Ability to teach, mentor, and serve as a resource for others.6. Ability to operate standard office equipment such as multi-line phone system, copier, fax machine, etc.7. Ability to meet assigned deadlines.8. Ability to interpret, comprehend, and transmit complicated and detailed instructions accurately.

INTERPERSONAL REQUIREMENTS : 1. Exhibits a commitment to the values expressed in the WMed Mission Statement.2. Demonstrates the ability to interact in a positive and helpful manner with all "customers" both internally and

externally.3. Reflects commitment to building a supportive work environment and maintains a positive attitude at the work

place and toward their job.4. Maintains the confidentiality of all patient, employee, physician and institutional related information.5. Demonstrates the ability to recognize priorities in organization of work flow. 6. Able to perform duties independently, with a minimal need for direct supervision.

ESSENTIAL DUTIES AND RESPONSIBILITIES : 1. Reviews, analyzes, and codes diagnostic and procedural information on encounter forms and hospital cards to

ensure accurate coding in according to ICD-9 and CPT guidelines.2. Enters codes and charges into eClinicalWorks system.3. Investigates and resolves coding and billing problems with the clinic staff and physicians. 4. Assures the final diagnoses and operative procedures as stated by the physician are valid and complete through

chart abstraction.5. Communicates chart documentation inconsistencies with physicians to obtain necessary information to code and

bill services.6. Utilizes reports and the systems claim scrubber to identify potential coding errors. Fix all errors in accordance

to coding standards and third party payer guidelines prior to claim submission.7. Prepares and transmits electronic claims submissions. Prints and mails HCFA claim forms when applicable.8. Maintain CEU’s in accordance to certification standards; review bulletins, newsletters, and periodicals to stay

abreast of current issues, trends, and changes in the laws and regulations governing medical record coding and documentation.

9. Availability to work occasional overtime on weekends or evenings to complete time sensitive projects.10. Acquires new knowledge for new technology and policy/procedure revisions.11. All other duties as assigned.


Metrics

How we will measure our progress and success:

Implementation Deadline: strictly adhering to our created implementation timeline which allows for a two week approved deviation.

Budget: obtaining budget approval and strictly staying within the budget threshold Provider Documentation Readiness Assessment: performing a base-line audit of 10

encounters (dates of service) for each provider being evaluated to determine the level of specificity provided in their current documentation to report the clinical condition against the increased documentation requirements of ICD-10-CM. This will enable us to effectively identify deficiencies and notable trends to educate and train providers. Once deficiencies have been noted and training has occurred we will perform a second audit to re-measure documentation specificity for the clinical condition against the increased ICD-10-CM documentation requirements. Meeting our compliance plans 90% accuracy rate will make this training a success.

Billing Department’s Readiness Assessment: perform a base-line audit on each coder prior to ICD-10-CM training to determine the number of base-line charts coded per hour. After ICD-10-CM training, perform a post audit review to determine the number of charts coded per hour per coder. Successful training in ICD-10-CM will allow coders to reach base-line benchmarks numbers within six month of finalized training.

Audit standard: a 90% coding standard is required of our providers and coders per our compliance plan. After our reviews, we will provide each provider and coder with a detailed audit report that indicates if the appropriate codes were selected based on the documentation. The report will highlight any deficiencies along with coding and documentation tips and improvement recommendations. Follow-up audits will be performed every three months for coders and providers that do not meet this standard. Meeting our compliance coding standard after a full year of education and training will make the restructuring of the department and addition of a second auditor a program success.

ICD-10-CM Training: train all providers, coders, and other staff on ICD-10-CM code structure, conventions, and guidelines. After training, every person will be issued an ICD-10-CM coding test. A passing grade of 80% will make our training a success.

Testing: performing claim submission tests to ensure claims pass through the 5010 edits. We will be successful when a 100% of our claims pass through the clearinghouse edits prior to October 1, 2014.

Claims Submission: measure our current claims first time pass through rates today and then measure our claims first time pass through rates after ICD-10-CM implementation. Implementation will be a success if we do not deviate more than 2% from our current pass through rate.


