Coding Audit and Reporting Written Assignment
Learning Objectives:
Upon completion of this assignment the student will be able to:
- Analyze and present quality data in graphical format.
- Assess performance based on policy guidelines.
- Graphically present the findings
- Formulate decision making and plan of action
Scenario: You have been promoted to the position of Coding Manager at National Medical Center (NMC) and are responsible for five (5) full-time and three (3) part-time coders. On a quarterly basis you, the Coding Manager, are required to complete a coding audit and prepare summary reports for each coder.
Recent Audit Results: The former Coding Manager completed the recent 4th Quarter audit, but she was not able to complete any of the reports prior to her departure. She has left you with the following audit information on a piece of scratch paper:
Coder 1 88.6%
Coder 2 96%
Coder 3 98.9%
Coder 4 92%
Coder 5 89.9%
Coder 6 94.6%
Coder 7 81%
Coder 8 91%
You do not know the coding accuracy policy, so you locate the following information in the policy and procedure manual:
Coding Quality Policy: NMC must uphold a high level of coding accuracy expectations to meet internal, Joint Commission, Medicare standards, and other regulatory expectations. In order to assure compliance with these standards, each coder will be audited on a quarterly basis through review of a random sample of their work. The following quality standards are expected:
- A random sample of 20 charts will result in a 94% or higher accuracy rate.
- Coders in their first six (6) months will remain on probation and will be expected to reach a 94% accuracy rate by the end of the probation period.
- Coders in their probation period are expected to reach at least an 80% accuracy rate leading to the 94% standard at the end of six (6) months. A continuous improvement is expected over the duration of the probationary period.
- A coder not meeting the quality standard will be put on a continued education plan developed by the Coding Manager.
- The Coding Manager will work with the coder on a regular basis to monitor training and improvement;
- The next quarterly audit should show improvement up to the 94% standard;
- If a coder does not meet the standard in two consecutive audits, they will be put on probation for three (3) months. The next audit, after the three (3) month probation must convey the 94% standard or the coder will be subject to termination.
Complete the following tasks:
- Create a memo to your supervisor, Mary Jones, Director of HIM. Be sure to be professional, accurate and specific about the actions that you are recommending. Search for Logo Memo in MS Word if you are unfamiliar with memo format.
- Open your memo with an introduction describing your approach to this audit.
- Describe what additional information you should collect to comply with the policy.
- Create an Excel spreadsheet. Enter the information that you found in previous audit files (below) along with the 4th Quarter audit summary information that the previous manager left for you.
- Construct one bar chart showing the history for each of the coders.
- Copy and paste the bar chart into your memo.
- Describe your findings. Use the additional information collected (below).
- Conclude your memo with the decisions you propose to the following questions:
- Which coders are concerns and why? List each one that you are concerned with and be specific about the part(s) of the policy in question.
- Which coder(s) require an education plan?
- Do any coders need to be placed on probation?
- Do any coders need to be considered for termination?
- Are any coders in their probationary period in jeopardy of not meeting the probationary expectations?
- Submit the memo and Excel spreadsheet to the assignment link in Blackboard.
Previous audit results:
| CODER | QUARTER 1 | QUARTER 2 | QUARTER 3 |
| 1 | 82% | 86% | 94% |
| 2 | 96.8% | 98% | 95.2% |
| 3 | 92% | 97% | 96.9% |
| 4 | 92% | 94% | 94% |
| 5 | 87% | 91% | 89% |
| 6 | 94.9% | 95.2% | 94.9% |
| 7 | NA | NA | NA |
| 8 | 97.2% | 94% | 96% |
Additional information collected: Collected from each of the coders’ files and prepared in table format to define their employment status.
| CODER | LENGTH OF EMPLOYMENT | NOTES |
| 1 | 1 year | |
| 2 | 7 years | |
| 3 | 4 years | |
| 4 | 11 years | |
| 5 | 1 year | 2ND Probation |
| 6 | 2 years | |
| 7 | 42 days | Address weak areas |
| 8 | 2 years | Sudden drop |
RUBRIC: Introduction and content (5 points), Excel format and graph (5 points), decision and conclusion (10 points), memo format, spelling, grammar, mechanics (5 points)
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