Technology Trends: Lean on Reports to Measure Efficiency
By Becki Carley, RHIA
For The Record
Vol. 34 No. 4 P. 8
In today’s health care arena, there is constant pressure to do more with less. While trying to figure out where we can be more efficient within the HIM department, there are several guidelines and reports to help us be more efficient in coding, analysis, scanning, transcription, release of information, and so forth. However, it is essential to ensure the reports are accurate. This may require troubleshooting and speaking with staff to decide whether reports are up to date.
By familiarizing yourself with the facility’s system reports, validating their accuracy, and then consistently utilizing them, status and improvement can be measured over time, including when new processes have been implemented.
Let’s first look at measuring coding efficiency. Discharged, not final billed (DNFB) reports identify accounts postdischarge or date of service that require coding to be completed so the bill can be submitted to the payer. DNFBs serve as an excellent source for spotting where coding may be causing delays.
To measure coding efficiency, it’s necessary to calculate turnaround time (TAT). While the TAT is essential to consistent revenue flow and undoubtedly affects the DNFB, it is not advisable to compromise quality over quantity. It is still possible to have quality with quantity when all required elements are in place.
A review of the elements that affect TAT is essential. These elements include provider documentation, query response, transcription, scanning, lab results, staffing, and coder knowledge. These factors should be monitored and adjusted when necessary. For instance, if documentation is lacking or there is a delay in responses to queries, ensure that providers are aware of their impact on prompt and accurate coding. Delivering regular updates helps providers stay up to date on documentation requirements. Depending on the sophistication of the organization’s reporting system, this may be a manually monitored process.
Clinical Documentation Improvement
Measuring the efficiency of clinical documentation improvement (CDI) resides at the top of many organizations’ to-do lists. The goal is to have the same diagnosis-related group (DRG) at any given date of service, also known as the “working” DRG, to match the DRG that is billed.
This can be a challenge unless there is effective communication among the key players, including coders, CDI specialists, and providers. The goals of a CDI improvement plan are to establish concurrent reviews of the medical record; assign working DRGs; update working DRGs upon findings of complications, comorbidities, and procedures; review for conflicting, incomplete, or nonspecific documentation; and seek clarification from providers.
CDI initiatives are expected to result in improved documentation, coding, and reimbursement. Therefore, reports should be designed to provide an overview that can compare working DRGs with what is being billed. From this information, organizations can begin to establish regular dialogue between CDI specialists and coders that will allow each group to learn from the other.
For organizations without a fully functional CDI program, concurrent coding and generation of working DRGs are highly recommended. This not only ensures obtaining documentation specificity and clarification promptly but also enhances the revenue cycle with claims being billed sooner.
During the development of a CDI initiative, reports should be designed to measure the success of concurrent coding, including TATs.
While some providers may not take a shine to documentation improvement efforts, they are of the utmost importance, especially when it comes to medical necessity. For example, denials occur often because clinical documentation of acuity is inadequate. Generating reports that display where denials are occurring because of medical necessity can be the genesis for solving the problem. These reports, along with education, are key tools to improve documentation and denial rates.
Use these reports to select the top three to five denials that require immediate attention. While long-term monitoring is ideal, coding volume will dictate the frequency with which it can occur. In any event, it is likely that any efforts in this area will be a boon to efficiency.
Other Report Types
A review of analysis efficiency, which can directly affect overall record completion and coding, is a useful report (known as a census report) to ensure the process is completed promptly. While it is recommended to implement a concurrent analysis program to help ensure providers are notified promptly of their deficiencies, using an admit and discharge census report helps ensure all records are analyzed for the required documentation. While not all systems are capable of generating analysis efficiency reports, they can be designed in Word or Excel and distributed as frequently as desired.
Setting expectation guidelines for improvement supplies measurable tools to reference and support staff evaluations.
Scanning efficiency reports may not exist within every system, but manual reporting is a viable option. While no one likes the extra work of manually tracking tasks, it may be necessary if an organization’s scanning is less than optimal. A complete EHR is not only needed but also essential for several responsibilities, including continued patient care. If all documents are not scanned timely, coding can suffer and affect reimbursement. Also, requests for documentation that already exists but has not yet been scanned can take longer to fill.
Completed scans can be monitored daily as well as through a census report. Before required quotas can be set, estimating the time required to scan documents is necessary. Consideration must be taken with regard to the type and age of scanners as well as the labeling convention that is required to properly identify the document within the EHR.
To make the process more efficient, concurrent scanning is one option to consider. Another measurement that affects overall scanning efficiency, scanning validation, is recommended to make the entire process complete.
With new requirements arriving seemingly monthly, the importance of maintaining smooth-running release of information processes is paramount. Whether this service is contracted or handled internally, the reporting and efficiency expectations are traditionally the same, with TAT easily topping the list of priorities.
Reports are usually separated by type of request, including patient, legal, billing, and disability. It’s important to note that TAT compliance among types differs. For example, continuity of care requests require a more immediate response as opposed to a legal request, in which processing may allow up to 30 days.
Contracted release of information service companies are accustomed to providing these types of reports at least monthly, depending on volume. Large organizations may want to review their release of information processes bimonthly. If release of information is managed internally and tracked within the organization’s system, reporting is necessary to ensure compliance with state and federal regulations as well as the organization’s own policies.
In addition, a disclosure tracking report, as required by HIPAA, should be readily available and reviewed regularly to ensure compliance.
Transcription reports are another handy HIM tool. With today’s sophisticated voice recognition systems, this may not be a current concern, but for those still utilizing transcription services, efficiency monitoring is essential for optimum continuity of care, documentation compliance, and coding efficiency.
Whether reports are generated from an organization’s operating system or created manually, it’s important to distribute them to staff in a timely manner. Doing so will keep staff informed of expectations and ensure that the data are being reviewed. Reports help staff identify and explain discrepancies and shortcomings that can be relayed to upper management. Furthermore, reports can be utilized to set staff goals, measure performance, enhance productivity, and support merit increases.
Not only is obtaining meaningful reports important to help monitor daily HIM department processes but it is also imperative to seeking continual operational improvement.
— Becki Carley, RHIA, is a senior HIM consultant with HCCS Coding and Consulting.