Strategies

We will begin to achieve our objectives by taking a closer look at how we have performed our internal reviews in the past and how we have communicated these results to our physician’s. Our past audit results indicate that our providers are not currently meeting our compliance rate. Therefore we need to change how we present the results to help our providers understand the material based on their learning styles. We must adapt our methods to the audience.

Currently, we are not able to get through audit reviews for all of our 50 physicians and 200 residents each year. To be successful we must reach out and educate all of our providers each year. To accomplish this goal we will need a second auditor. Posting this position is our first priority. We will also need to restructure the billing department to add another coder to allow prospective reviews of the providers coding. We will change the coder’s structure to assign them to specific clinics. This will open lines of communication so each provider personally interacts with the same person and allow the coder’s to specialist’s for the practice they code for.

Education is a critical success factor in the successful implementation of ICD-10. To empower the staff in this key endeavor it will be imperative to have a clear strategy that is recognized and supported by the organization. An effective strategy will build confidence in the organizations’ ability to make informed decisions and recommendations for the rollout of this new code set. Our strategy will include four strategic objectives that will set direction for all education efforts so the message is consistent, effective, and clear. These four strategic objectives are: building diagnosis and procedure coding awareness across the practices, maximizing educational opportunities with the hiring of an additional auditor, engaging staff in ICD-10 coding and sustaining their interest with the restructuring of the billing department, and collaborating with others both internally and externally to enhance knowledge of ICD-10 and coding change implication to prepare for a smooth implementation. To validate our efforts and the learning experience of our staff, coders will be required to take an ICD-10 proficiency exam through the AAPC as well as joining the providers and other staff in taking a code-set test in which they must pass with an 80% accuracy rate.

Processes have a significant impact on performance and process improvement is necessary to improve the overall health of our organization. Process control will improve the quality of our outputs and effectively produce the appropriate amount of inputs (Longest & Darr, 2008). Below we will define the boundaries of our process changes that will improve our documentation and prepare our organization for ICD-10.

Hold a kick off meeting to request presence of every person on the steering committee to discuss the timeline and job roles of each

Begin analyzing system applications that use coding data to make sure all are reformatted or revised

Obtain budget approval Hire 2nd auditor by December 1, 2013 Cross-train and educate coders on their new roles and clinic assignments starting now Restructure department so auditor’s report to Billing Manager and coder’s begin their

new clinic assignments by January 2, 2014


Purchase ICD-10 curriculum for coder’s training now and give coder’s a deadline of February 1, 2014 to have training completed and proficiency test passed

Start reviewing provider documentation now to find the areas that lack in specificity to assess risk and identify training needs

January 1, 2014 begin educating providers on documentation requirements to be able to code in ICD-10

Upgrade software to version 10 in January to be able to utilize ICD-10 codes in system for cross-coding practice

Train coders, billers, and auditors on ICD-10 in March 2014 requiring them to pass a 50 question assessment test

Train providers, residents, and all other staff in July/August 2014 requiring them to pass a 50 question assessment test

Test systems in September to make sure they are working properly and that insurance carriers will be able to process our claims on October 1, 2014

Develop and revise all policies and procedures in September 2014 that are impacted by ICD-10

Go live October 1, 2014, schedule coder’s and auditor’s to be on the floors and available to providers during the first two weeks of the transition


GAP Analysis (SWOT)

Strengths: All coders and physicians currently receive training based on compliance in the organization and are up to date on coding issues. We have an internal auditing process in place to continuously assess and monitor compliance and provide education for all providers falling below the 90% standard. Our organization has converted to 5010 transaction sets in preparation for ICD-10. We review our insurance contracts bi-annually and will pull all contract and review against medical policies as health plans publish their ICD-10 changes.

