Quality Standards Coding Audit Results
This is the second assignment in the Virtual Capstone Project. The AHIMA Engage Community has been accessed and has provided valuable information on coding production and quality coding standards. This information supports you as you continue to follow up with the CFO on Dr. Crowe’s physician income issue. The assignment in this module will use a Decision Matrix, which is a popular tool used to assist with complex business choices.
This assignment contains four parts:
- Part 1: Gathering Data: Facility Information
- Part 2: Gathering Data: Connecting with Coding Outsource Companies
- Part 3: Decision Matrix: Locate and Enter Data
- Part 4: Prepare Your Submission
To begin this assignment, first read the scenario below and then perform the steps in the four parts that follow.
Scenario:
The Coding Unit Problem continues to develop. You realize that physician income is directly connected to coding which is part of your department. The status of the Coding Unit is as follows:
- Staffing: 25 FTEs (10 coders are assigned to Physician Office Coding)
- Assignments: Ip, Op, ER, MD Office and Professional Fee Coding
- Staff works Remote, out of office after training complete
- Over the last 4 years, the Coding Unit has had 4 different coding managers.
Alyza obtains coding production and quality standard comparison information on physician office coding from the AHIMA Engage Community. Using the standardized data and her own benchmarks, she compares the data to her current 10 physician coding staff members. Using database queries, she validates that all ten coders are meeting the production standards and then prepares a coding audit from the most recent 3 months to ensure her coders are meeting quality standards. The quality standard is set at 92% which is in line with data obtained from the Engage Community.
Quality Standards Coding Audit Results
As the Director of HIM you report the production and quality findings above to the CFO who is concerned and responds that he wants you to evaluate the possibility of outsourcing the coding work for physician office coders. The CFO went through a complete coding outsource at Rush Memorial and the financial results were very impressive. He further indicates that Fantasticode handled the coding outsource project, and their 15 years of coding experience ensured that the outsource project was successful.
You review outsource decision criteria considerations with him which include 1) financial costs of physician coding, 2) benefit impact of existing coders, 3) years of coding experience, and in addition the CFO acknowledges that any staffing outsource at LiveWell will 4) impact the facility reputation. The CFO directs you to complete research, gather all information and report back with a recommendation in 30 days. He further directs you to keep your data gathering confidential and to work directly with Human Resources for data gathering.
Part 1: Gathering Data: Facility Information
Suzanne, the HR Director, is prepared with data when you arrive to her office. She shares the following information with you:
- Full time employees get insurance benefits at a cost of $500 to LiveWell, per month, per person.
- Part time employees do not get insurance.
- Hokim, Janet, Bernie, and Carol all make $22.00 per hour and are full-time.
- Penny, Vernita, and Shemaya all make $24.00 per hour and are full-time.
- Mila, Marcy, and Tom are part-time and make $22, $24, and $25 per hour respectively.
- All full-timers work 2080 hours per year and part-timers work 1040 hours per year.
You use this information to complete Table 2 below to determine cost of the Physician Office Coding Team. However, Suzanne was unable to provide complete information for you so she left a message with Benefits Specialist, Kathy, regarding one employee benefit, Short Term Disability. Kathy, in turn, left a voicemail with her reply.
Do the following:
- Review Kathy’s voicemail by clicking the link below and extract the information you need from her reply:
- Download the assignment template below and complete Table 2 in the template:
Table 2
The HR director also contacts the Marketing/Public Relations department and requests a Public Relations evaluation. She asks “How will an outsourcing of employee work impact the reputation of LiveWell?” Suzanne doesn’t specify any type of employee, unit, or department. The marketing director provides the following response after a thorough analysis, and in Table 3 below you assign decision scores to the information for use in the Decision Matrix later in this assignment:
Finally, Suzanne also offers you the short list below for benefit consideration which ideally will equate to the benefits that the physician coding employees currently receive at LiveWell.
Benefit Evaluation for Staff
- Life insurance equivalent to LiveWell
- Health insurance coverage and cost comparable to LiveWell
- Vacation time eligibility and provision comparable to LiveWell
- Short term disability provided comparable to LiveWell
LiveWell benefits and those rated as “comparable” will be rated as a 2 in the Decision Matrix. Benefits that exceed LiveWell’s will be rated as a 3, and benefits that fall below will be rated as a 1.
After gathering all LiveWell employee information above, you proceed with data gathering from Coding Outsource Companies.
Part 2: Gathering Data: Connecting with Coding Outsource Companies
To continue and complete the criteria consideration requested by the CFO, you confidentially contact a local coding company, Competent Coding Company (CCC) that you have used periodically over the last 4 years when the workload fell outside of turnaround guidelines. Additionally, a fellow professional whom you graduated from college with and have stayed in touch with uses Midwest HIM Professionals (MHP) which is a nationwide coding company. You request information from both companies and give them a 2 week deadline for the information.
The CFO’s secretary calls you and tells you to expect a call from Fantasticode who will also bid on the physician office coding project. You place all gathered data from the coding companies in the table below.
To complete data gathering for the decision matrix, you prepare Table 5 below which assigns a value to both the Cost Criteria and the Years in Service Criteria.
Part 3: Decision Matrix: Locate and Enter Gathered Data
Use data provided above in Tables 2, 3, 4, and 5 to complete the Decision Matrix below in Table 6. Then total up the scores and use the scoring result to make a recommendation to the CFO in your upcoming meeting. Type your entries into the Module 06 Virtual Capstone Project Template you started to complete in Part 1 of this assignment.
Part 4: Prepare Your Submission
Complete your submission for this assignment as follows:
- Ensure that Tables 2 and 6 of the Module 06 Virtual Capstone Project Template are completed.
- Research the following questions using two different credible resources:
- Why use a Decision Matrix: how is it helpful in the evaluation of complex business decisions?
- How to use a Decision Matrix: what key steps should be followed?
- Add your answers to these questions, in paragraph form, to the end of the Module 06 Virtual Capstone Project Template. Be sure to cite your sources and include an APA-formatted reference page.