Coder Productivity Benchmarks

Coder Productivity Benchmarks A Special Report An HCPro Publication

Dear reader, Establishing coder productivity standards can be difficult because you must take various factors into account, and there are no apple-to-apple comparisons on which you can base your own requirements. Do your current full-time equivalent (FTE) employees keep your hospital or physician practice running efficiently? Are you looking for ways to justify additional FTEs? How can you establish fair productivity standards that accurately reflect your coders workload? HIM directors and physician practice managers can develop coder productivity standards by learning from their peers, as well as taking into account data that drill down into the factors that affect productivity. This special report includes selected results from HCPro s April 2009 coder productivity survey that polled 215 readers in the following settings: Acute care community hospital (nonteaching): 45% Acute care teaching hospital: 26% Clinic/physician office: 12% Critical access hospital: 7% Freestanding ambulatory surgery center: 5% Freestanding rehab: 2% Freestanding skilled nursing facility: 1% Long-term acute care hospital: 2% The report provides a detailed breakdown of coder productivity according to bed size and record type. In addition, we ll take a look at how working remotely affects productivity. We hope the report will serve as a useful benchmarking tool for you and your organization. Sincerely, Lisa A. Eramo, CPC Senior Managing Editor 781/639-1872, Ext. 3923 leramo@hcpro.com Table of contents Ensure accurate inpatient coder productivity benchmarks........................................ 3 Noncoding duties that affect coder productivity............................................... 4 Set the bar with outpatient coder productivity standards........................................ 5 Outpatient coder productivity standards according to record type................................. 6 Establish benchmarks: Know the factors that affect coder productivity.............................. 8 Factor #1: Bed size................................................................. 8 Factor #2: Record format............................................................. 11 Factor #3: Remote coding............................................................ 13 Use a time ladder and work distribution chart to take a closer look at coder productivity................ 15 2 Coder Productivity Benchmarks: A Special Report

Ensure accurate inpatient coder productivity benchmarks The results of HCPro s April 2009 coder productivity survey highlight two common themes among coding managers and professionals: Productivity should never be the sole focus; hospitals must also address quality concerns The nuances of each facility make assessing productivity difficult The survey found that 23% of the 215 respondents have not established a quality baseline. CMS continued reduction in reimbursement along with an increase in federal and commercial payer oversight and auditing activity mean that HIM departments must establish a quality expectation and mechanisms to monitor it, says Rose T. Dunn, RHIA, CPA, FACHE, chief operating officer at First Class Solutions, Inc., in St. Louis. More than 50% of respondents said they undergo external coding quality audits at least annually or as often as quarterly. Reimbursement changes and an increase in uninsured patients make accurate coding imperative for healthcare providers if they hope to receive the reimbursement to which they are entitled, Dunn adds. The survey also found that 37% of respondents whose facilities have a quality baseline said their expectation is 95% 96%. These providers should conduct an internal or external coding quality review to determine the gap between current performance and this expectation, Dunn says. Assessing the nuances of each facility presents unique challenges, especially when considering coders noncoding responsibilities. Remember that extra tasks should not distract coders from their primary function (i.e., accurately and completely coding the record), Dunn says. See Noncoding duties that affect coder productivity on p. 4 for a summary of the survey findings. These extra tasks, as well as other regulatory changes, affect coder productivity. For example, one respondent from a New York acute care hospital wrote that MS-DRGs increase the amount of time it takes to code a record, thereby decreasing coder productivity. Four respondents laid the blame on present-on-admission (POA) indicators. The lack of national productivity standards, coupled with high productivity expectations, breeds the greatest amount of frustration, according to many survey participants. Coding productivity needs to be reestablished to include expectations for POA indicators reporting, the query process, and abstracting functions, wrote one respondent from a medium-size Texas teaching hospital. Another respondent from a large teaching hospital in Florida added, Across the nation, there does not seem to be an apples-to-apples number for productivity. Coding practices Although there are no national productivity standards, it is possible to establish standards within your facility by looking at how you stack up against other hospitals. To start, use the following statistics from the survey for inpa tient records coded per hour: than 3: 12% 3: 29% 3.5 3.75: 14% 4: 10% than 4: 6% (we don t have a standard): 15% (we don t code this record type): 14% For those who think working remotely breeds lower productivity, think again. Of the 83 respondents who allow a remote option for coders, 43% reported those remote workers have a higher productivity because of the arrangement. Eleven percent reported remote workers had a lower productivity due to reasons such as a slow Internet connection or lack of interaction with coworkers. There is much to consider in coding a record the time to search a subject or getting the little details done, wrote one respondent from an Illinois acute care teaching hospital. n July 2009 3

