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Coding Workflow and Process Audits

By Ashley Cleavenger, CPC, CCS-P

In the era of so many workplace, staffing, and process changes to accommodate the world around us, it is imperative that HIM departments and provider office management stay up to date with fluctuations in workflow processes and coder productivity. Changes in these areas often begin subtly but can develop into major issues within just a few months. Regardless of staff size and volumes, all coders should have a workflow structure as well as quality and productivity measures to maintain. The key is to set attainable goals that are effective in reducing redundant tasks and avoiding spikes in backlogged charges. But what are attainable goals? How do you set and maintain an effective workflow?

The answers to these questions will vary from practice to practice. However, the way in which workflow processes are solidified and put into policy should include similar steps known as a workflow process audit.

Initially, a baseline review of current workflows, policies, and charge volumes should be done. During this phase you should also be checking current coder productivity, comparing them with one another when coders perform like tasks and analyzing those numbers against average volumes and backlog.

To improve upon any process, you must first know where your starting point is. Analyzing total input and output of charges over a certain amount of time will show periodic fluctuations in backlogs. Noting trends such as volume spikes and/or staffing deficits will help to validate temporary backlog increases and possibly support the need for additional staff after the process audit is complete. Using this information, you should be able to identify key areas of improvement.

Once you’ve performed your baseline data review, it’s time to get staff input on current workflows as well as pain points in their processes. Your coding staff are the frontline and your best resource to gauge what’s working well and what can be improved upon for day-to-day tasks. One recommendation would be to shadow multiple staff members while they perform daily tasks. Ask them what works well vs what they feel they’re spending too much time on. Note whether they are utilizing all current resources and verify that they use any system shortcut keys or other time-saving accommodations. Don’t forget to review provider query processes as well as documentation deficiency and addendum workflows.

After shadowing and data analysis, a standardized coding workflow document should be developed to include a step-by-step coding manual, query and addendum processes (with examples of common or repetitive issues when possible), as well as coding tips and system navigation shortcuts. Screen snips and visuals tend to be very helpful when translating this information to staff. This approach can be used for existing staff and as an onboarding tool for new hires to ensure that all staff members are using the same process and the tools to complete charges.

Often the most daunting hurdle when auditing and updating workflows or implementing process improvements is education. Being able to effectively communicate changes or updates is vitally important. While change in the coding world is inevitable, workflow and process changes are typically a harder sell than yearly coding guideline updates. Prior to implementation, we recommend holding either a specialized educational session or meeting geared toward reviewing the updated workflows and any other process changes. These sessions will allow for coder input and facilitate a group discussion about any changes needing to be made.

By using coder input during the analysis phase, process improvements derived from fellow coding staff can be highlighted to show and support the collaborative efforts of management and coders in the audit/improvement processes. After any educational session(s), the written workflow and any updated policies should be sent to all affected staff along with an acknowledgement of understanding (eg, PDF to be signed, e-mail back to management).

In the weeks after implementation, expect questions, a learning curve, and a few hiccups. Schedule a follow-up meeting to discuss these questions and review solutions as a group when necessary. Positive feedback during this meeting is always recommended, as process changes can be stressful on everyone involved. We also recommend continuing to trend charge volumes, coder productivity, and pain points within the new process for the final phase of the workflow or process audit. Improvements in workflows and backlogs are typically seen within two to three months after implementation.

Finally, a postimplementation follow-up audit should be performed using the same metrics, timeframes, and standards as the initial review. These findings should show marked improvement when compared with one another. Highlight areas where workflow updates have helped streamline productivity and task completion. Additionally, it can be used to identify areas that still require attention and possible adjustments. Review the comparative data and schedule additional staff training and/or send out updated workflows (with coder acknowledgement required) in order to finalize the audit process.

As you well know, coding management and process improvements are ever evolving and require periodic auditing to stay up to date with changes in guidelines, EMR system updates, staffing changes, and volume adjustments.

— Ashley Cleavenger, CPC, CCS-P, initially joined the RCCS, Inc consulting team in June 2019. She was onboarded as a subject matter expert in surgical and evaluation and management coding. In October 2020, she moved into the role of manager of coding+ where she currently manages all RCCS, Inc coding specialists and client accounts across a wide range of specialty and surgical services.