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December 2014

Step it Up!
By Judy Sturgeon, CCS, CCDS
For The Record
Vol. 26 No. 12 P. 28

The budget is busted. The CFO is tearing his hair out over the number of uncoded charts. You protest that the case mix is the highest in the facility's history, and the coding has never been more accurate. You've spent years building a staff of experienced, capable, and quality coders. Considering the administration won't grant overtime, what else can be addressed in order to get the accounts receivable down to the CFO's expectations?

It may simply be a matter of production: Your coders are excellent, but are they fast enough? After all, speed is the other half of any successful coding department. There must be a balance between accuracy and speed, between perfection and productivity. Do you have coders who score impressive results on their quality audits, but just can't seem to complete as many charts as their colleagues? Do you have any coders who are not keeping up at all?

If you're a coding department head or just in charge of its productivity, there's no getting around the fact that the staff must be accountable, not only for the production standards but also its accuracy rate. But how can this dual goal be achieved?

Possible Solutions
First, evaluate the standard. Is it realistic? Are other coders meeting the standard and still achieving the desired coding accuracy? If so, then the standard itself probably isn't the issue.

With the demand high for accomplished coders who can meet accuracy standards, it's wise for coding managers to keep current coders and instead invest time in improving productivity. If the standard is reasonable, the next question is, why is any particular coder not meeting productivity? The answer will help identify an effective course of action.

Is the lagging coder working on the same type and complexity of charts as those who are having no trouble meeting their goals? Discourage cherry picking of charts by ensuring that everyone is assigned daily work lists of similar difficulty. Medical service, surgical service, charges per chart, and length of stay are examples of possible criteria for work assignments.

Was the coder previously able to meet productivity standards? If so, look for clues about what may have changed in the coder's world. If productivity was up to snuff in the office but dropped off when remote coding was implemented, it may be necessary to bring that coder back onsite. Not everyone has a home setting that is conducive to the concentration levels essential for productive coding. And not everyone has the necessary temperament or focus to maintain speed and accuracy in a location where they also have social interruptions and chores to complete.

If personal problems may be contributing to a drop in productivity, offer employee assistance, if available. To avoid being perceived as intrusive and singling out one individual, make the information available to the entire staff at an office meeting. Resolving offsite personal problems can help remedy a drop in work performance.

How Is Time Spent?
Don't ignore time management education. Some helpful suggestions may include blocking out dedicated time for checking e-mail rather than interrupting work every time a message arrives.

Do your part to actively manage distractions. For all but emergencies, encourage having phone calls go to voicemail to be addressed later at an assigned time. Enforce cell phone restrictions and allow personal Internet use only during structured breaks. Insist that noisy office mates save extended conversations for break times and have them be conducted away from the coding area. Little distractions can create large concentration lapses that can lead to significant productivity losses. Eliminate a dozen or so of these nuisances each day, and watch production levels rise for all staff members.

Keyboard shortcuts are another potential time-saver. Are there speedy coders on staff who don't appear to use the computer mouse, but their fingers are flying on the keyboard all day long? Find out their secret. Does one press of the comma key accomplish as much as three mouse clicks? Does the Tab key replace one wrist motion and two mouse clicks? Multiply a shortcut or two by hundreds of saved clicks and wrist motions every day, and it may make the difference between "snail" and "sail" on the productivity rate chart.

Look for Clues
If the reason behind a productivity loss can be identified, the solution may become clearer. For example, daily time slots may need to be organized for struggling coders to work on the cases giving them trouble. Another option is to assign easier charts for a couple of days then gradually increase the degree of difficulty over a designated time period. Coders whose confidence has waned need to have their self-worth rebuilt. Hitting the reset button for a week or two may be the tonic necessary to get their productivity levels up to par.

If a coder has never been able to obtain the expected productivity rate, but is near or at the top in terms of accuracy, the department may have a reader and not a coder on its hands. Effective coders must not only read and comprehend clinical documentation, be well versed in complex coding rules, skim over nonessential information, and disregard duplicates but also snag the smallest addendum that links a symptom to cause.

To help struggling coders, consider pairing them with proficient colleagues. Challenge faster coders to become teachers for a few days. Have them observe how the slower coder works then switch places and allow the student to watch the masters in action. What are the experts doing that sets them apart? Where are slower coders becoming bogged down? What bad habits can be eliminated?

Don't expect an overnight transformation, but set specific, measurable, and attainable milestones. Replace "Go faster or you're fired!" with "Code 15 charts per day this week, 16 per day next week" until the coder eventually meets the hospital's standard. To improve this strategy's chances of succeeding, make it a cooperative by asking the coder to help set the milestones instead of making it appear as if the program is being dictated by management. Whenever possible, offer assistance, but remember to hold the coder accountable for meeting the agreed-upon goals. Also, continue to monitor coding accuracy because harried departments can't afford to fix one critical problem at the expense of another.

Finally, coding managers must hold themselves accountable. If the coder ultimately fails to meet the productivity standard, managers must take action. It may entail moving the coder to a lower level of coding or a complete reassignment of tasks. Managers also may be left with no other option but to dismiss the coder. To do less would send the wrong message to the rest of the coding staff.

Standards aren't suggestions; they're requirements, and if one person on the team is allowed to ignore them, others are sure to follow suit. As a result, a once-stellar department—and perhaps the coding manager as well—can suffer serious consequences.

— Judy Sturgeon, CCS, CCDS, is the clinical coding/reimbursement compliance manager at Harris County Hospital District in Houston and a contributing editor at For The Record. While her initial education was in medical technology, she has been in hospital coding and compliance for 26 years.