Noncoding duties that affect coder productivity 80% 78% 70% 64% 60% 58% 60% 50% 49% 40% 39% 34% 30% 28% 20% 10% 20% 20% 20% 18% 12% 13% 10% 11% 7% 18% 14% 21% 17% 12% 11% 0% Answering calls/questions from the business office/patient financial services Answering calls/questions from physician offices Answering coding questions from utilization review/case management Abstracting (cancer registry) Abstracting/collecting occurrence data Abstracting (core measures) Abstracting for the operating room (blood loss, anesthesia type, etc.) Abstracting (performance improvement data) Providing analysis (deficiencies) Appealing denials Assigning POA indicators Assigning working DRGs Assisting with or performing release of information Assisting with or performing transcription Performing clinical documentation improvement activities Filing coded records Handling incomplete records management Obtaining information to support medical necessity Assisting with record assembly Recording retrieval/filing (including inserting loose materials) Responding to recovery audit contractor requests Serving as director/manager of the department Querying physicians to clarify information for more specific coding Source: HCPro s April 2009 coder productivity benchmarking survey. 4 Coder Productivity Benchmarks: A Special Report

Set the bar with outpatient coder productivity standards Establishing coder productivity standards is a necessary and challenging part of running an efficient HIM department. Without standards, coders don t know what directors and managers expect of them and they don t have a productivity goal to which they can aspire. Seventy-three percent of the 215 respondents to HCPro s April 2009 coder productivity survey reported having established a general coding productivity standard. Although having standards is important, the one area in which directors or managers sometimes fail is in monitoring those standards, says Glenn Krauss, RHIA, CCS, CCS-P, CPUR, senior consultant at QHR in Brentwood, TN. Outpatient standards, in particular, aren t monitored as closely because inpatient cases tend to bring in more money, Krauss says. Not revisiting outpatient productivity standards on a weekly or monthly basis for each coder could be a big mistake, he says, adding that if a coder is not performing up to par, it s better to recognize that early on and set realistic goals rather than to realize it during a six-month or annual evaluation. What s challenging about productivity standards is that there s no one-size-fits-all solution, says Joe Rivet, CCS-P, CPC, CEMC, CICA, regulatory specialist at HCPro, Inc., in Livonia, MI. The problem is that people are looking for something that doesn t exist, Rivet says. Every facility is unique. Facilities should really be looking at their operations, flows, and processes to create their own benchmarks for productivity. When monitoring outpatient coding productivity standards, directors and managers should routinely ask the following questions to ensure accurate and fair expectations: Do outpatient coders also code inpatient services? Inpatient and outpatient coding require two different skill sets, says Rivet. The rules between inpatient and outpatient are very different. Outpatient rules are unique, and you use CPT far more than you would on the inpatient side, he says. Because of these differences, productivity standards vary greatly between the two. In smaller facilities, coders typically code both types of records, Rivet says. But larger facilities may have more full-time equivalents, allowing for specialization. One advantage of separating coders according to record type is that it could increase productivity. If you do something all the time, you re going to get to know the types of diseases and procedures that represent the product line and can move more quickly through the encoder or book, Rivet says. A disadvantage is that coders who code only one record type may become bored with the task and yearn for more variety, Krauss says. It s important to distinguish whether coders code inpatient records, outpatient records, or both because each record type has its own challenges. For example, inpatient coders must scour records in search of complications and comorbidities (CC) or major CCs. They must also assign the present-on-admission indicator and follow up with physicians regarding queries for added specificity. On the outpatient side, coders struggle with medically unlikely edits, NCCI edits, modifiers, and verifying medical necessity, Krauss says. All of these factors affect coding productivity. What type of outpatient records do coders code? Outpatient productivity standards could vary greatly depending on the record type. [Interventional radiology] cases or any other type of invasive procedure is more complex than a straightforward ER or clinic visit, Rivet says. See Outpatient coding productivity standards according to record type on p. 6 for specific standards for ambulatory surgery, ED, outpatient testing reports (noninterventional), interventional outpatient testing reports (e.g., cardiac catheterizations and angiographies), clinic visits, and observation. > continued on p. 7 July 2009 5

