Submit the following question to think about as you design this:
Who will be responsible for providing education regarding coding issues?
Who will be responsible for arranging clinical education sessions?
Who will audit charts?
Who will answer coding questions for the coders?
Who will monitor coding improvement and provide progressive discipline when required?
Note: The more administrative duties given to the data quality auditor, the fewer number of charts he or she can review on a daily basis.
Please also include the following:
- A schedule that optimally utilizes the data quality auditor's position before scheduling external reviews that have an additional cost. The data quality auditor's review schedule should be designed not to delay the completion of accounts for billing. If the DQA has piles of charts to review, then the bills are not being released for payment. The workflow must be logical.
- There should be at least one education session per month. The month of September should include an in-service for ICD-9-CM updates, and December should include an in-service for CPT/HCPCS updates. Keep in mind that scheduling too many sessions per month may negatively affect productivity.
Educational topics should be related to clinical areas where there was significant MS-DRG coding variation [Respiratory, Cardiology and Vascular Services].
Educational topics should relate to coding areas identified in the Variation Log by Type of Error including:
- Correct coding of major complications and comorbidities and complications and comorbidities
i. This is again emphasized in the MS-DRG relationship assessment where several pairs of with and without MCC/CC MS-DRGs are reported at a higher rate at the hospital than in the state.
- Correct sequencing of diagnoses
- Specificity of codes
i. A conversation regarding documentation issues may be warranted here.
- Be CREATIVE!
Reporting coding quality statistics:
- How are you going to maintain the coding quality statistics? I