Weaknesses: Upon initial review of documentation there appears to be an issue with meeting the new ICD-10 standards of specificity, granularity, and laterality. We must convert to eCW’s version 10 to be able to load and accommodate ICD-10-CM. Currently short staffed; need to reorganize billing department to transition an AR member to the coding side and post an additional auditor to help with pre- and post- implementation and provider documentation readiness reviews. Funding of training is not accounted for in the budget for providers and other staff. Need to expand education and training for documentation and compliance accuracy for providers and coders.

Opportunities: Will begin focused quarterly auditing and monitoring reviews geared towards using ICD-10-CM codes and review provider documentation to ensure compliance. It will set a date with our software and system vendor to upgrade to version 10 by February 1st, 2014. We will expand budget to include addition of software upgrade which was not previously budgeted for. All coders will attend education for ICD-10 code sets through the AAPC as well as through the organization. All providers and remaining staff will obtain scheduled education through the organizational training sessions. We will work with project team to ensure readiness.

Threats: Must find the time and resources to review all carrier medical policies for ICD-10. Work with the reluctant physicians to change documentation practices relative to ICD-10 and get all residents trained and audited on ICD-10 documentation to ensure all providers are ready. Providers feel their documentation is sufficient now so we need to obtain additional time to educate providers to get them better prepared and help them understand the significant differences and changes necessary to be compliant. Learning a new code set will slow down the productivity of the providers and coding staff that must bounce back within three months of the transition. There are also unknown factors as to what new regulations will be enacted and with health care reform, not certain how this will impact or affect the overall process and medical practices.


Financial Analysis

WMU School of MedicinePATIENT BILLING BUDGET

Annual AnnualBudget Budget Budget

Prior to Change Including New Auditor Change

Personnel Expenses6400 Staff salaries $ 543,460 $ 600,206 $ ( 56,746 )6404 Staff overtime $ 3,000 $ 3,275 $ ( 275 )6405 Staff temporary services $ 30,000 $ 30,000 $ - 6490 Staff fringes $ 177,460 $ 196,185 $ ( 18,725 )

Total Personnel Expenses $ 753,920 $ 829,666 $ ( 75,746 )

Operating Expenses7100 Office supplies $ 13,000.00 $ 13,300.00 $ ( 300.00 )7300 Postage $ 6,000.00 $ 6,100.00 $ ( 100.00 )7400 Phone line charges $ 4,200.00 $ 4,500.00 $ ( 300.00 )7600 Dues & Subscriptions $ 7,000.00 $ 7,200.00 $ ( 200.00 )

7750 Staff Professional Development $ 9,000.00 $ 10,000.00 $ ( 1,000.00 )

8700 Rent - building/parking $ 2,500.00 $ 2,500.00 $ -

Total Operating Expenses $ 41,700.00 $ 43,600.00 $ ( 1,900.00 )

----------------------------------

- - Total Expenses $ 795,620.00 $ 873,265.86 $ ( 77,645.86 )

- - -

Personnel Change: Budget FTE Filled FTEManager 1.00 1.00Coder 1.00 1.00Coder 1.00 1.00Coder 1.00 1.00Coder 1.00 1.00Coder 1.00 1.00AR 1.00 1.00AR 1.00 1.00AR 1.00 1.00AR 1.00 1.00AR 1.00 1.00AR 0.50 0.50Auditor 1.00 1.00Auditor 1.00 0.00


Total: 13.50 12.50 Over (Under) Variance: -1.00

Organizational Alignment

Creating a successful environment comes from valuing employees and building a positive and energizing culture within the department (Longest & Darr, 2008). To do this I will embrace the learning process with my team and act as a resource for my staff during this learning process. I will listen to the team and ask their opinions to ensure that they feel valued during this transition. I will help them establish, build, and sustain professional contacts for the purpose of networking. I will praise them for their accomplishments giving them the self-confidence required to perform these new roles. I will set clear and concise expectations and reward them for their accomplishments and a job well done.