Outpatient coder productivity standards according to record type Ambulatory surgery records per hour Clinic visit reports per hour We don t code this record type: 17% We don t have a standard: 16% than 8: 7% 8: 6% than 4: 5% 7: 9% 4: 6% 5: 16% 6: 18% We don t code this record type: 44% than 8: 3% 8: 5% We We don t don t have have a a standard: 20% 20% 9: 1% 10: 6% 12: 3% than 12: 17% 11: 1% Observation cases per hour We don t code this record type: 21% than 4: 9% 4: 10% ED records per hour 6: 2% 7: 2% 9: 2% than 6: 2% We don t code this record type: 23% 10: 13% We don t have a standard: 21% than 8: 6% 8: 4% 7: 3% 6: 9% 5: 17% We don t have a standard: 16% than 12: 29% 12: 7% 11: 1% Outpatient testing reports per hour (Non-interventional) (Interventional) We don t code this record type: 28% than 20: 8% 20 25: 19% than 4: 4% We don t code this record type: 27% 4: 6% 5: 12% 6: 8% We don t have a standard: 20% than 31: 13% 26 31: 12% Source: HCPro s April 2009 coder productivity benchmarking survey. We don t have a standard: 18% than 10: 9% 10: 5% 7: 6% 8: 4% 9: 1% 6 Coder Productivity Benchmarks: A Special Report

Set the bar < continued from p. 5 What other noncoding duties do outpatient coders perform? Noncoding duties can greatly affect coding productivity, and you should take them into account when establishing standards, Rivet says. For example, outpatient coders often perform data entry and loose filing, answer phones, order supplies, and retrieve records. Of those respondents who reported that coders code outpatient records only, nearly 63% said they also answer calls and questions from the business office and patient financial services. Fifty-six percent said outpatient-only coders obtain information to support medical necessity. Thirty-eight percent said they respond to recovery audit contractor requests, and another 38% said they answer calls and questions from physician offices. Coders who code for labs, x-rays, or other ancillary departments may need to go to the department to pick up the record, Rivet says. Often, they may need to alphabetize the records as well, and each of these tasks takes time. For which omissions do outpatient coders check? Omissions, such as a missing operative note or pathology report, are perhaps the biggest barrier to an outpatient coder meeting productivity expectations, says Krauss. Of those respondents who reported that coders code outpatient records only, nearly 63% reported that these coders also check for omissions in ambulatory surgery/ outpatient records. Twenty-five percent said they check for omissions in ED records, and another 25% said they check for omissions in outpatient testing records. Is it missing, or did the physician not perform it? If it s not documented, then it didn t happen, Rivet says, adding that outpatient coders must frequently track down missing signatures or attestations for teaching hospitals. What ED services do coders code? In some facilities, coders only code facility ED services, whereas in others, they code facility and professional services, Rivet says. When coders code both, adjust productivity standards accordingly. Twenty-seven percent of respondents reported that coders assign diagnoses on the physician s bill, 20% said they assign procedures on the physician s bill, and 27% said they assign the physician E/M level. What is the skill level of the individual coder? When setting productivity goals, take coders skill sets into account, particularly when the coder is new to the organization, Rivet says. Even if the person is seasoned but new to the organization, there should be some ramp up, he says. Set goals for one month, two months, three months, etc., into the employment. Although it s important to consider a coder s skill set when determining whether he or she can reasonably meet predetermined standards, directors and managers shouldn t set standards solely based on skills, Krauss says. If you have too many standards, it defeats the purpose and is not a standard anymore, he adds. If someone is not meeting the standard, figure out what you can do to help that person get where he or she needs to be. n One-stop shop for HIM resources To help increase the efficiency of your HIM department, consider adding these HCPro resources to your toolbox: Coding Productivity: Tapping Your Team s Talents to Improve Quality and Reduce Accounts Receivable The HIM Director s Handbook More With Less: Best Practices for HIM Directors, Second Edition To learn more about the results of HCPro s April 2009 coder productivity survey, purchase a copy of HCPro s audio conference Benchmark Coder Productivity to Improve and Justify FTEs. For more information about any of these products, call HCPro s customer service department at 877/727-1728. July 2009 7

