HIM 317 Principles Of Health Information Management

Questions: Molly, the coding supervisor of Homer General Hospital, has a problem. Her Discharged Not Final Billed (DNFB) report is staying significantly over the limit that administration desires. She is also behind in some of the compliance monitoring that needs to be completed. Molly has been given the mandate to determine what needs to be done to bring the DNFB down and still maintain quality, as well as keep current in the compliance monitoring. She pulled together the information shown in the table below. Analyze this situation from every aspect, including but not limited to quality, legal, and management, and answer the following questions: What additional information should Molly gather? What are Molly’s options? How can you ensure quality of coding while at the same time emphasizing volume? What would you recommend to solve Molly’s problems? Data Table Analysis for Discharged Not Final Billed (DNFB) Number of current employees Coding supervisor 1 Coders (all types of charts) 3 Number of vacant positions Coders 1 Volume (average per day) Inpatient 70 Outpatient 177 Emergency Room 122 Outpatient Surgery 90 Productivity Standards (per 8-hour day) Inpatient 25-28 Outpatient 170-185 ER 120-125 Outpatient Surgery 85-100 Amount of time currently spent on compliance issues Hours per week 10 Amount of time that Molly feels should be dedicated to compliance to do it right Hours per week 32 Current DNFB $1.2 million Desired DNFB level $600,000 Aging Current charts (3-day bill hold) 35% 4-10 days old 20% 11-21 days old 15% 22-30 days old 15% More than 30 days old 10% Answers: 1. Molly the coding supervisor of the Homer General Hospital has been unable to effectively monitor the discharged not final billed (DNFB) report, which is much above the limit set by the hospital administration. She is also facing some problems in compliance monitoring. This could be attributed to the lack of long –standing medical records or charts, which leads to missing important patient records during the coding process. Therefore, Molly needs to find out ways to collect the unreported and long standing hospital records. 2. As per the data table , Molly spends 10 hours on an average in settling down compliance issues whereas she feels that she should spent at least 32 hours in doing the same. Therefore, in order to keep current in compliance monitoring along with maintaining the quality she could use automated systems and software to optimize and provide an integrated view of data. Some of the additional problems faced in this regard are the lack of physician documents supporting every treatment. This often hinders the coding process resulting in financial bottlenecks. The use of digitization such as recording and storage of patient’s information within the Electronic Health Records (EHR) can make the coding more swift and accurate (Weaver et al. 2016). 3. Molly can use medical reviewto access the quality of the coded terms along withactive documentation. The process of documentation helps in maintaining accuracy and consistency within the team of coders. Standard monthly metrics and evaluation tool can be used to measure the performance of individual coders (Kontos et al. 2014). High quality output data can be reported when the quality of information reported is maintained with appropriate term selection. The organization need to ensure that continuous oversight of the quantity of data is maintained. The development of standard workflow, defining of benchmarks for quality can improve the quality of coding. Additionally, installation of electronic health records and training the health professionals in using the EHRs to the optimum level can help in uplifting and improving the coding volume (Clack and RHIA, 2015). This can consecutively lower down the number of discharged not billed final reports and improve the bottleneck situation of medical financial layoffs. 4. In order to solve the problem situation faced by Molly a number of steps could be undertaken such as active documentation along with recruitment of more number of coders. In this regard, the coders need to be sufficiently trained in the areas of active digitization. The healthcare scenario has seen a great revolution with the advent of the electronic health records. The EHR provides an effective online interface for the recording and maintaining of the patient records. However, the problem that lies with many hospitals is that still pen and paper mode is still followed for documentation (Lail et al.2016). This makes the entire process of coding much more laborious and time consuming. Therefore, the implementation of such systems can help in faster filing and clearing of the hospital bills. Additionally, integrated e-mail services could be used where all the relevant patient transaction details are sent to them over a mail and could be used for future references. References Clack, C.A. and RHIA, C., (2015). VI. Medical Billing and Reimbursement Systems. Professional Review Guide for the CCS Examinations, p.143. Kontos, E., Blake, K.D., Chou, W.Y.S. and Prestin, A., (2014). Predictors of eHealth usage: insights on the digital divide from the Health Information National Trends Survey 2012. Journal of medical Internet research, 16(7), pp.45-81. Lail, P.J., Laird, S.S., McCall, K., Naretto, J. and York, A., (2016). Facility Closure: How to Get In, Get Out, and Get What Is Important. Perspectives in health information management, 13(Fall), pp.54-67. Weaver, C.A., Ball, M.J., Kim, G.R. and Kiel, J.M., (2016). Healthcare information management systems. Cham: Springer International Publishing,pp.35-67.

HIM 317 Principles Of Health Information Management

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