Restructured Team Model

Manager: Heather Smith

Auditing Team: David WierickOpen Position

Coding Team: Mary Beronja-Bunch Orthopedics, Family Medicine & RadiologyLori Meier Psychiatry

Deb Erickson Surgery & Medicine-Pediatrics Rebecca Leep Pediatrics, Pediatric Sub-specialty &

Infectious DiseaseMelissa Houseman Internal Medicine, Internal Medicine Sub-

specialty & Laboratory

Billing Team: Kara Srackengast Medicare & Medicaid (all products)Kathy Thomas Blue Cross Blue Shield & West Michigan

Air CareKelly Longest PsychiatryLowyn Cantrell Patient Financial Counselor, Workman’s

Compensation & Automobile Accident Assist with Psychiatry follow up

Peggy Meier Commercial & Assist with Blue Cross Blue Shield follow up

Kelli Presley Payment Poster, ERA resolution specialist, Assist with Medicaid eligibility checks & Assist with all AR follow up


Team Member Job Description, Auditor

Coding Auditor: Responsible for the auditing of new and existing medical records in accordance with the company’s compliance plan, training of medical staff on physician rules, CPT and ICD-9/ICD-10 coding, focusing specifically on the accuracy of the coding and the adequacy of the documentation. Coordinates, implements, monitors and enforces compliance initiatives for WMU School of Medicine. CPC, CPMA or CCS-P, CHAP required.

EDUCATION AND/OR EXPERIENCE: Certified coder with minimum five years of extensive coding experience. Certified Auditor with minimum of two years of auditing experience in a physician practice or a managed healthcare setting is required. AHIMA approved ICD-10 Trainer strongly preferred. Bachelor’s degree preferred. A Registered Nurse or Licensed Practical Nurse strongly preferred.

OTHER SKILLS AND ABILITIES:

1. Knowledge and proficiency in CPT/ICD-9/ICD-10 coding, medical billing and claims processing.

2. Knowledge and proficiency in medical terminology.3. Knowledge and proficiency in word processing and file management using Word and other

software as required by the department. Ability to use coding software preferred.4. Must demonstrate positive relationships with physicians and peers.5. Knowledge and proficiency in grammar and spelling skills.6. Ability to operate automated standard office equipment such as multi-line phone system,

transcription equipment, copier, fax machine, shredder, etc.7. Ability to effectively communicate with others verbally and in writing.8. Ability to meet assigned deadlines.9. Ability to interpret, comprehend, and transmit complicated and detailed instructions

accurately.10. Analytical Ability11. Report preparation skills essential;

INTERPERSONAL REQUIREMENTS:

1. Exhibits a commitment to the values expressed in the School of Medicine Mission Statement.2. Demonstrates the ability to interact in a positive and helpful manner with all "customers" both

internally and externally.3. Reflects commitment to building a supportive work environment and maintains a positive

attitude at the work place and toward their job.4. Maintains the confidentiality of all patient, employee, physician and institutional related

information.


5. Demonstrates the ability to recognize priorities in organization of work flow. 6. Able to perform duties independently, with a minimal need for direct supervision.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

1. Coordinates implementation, monitoring and enforcement of compliance initiatives for employed physicians, to comply with applicable laws as they relate to billing procedures and requirements.

2. Responsible for clinical documentation analysis (medical), documentation completeness, coding accuracy and compliance.

3. Assists with training and education related to corporate compliance to physicians and departments.

4. Coordinates audit and training activity with Director of Clinical Business Services and Billing Manager.

5. Independently assesses critiques and makes authoritative recommendations for revisions to the organization’s coding and documentation techniques and policies. Monitors compliance on an ongoing basis and ensures that approved recommendations are implemented.

6. Works collaboratively with medical staff, nursing staff and other patient care givers to improve the quality of chart documentation to accurately reflect services provided.

7. Initiates communication with physicians in order to obtain or offer more specific principal diagnosis. Solicit clarification of existing documentation in the medical record that supports patient’s severity of illness.

8. Actively participates with external contacts: insurance companies, Medicare and Medicaid, consultants, and Joint Commission.

9. Develops and presents pertinent information to appropriate administrative and medical staff departments.

10. Responds to questions, issues and reports of potential issues in coordination with the Associate Dean Administration and Finance and Billing Manager.