Establish benchmarks: Know the factors that affect coder productivity Bed size, record format, and remote coding can greatly affect inpatient and outpatient coder productivity. Below are graphic representations of findings from HCPro s April 2009 coder productivity benchmarking survey. Factor #1: Bed size Observation cases Number of beds than 4 4 5 6 7 8 than 8 (we don t have a standard or performance expectation) (we don t code this record type) than 75 26% 14% 17% 37% 0% 11% 8% 33% 35% 75 150 11% 19% 17% 5% 14% 11% 23% 17% 20% 151 226 32% 19% 14% 0% 14% 11% 15% 7% 2% 227 302 16% 10% 6% 16% 0% 11% 8% 2% 2% 303 378 16% 10% 6% 16% 0% 11% 0% 4% 2% 379 454 0% 0% 11% 0% 14% 22% 8% 2% 4% 455 530 0% 10% 3% 5% 14% 0% 8% 2% 2% 531 606 0% 0% 3% 0% 14% 11% 0% 0% 4% 607 682 0% 0% 14% 0% 0% 0% 0% 2% 0% 683 758 0% 5% 0% 5% 0% 0% 0% 4% 0% 759 834 0% 5% 0% 0% 14% 0% 8% 0% 0% 835 910 0% 0% 0% 5% 0% 0% 8% 0% 4% 911 986 0% 0% 0% 0% 14% 0% 0% 0% 0% than 986 0% 10% 6% 5% 0% 11% 0% 7% 0% 0% 0% 3% 5% 0% 0% 15% 20% 24% Clinic visits Number of beds than 8 8 9 10 11 12 than 12 (we don t have a standard or performance expectation) (we don t code this record type) than 75 17% 20% 0% 15% 0% 29% 16% 21% 34% 75 150 0% 30% 0% 23% 0% 14% 22% 19% 13% 151 226 17% 20% 0% 15% 0% 0% 5% 9% 13% 227 302 17% 0% 50% 8% 0% 14% 5% 5% 6% 303 378 33% 10% 50% 15% 50% 14% 3% 0% 5% 379 454 0% 0% 0% 0% 0% 14% 8% 2% 6% 455 530 0% 0% 0% 0% 0% 0% 11% 2% 3% 531 606 0% 10% 0% 0% 0% 0% 0% 0% 4% 607 682 0% 0% 0% 15% 50% 0% 3% 0% 2% 683 758 0% 0% 0% 8% 0% 0% 0% 5% 1% 759 834 0% 10% 0% 0% 0% 0% 0% 0% 2% 835 910 0% 0% 0% 0% 0% 0% 3% 0% 3% 911 986 0% 0% 0% 0% 0% 0% 0% 0% 1% than 986 0% 0% 0% 0% 0% 0% 11% 5% 3% 17% 0% 0% 0% 0% 14% 14% 33% 3% 8 Coder Productivity Benchmarks: A Special Report

