Diagnose Your Coding Problems

At their best, clinical coding departments produce high-quality, consistent, timely data for reimbursement and reporting. However, when people, processes, or systems are faulty, organizations begin to experience chronic aches and pains--primarily financial. The three most common coding ailments are staffing issues, problems with quality and consistency, and low coder productivity, which usually manifest themselves through a low or fluctuating case mix. By accurately diagnosing and treating the core issue, providers can take a more active role in improving coding outcomes--and enhancing fiscal health.

Accurately Diagnosing the Problem

Case mix index is used in many ways by healthcare organizations. CMI reflects the mean weight of the various diagnosis-related groups assigned to hospital patients. It is considered a marker for the severity of illness treated within a facility, and it is tracked by Medicare. Equally important, CMI is often used by healthcare executives as the barometer of coding success.

If the CMI falls below the annual budgeted indicator, the first place executives turn is to health information management, specifically coding. If the case mix is higher than budgeted, it may be an indicator of overcoding. If the ease mix is lower than budgeted, it may be the reverse, undercoding. As a benchmark, CMI should be monitored monthly at a minimum, and if significant fluctuations are occurring, a closer look is warranted. Any change in services provided, patient population served, or staffing within the coding department could impact CMI (see the exhibit on page 101). Although CMI might be the first indication of coding problems, the root cause can often be related to several factors outside the coding area.

Within the coding realm, there are three key issues that impact CMI: staffing, quality, and productivity.

Staffing Issues: The Common Cold of Coding

The most common staffing issue provider organizations face is the recruitment and retention of highly qualified coders. If your organization is experiencing problems in this area, you are not alone. In fact, a recent American Heakh Information Management Association survey found that 82 percent of hospitals nationwide have difficulty finding the qualified coders they need (Friedman, B., "Coding Technology Today: AHIMA Survey Sheds Light on Coding's Progress Toward Automation," Journal of AHIMA, April 2006, pp. 66-68). And 20 percent of HIM directors surveyed state that staffing is their top management issue (Meadoweraft, T., "HIM Salary Survey," For the Record, June 26, 2006, pp. 16-20). Staffing issues are most simply identified through ongoing coder vacancies.