Summary statement about the coding unit’s quarterly performance

As a leader and manager, the health information administrator is responsible for monitoring and evaluating the performance of processes. This responsibility requires the manager to determine key performance indicators to be included in the monitoring and evaluation process.

You are the HIM director at Grey’s Hospital. You are a member of the revenue cycle department and are charged with monitoring and evaluating key HIM RC processes that impact the stability and health of the facility’s revenue cycle.

During the claims, production process claims are scrubbed and modified to ensure that a clean claim is submitted to the payer. Grey’s Hospital tracks claims through this process so that inefficiencies in the RC can be addressed. Below are the claims production data for June through August. The HIM coding unit’s clean claim metric standard is 95 percent.

Prepare a summary statement about the coding unit’s quarterly performance. Create a graphic display that summarizes the coding unit’s performance in relation to their standard. Is the unit performing as expected, or is there a need for a root cause analysis and process improvement? If there is room for improvement, brainstorm some ways the coding manager could educate the staff.

 

Claim Production Quarterly Report—Grey’s Hospital

 

 

Claim Issue Identified by Scrubber

 

 

Number of Claims Requiring Rework Prior to Submission

 

 

June

 

 

July

 

 

August

 

 

5,500 claims processed

 

 

6,200 claims processed

 

 

5,850 claims processed

 

 

Claim failed patient identifier edits

 

 

115

 

 

213

 

 

137

 

 

Claim failed provider identifier edits

 

 

12

 

 

5

 

 

21

 

 

Claim failed coding/modifier edits

 

 

220

 

 

496

 

 

351

 

 

Claim failed date of service edits

 

 

10

 

 

25

 

 

14

 

 

 

 

 

 

 

 

 

 

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