Establish benchmarks: Know the factors that affect coder productivity (cont.) Interventional outpatient testing reports (e.g., cardiac caths and angiographies) Number of beds than 4 4 5 6 7 8 9 10 than 10 (we don t have a standard or performance expectation) (we don t code this record type) than 75 13% 8% 16% 11% 0% 13% 0% 30% 47% 24% 38% 75 150 13% 8% 12% 11% 17% 25% 50% 20% 5% 22% 18% 151 226 13% 33% 16% 17% 8% 0% 0% 10% 5% 5% 10% 227 302 13% 0% 8% 6% 17% 0% 0% 10% 11% 5% 5% 303 378 13% 8% 4% 17% 17% 0% 0% 0% 11% 5% 3% 379 454 0% 8% 16% 11% 8% 0% 0% 0% 11% 2% 0% 455 530 13% 8% 4% 6% 8% 0% 0% 0% 5% 2% 2% 531 606 0% 0% 8% 0% 8% 13% 0% 0% 0% 0% 2% 607 682 0% 8% 8% 0% 0% 25% 0% 10% 0% 0% 0% 683 758 0% 0% 0% 6% 0% 13% 0% 0% 0% 2% 2% 759 834 0% 0% 0% 0% 8% 13% 0% 0% 0% 0% 2% 835 910 0% 0% 0% 6% 0% 0% 0% 10% 0% 0% 3% 911 986 0% 0% 0% 0% 8% 0% 0% 0% 0% 0% 0% than 986 13% 17% 4% 6% 0% 0% 50% 0% 0% 5% 2% 13% 0% 4% 6% 0% 0% 0% 10% 5% 27% 13% Outpatient testing reports (non-interventional) Number of beds than 20 20 25 26 31 than 31 (we don t have a standard or performance expectation) (we don t code this record type) than 75 22% 20% 8% 28% 35% 29% 75 150 11% 10% 35% 24% 16% 10% 151 226 17% 22% 8% 10% 7% 5% 227 302 11% 5% 8% 10% 5% 5% 303 378 11% 15% 8% 3% 0% 5% 379 454 6% 2% 8% 14% 2% 3% 455 530 6% 2% 12% 3% 2% 2% 531 606 6% 0% 0% 0% 0% 7% 607 682 6% 7% 0% 0% 2% 2% 683 758 0% 0% 4% 0% 2% 3% 759 834 0% 2% 0% 0% 0% 3% 835 910 0% 2% 0% 0% 0% 5% 911 986 0% 2% 0% 0% 0% 0% than 986 6% 2% 8% 3% 5% 3% 0% 7% 4% 3% 23% 16% > continued on p. 10 July 2009 9

Establish benchmarks: Know the factors that affect coder productivity (cont.) ED records Number of beds than 6 6 7 8 9 10 11 12 than 12 (we don t have a standard or performance expectation) (we don t code this record type) than 75 25% 50% 20% 0% 25% 19% 50% 20% 14% 40% 35% 75 150 0% 0% 0% 43% 0% 7% 0% 40% 21% 11% 14% 151 226 25% 0% 20% 43% 25% 7% 0% 13% 14% 9% 2% 227 302 0% 0% 20% 0% 0% 7% 50% 0% 11% 3% 4% 303 378 25% 25% 20% 0% 25% 4% 0% 20% 10% 0% 0% 379 454 0% 0% 0% 0% 0% 19% 0% 7% 6% 0% 2% 455 530 0% 0% 0% 0% 25% 0% 0% 0% 6% 3% 4% 531 606 0% 0% 0% 0% 0% 7% 0% 0% 2% 0% 4% 607 682 0% 0% 20% 0% 0% 15% 0% 0% 2% 0% 0% 683 758 0% 0% 0% 0% 0% 4% 0% 0% 3% 3% 0% 759 834 0% 25% 0% 0% 0% 0% 0% 0% 0% 0% 4% 835 910 0% 0% 0% 0% 0% 4% 0% 0% 2% 0% 4% 911 986 0% 0% 0% 0% 0% 0% 0% 0% 2% 0% 0% than 986 0% 0% 0% 14% 0% 7% 0% 0% 3% 9% 2% 25% 0% 0% 0% 0% 0% 0% 0% 5% 23% 25% Ambulatory surgery records Number of beds than 4 4 5 6 7 8 than 8 (we don t have a standard or performance expectation) (we don t code this record type) than 75 20% 23% 11% 21% 10% 23% 27% 43% 36% 75 150 10% 23% 20% 8% 15% 23% 20% 14% 19% 151 226 30% 23% 11% 13% 15% 0% 20% 6% 0% 227 302 0% 0% 11% 8% 15% 8% 0% 3% 6% 303 378 20% 8% 6% 11% 10% 8% 7% 0% 3% 379 454 0% 0% 14% 11% 0% 15% 0% 0% 0% 455 530 0% 15% 0% 5% 10% 0% 7% 3% 0% 531 606 0% 0% 6% 0% 5% 8% 0% 0% 3% 607 682 0% 8% 6% 3% 10% 0% 0% 0% 0% 683 758 10% 0% 3% 5% 0% 0% 0% 0% 0% 759 834 0% 0% 0% 3% 5% 0% 0% 0% 3% 835 910 0% 0% 0% 3% 0% 0% 7% 0% 6% 911 986 0% 0% 0% 0% 5% 0% 0% 0% 0% than 986 0% 0% 9% 5% 0% 8% 0% 6% 3% 10% 0% 3% 5% 0% 8% 13% 26% 22% 10 Coder Productivity Benchmarks: A Special Report

