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.
Expert Solution Preview
The ongoing review and monitoring schedule for medical college students should include the following key items. Firstly, a distinction should be made between the duties of the coding manager and the data quality auditor in regards to the plan, with clear identification of responsibilities for providing education on coding issues, arranging clinical education sessions, auditing charts, answering coding questions for coders, and monitoring coding improvement. Secondly, a schedule should be developed that optimally utilizes the data quality auditor’s position before scheduling external reviews, with consideration given to not delaying completing accounts for billing and ensuring a logical workflow. Thirdly, there should be at least one education session per month, with topics related to areas of significant MS-DRG coding variation and coding areas identified in the Variation Log by Type of Error, such as correct coding of major complications and comorbidities and correct sequencing and specificity of codes. Lastly, it is important to note that the more administrative duties given to the data quality auditor, the fewer charts they can review on a daily basis.
