There is no one “correct” answer to this exercise. However, some key items should be found on the students on-going review and monitoring schedule.
The student should make a distinction between the duties of the coding manager and the data quality auditor in regards to the plan.
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/she can review on a daily basis
The student should develop 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 to not delay the completing 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. But there should also not be too many sessions per month so that productivity is not negatively affected.
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.
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