Establish benchmarks: Know the factors that affect coder productivity (cont.) Inpatient records Number of beds than 3 3 3.5 3.75 3.76 4 than 4 (we don t have a standard or performance expectation) (we don t code this record type) than 75 20% 20% 3% 38% 8% 46% 37% 75 150 12% 14% 20% 19% 17% 18% 17% 151 226 16% 13% 17% 10% 17% 6% 0% 227 302 8% 9% 17% 5% 0% 0% 0% 303 378 4% 9% 10% 14% 8% 0% 0% 379 454 4% 11% 7% 5% 0% 0% 0% 455 530 0% 6% 3% 0% 8% 3% 3% 531 606 0% 6% 0% 0% 0% 0% 3% 607 682 4% 3% 7% 5% 0% 0% 0% 683 758 8% 2% 0% 0% 8% 0% 0% 759 834 0% 2% 3% 0% 8% 0% 0% 835 910 8% 2% 3% 0% 0% 0% 0% 911 986 4% 0% 0% 0% 0% 0% 0% than 986 8% 2% 10% 0% 8% 6% 0% 4% 2% 0% 5% 17% 21% 40% Factor #2: Record format Observation cases Record type than 4 4 5 6 7 8 than 8 (we don t have a standard or performance expectation) (we don t code this record type) The entire record is online 53% 48% 31% 42% 14% 22% 31% 13% 13% Most transcribed reports and lab data are online and/or some documents are scanned 0% 10% 14% 16% 0% 0% 8% 15% 13% The entire record is paper-based 16% 10% 11% 11% 0% 33% 15% 20% 41% The record is partially online and partially paper-based 32% 33% 43% 32% 86% 44% 46% 52% 33% Clinic visits Record type than 8 8 9 10 11 12 than 12 (we don t have a standard or performance expectation) (we don t code this record type) The entire record is online 50% 40% 50% 46% 0% 0% 35% 14% 26% Most transcribed reports and lab data are online and/or some documents are scanned 0% 10% 50% 8% 50% 14% 14% 19% 6% The entire record is paper-based 17% 0% 0% 0% 50% 14% 16% 28% 24% The record is partially online and partially paper-based 33% 50% 0% 46% 0% 71% 35% 40% 43% > continued on p. 12 July 2009 11