11. Availability to work occasional overtime on weekends or evenings to complete time sensitive projects.

12. Acquires knowledge for new technology and policy/procedure revisions.13. Participates on the School of Medicine Compliance Committee as directed by the Associate

Dean Administration and Finance.14. All other duties as assigned.


Auditor’s Defined Roles

Auditor 1: Annual Audits All Clinics (20 Attending Charts; 10 clinic, 10 hospital)

Bi-Annual Re-Audits for Attending’s not meeting Coding accuracy percentage

Focused Audits (Surgical Coding, Payer Specific Coding & Guidelines, Diagnosis Reviews, Problem Code Reviews; 99211, 99212, 99215, 99204, 99205)

Individual Faculty Education (1-Hour for New Hires, Audit Results, Q&A)

Group Faculty Education (1-Hour Quarterly Meeting with Attendings)

ICD-10 Documentation Reviews & Provider Education to meet new standards

ICD-10 Training (August/September 2014)

Works with eCW/IT teams to develop templates that meeting coding standards

Auditor 2: Resident Education Audits (10 Resident Charts; 5 clinic, 5 hospital)

Individual Resident Education (1-Hour Sessions for New Hires, Audit Results, Q&A)

Group Resident Education (2-Hour Sessions with coding examples and test for Resident’s during July/August Transition for 1st & 2nd Year)

Focused Audits (Surgical Coding, Payer Specific Coding & Guidelines, Diagnosis Reviews, Problem Code Reviews; 99211, 99212, 99215, 99204, 99205)

Group Education (1-Hour to go over Audit Findings by clinic as needed)

Quarterly Coding Staff Audits & Educational Reviews

Fields Coding/Billing Dept questions/reviews for denied claims

ICD-10 Training (August/September 2014)

Works with eCW/IT teams to develop templates that meeting coding standards


Monitoring and Review

The first 30 days after go live, claims processing will be monitored daily for rejections or denials. Any claims issues will be resolved and resubmitted within 24 hours. Coder productivity will be reviewed over the first six months and a temp agency will be on stand-by if additional resources are needed to maintain revenue expectations. Both auditors will pull random samples of provider documentation to continue reviews on quality, specificity, and accuracy for the first three months. I will monitor our benchmark reports closely during the first six months of transition looking for problem areas, inadequacies or weak areas within the process. Identified areas will be fixed immediately to prevent reimbursement delays. During the first several months we will revisit the new policies and procedures to ensure that nothing was missed and that no improvements are necessary. Once it is established that all the objectives were attained and the transition phase is complete, we will continue to monitor productivity and performance benchmarks monthly.


Reassessment and Revision

Productivity and workflows will continue to be assessed after the transition annually to ensure that intervention is not needed and that there isn’t a need for further improvement in processes. We will embrace continuous quality improvement (CQI) methods to identify how we are functioning and to look for ways to further improve the benchmarks and standards of the department (Longest & Darr, 2008). Training and education will continue with staff and providers on an on-going basis. For those meeting the standards, they will receive an annual review with a follow up session to help them continue to grow in their documentation and coding efforts. For those not meeting the standards, we will perform quarterly reviews with focused training and educational sessions to improve their knowledge and bring them up to our compliance rate.


References

AHIMA. (2012). HHS Announces: ICD-10 delayed one year. Retrieved from:

http://journal.ahima.org/2012/08/24/hhs-announces-icd-10-delayed-one-year/

Longest, Jr., B.B., & Darr, K. (2008). Managing health services organizations and systems, 5th

ed. Baltimore, Maryland: Health Professions Press

US Department of Health & Human Services (HHS). (2009). HHS issues final ICD-10 code sets

and updated electronic transaction standards rules. Retrieved from:

http://www.hhs.gov/news/press/2009pres/01/20090115f.html

Documents

hsmithleade Web viewOBjective. 5. current. Team Member Model. 6. Team Member job descriptions, Coder. 7. Metrics