Establish benchmarks: Know the factors that affect coder productivity (cont.) Interventional outpatient testing reports (e.g., cardiac caths and angiographies) Record type than 4 4 5 6 7 8 9 10 than 10 (we don t have a standard or performance expectation) (we don t code this record type) The entire record is online 50% 50% 40% 50% 25% 50% 50% 20% 16% 10% 20% Most transcribed reports and lab data are online and/or some documents are scanned 0% 8% 8% 11% 17% 0% 0% 20% 11% 24% 5% The entire record is paper-based 13% 0% 16% 11% 17% 13% 0% 0% 21% 22% 35% The record is partially online and partially paper-based 38% 42% 36% 28% 42% 38% 50% 60% 53% 44% 40% Outpatient testing reports (non-interventional) Record type than 20 20-25 26-31 than 31 (we don t have a standard or performance expectation) (we don t code this record type) The entire record is online 56% 32% 35% 28% 12% 22% Most transcribed reports and lab data are online and/or some documents are scanned 11% 12% 12% 7% 19% 7% The entire record is paper-based 0% 10% 15% 28% 23% 31% The record is partially online and partially paper-based ED records Record type 33% 46% 39% 38% 47% 40% than 6 6 7 8 9 10 11 12 than 12 (we don t have a standard or performance expectation) (we don t code this record type) The entire record is online 50% 50% 20% 43% 50% 44% 50% 27% 27% 11% 20% Most transcribed reports and lab data are online and/or some documents are scanned 0% 25% 40% 0% 25% 7% 0% 0% 11% 17% 10% The entire record is paper-based 25% 0% 20% 14% 0% 4% 0% 13% 19% 26% 35% The record is partially online and partially paper-based Ambulatory surgery records Record type 25% 25% 20% 43% 25% 44% 50% 60% 43% 46% 35% than 4 4 5 6 7 8 than 8 (we don t have a standard or performance expectation) (we don t code this record type) The entire record is online 70% 39% 31% 34% 30% 15% 20% 6% 25% Most transcribed reports and lab data are online and/or some documents are scanned 10% 8% 11% 18% 0% 8% 13% 14% 8% The entire record is paper-based 10% 8% 11% 8% 15% 23% 33% 29% 39% The record is partially online and partially paper-based 10% 46% 46% 40% 55% 54% 33% 51% 28% 12 Coder Productivity Benchmarks: A Special Report

Establish benchmarks: Know the factors that affect coder productivity (cont.) Inpatient records Record type than 3 3 3.5 3.75 3.76 4 than 4 (we don t have a standard or performance expectation) (we don t code this record type) The entire record is online 44% 27% 50% 24% 33% 6% 13% Most transcribed reports and lab data are online and/or some documents are scanned 12% 6% 10% 10% 8% 18% 17% The entire record is paper-based 20% 14% 10% 19% 17% 30% 37% The record is partially online and partially paper-based 24% 53% 30% 48% 42% 46% 33% Factor #3: Remote coding 1. Do you offer a remote (at home) coding option for your employed coders? 2. If you do have a remote coding program, have you noticed any differences in productivity for your remote staff members? 53% No, and we don t have any plans to do so in the near future 34% Yes 46% No, their productivity has remained the same 43% Yes, they have a higher productivity 13% 11% No, but we re planning on implementing Yes, they have a lower productivity one in the next 12 months > continued on p. 14 July 2009 13

Establish benchmarks: Know the factors that affect coder productivity (cont.) 3. If your remote coders have a lower productivity, which of the following have you noticed? Please check all that apply. Coders have battled slow Internet connections Coders have encountered disconnects and other connectivity issues Some coders have lacked motivation/self-discipline Some coders have experienced home interferences (e.g., children and spouses) Some coders have complained about the lack of coworker interaction, particularly when they have coding-related questions 50% 50% 40% 38% 38% 30% 25% 20% 10% 6% 0% Source: HCPro s April 2009 coder productivity benchmarking survey. 14 Coder Productivity Benchmarks: A Special Report

Use a time ladder and work distribution chart to take a closer look at coder productivity HIM directors may need to capture data to identify activities that are time-wasters for coders and that can be done more cost-effectively by other staff members. One tool that is helpful in capturing such data is the time ladder (see p. 16). The employee completes the time ladder throughout the day at given intervals. At the end of a given period, usually not less than 10 working days, the manager compiles the ladders to determine the amount of time spent on the given activities and whether it is appropriate to assign some activities to other employees. Once the reassignment is made, the proportionate amount of time is returned to the individual to perform his or her designated duties. To view the distribution of work (based on one day s input from the time ladder), see Distribution of work time by function below. From the time ladder example, you can see that Carolyn Coder has several duties that qualify for evaluation, such as covering the phone for the receptionist and filing records. If the manager reassigned the receptionist and filing duties to others, Carolyn would capture 113 minutes in this day, or nearly two hours, to do coding. Additionally, unless Carolyn s extended lunch is authorized by the organization, the manager may wish to speak to Carolyn about it. However, HIM recognizes that there are activities that need the input of professional coders, such as: Charge master maintenance Documentation improvement Quality Improvement Organization (formerly known as the professional review organization) findings or thirdparty payer coding related denials The time away from coding can be significant, but it is a necessity in many organizations. And in many instances, coders who enjoy variety in their days may find it rewarding to be involved in such activities. Forbidding their involvement may cause job dissatisfaction and result in the loss of quality coding professionals to another organization. Therefore, the HIM manager must balance the need for high and accurate coding production with the need to maintain employee satisfaction. Distribution of work time by function Function Time spent Percent of total time Coding 240 minutes 240/480 = 50% Covering for the receptionist 45 minutes 45/480 = 9.4% Filing records/documentation 68 minutes 68/480 = 14.2% Searching for documentation 45 minutes 45/480 = 9.4% Business-related calls 15 minutes 15/480 = 3.1% Breaks 37 minutes 37/480 = 7.7% Other (printing) 30 minutes 30/480 = 6.2% Total 480 minutes Productive time 428/480 minutes 89.2% > continued on p. 16 July 2009 15

Use a time ladder and work distribution chart to take a closer look at coder productivity (cont.) Time ladder for employee: 7:00 7:15 7:30 7:45 8:00 8:15 8:30 8:45 9:00 9:15 9:30 9:45 10:00 10:15 10:30 10:45 11:00 11:15 11:30 11:45 12:00 12:15 12:30 12:45 1:00 1:15 1:30 1:45 2:00 2:15 2:30 2:45 3:00 3:15 3:30 3:45 4:00 4:15 Time ladder Time ladder for employee: Carolyn Coder 7:00 Inpt charts 7:15 Inpt charts 7:30 Searching for missing cases 7:45 Call from business office 8:00 Inpt charts 8:15 Ambi surg 8:30 Ambi surg 8:45 Ambi surg 9:00 Ambi surg 9:15 Break 9:30 Inpt charts 9:45 Inpt charts 10:00 Inpt charts 10:15 Restroom 10:30 Inpt charts 10:45 Inpt charts 11:00 Inpt charts 11:15 Inpt charts 11:30 Lunch 11:45 Lunch 12:00 Lunch 12:15 Searching for path reports 12:30 Searching for path reports 12:45 Printing dictated report 1:00 Covering phone for receptionist 1:15 Covering phone for receptionist 1:30 Covering phone for receptionist 1:45 Inserting paths and dictated reports 2:00 Inserting paths and dictated reports 2:15 Ambi surg 2:30 Ambi surg 2:45 Restroom/filing records in incomplete 3:00 Filing records in incomplete 3:15 Filing records in incomplete 3:30 3:45 4:00 4:15 Source: Coder Productivity: Tapping Your Team s Talents to Improve Quality and Reduce Accounts Receivable, published by HCPro, Inc. 07/09 SR4309 This special report is published by HCPro, Inc., 200 Hoods Lane, Marblehead, MA 01945. Copyright 2009 HCPro, Inc. All rights reserved. Printed in the USA. Except where specifically encouraged, no part of this publication may be reproduced, in any form or by any means, without prior written consent of HCPro, Inc., or the Copyright Clearance Center at 978/750-8400. Please notify us immediately if you have received an unauthorized copy. For editorial comments or questions, call 781/639-1872 or fax 781/639-2982. Opinions expressed are not necessarily those of the editors. Mention of products and services does not constitute endorsement. Advice given is general, and readers should consult professional counsel for specific legal, ethical, or clinical questions. HCPro, Inc., is not affiliated in any way with The Joint Commission, which owns the JCAHO and Joint Commission trademarks. 16 Coder Productivity Benchmarks: A Special Report