Practical Guide to Coding Practical Guide to Coding …

1 A division of BLRP ractical Guide to Coding ManagementRose T. Dunn, MBA, RHIA, CPA, FACHE, FHFMAThe change to ICD-10 impacted more than just code selection. It affected coder productivity and accuracy, the number of available coders, the need for coder education and training, and the increased need for auditing all core responsibilities and issues that Coding managers now face in this post-ICD-10 world. The old rules and standards for running a department no longer apply, and Coding managers must update their efforts just as the coders themselves did.

2 This book gives readers new benchmarks, standards, and tips to ensure they re running an effective department. It provides strategies to retain coders and best practices on how to balance internal and outsourced coders, as well as how to manage on-site and remote staff. This book provides much-needed information for managers on how to educate their teams on the role of Coding within the revenue cycle as a Winners Circle, Suite 300 Brentwood, TN PGCMP ractical Guide to Coding ManagementRose T. Dunn, MBA, RHIA, CPA, FACHE, FHFMAJustCoding's Practical Guide to Coding management | Rose T.

3 Dunn, MBA, RHIA, CPA, FACHE, 110/18/16 12:58 PMPractical Guide to Coding ManagementRose T. Dunn, MBA, RHIA, CPA, FACHE, FHFMAJustCoding s Practical Guide to Coding management is published by HCPro, a division of 2016 HCPro, a division of BLRAll rights reserved. Printed in the United States of America. 5 4 3 2 1 ISBN: 978-1-68308-088-6No part of this publication may be reproduced, in any form or by any means, without prior written consent of HCPro or the Copyright Clearance Center (978-750-8400).

4 Please notify us immediately if you have received an unauthorized provides information resources for the healthcare industry. HCPro is not affiliated in any way with The Joint Commission, which owns the JCAHO and Joint Commission T. Dunn, MBA, RHIA, CPA, FACHE, FHFMA, AuthorAmanda Tyler, EditorMelissa Osborn, Product DirectorErin Callahan, Vice President, Product Development & Content StrategyElizabeth Petersen, Executive Vice President, HealthcareMatt Sharpe, Production SupervisorVincent Skyers, Design Services DirectorVicki McMahan, Sr.

5 Graphic DesignerSusan Robinson, Graphic DesignReggie Cunningham, Cover DesignerAdvice given is general. Readers should consult professional counsel for specific legal, ethical, or clinical questions. Arrangements can be made for quantity discounts. For more information, contact:HCPro100 Winners Circle, Suite 300 Brentwood, TN 37027 Telephone: 800-650-6787 or 781-639-1872 Fax: 800-785-9212 Email: HCPro online at and s Practical Guide to Coding management | iii 2016 HCProTable of ContentsAbout the Author.

6 ViiAcknowledgments ..ixChapter 1: Introduction to Coding and management ..1 What Is Coding ? ..1 When Did Coding Begin? ..2 Who Are Coders? ..3 What Is management ? ..4 Chapter 2: Effective Coding Work Environment ..11 Organizing the Coding Function ..11 Other Coding Cycle ..22 Scheduling ..23 Location and Space ..25 Workspace, Equipment, and Technology ..27 Reporting Structure ..29 Chapter 3: Staffing the Coding Function ..35 Staffing Considerations ..35 How Much Staff Is Needed ..38iv | JustCoding s Practical Guide to Coding management 2016 HCProRecruiting Applicants.

7 42 Interviewing Applicants ..43 Orienting the New Employee ..45 When the Right Applicant Can t Be Found ..46 Scheduling ..50 Chapter 4: Coding Compliance and External Forces ..53 Compliance Compliance Initiatives ..53 Other Coding Compliance Requirements ..56 Chapter 5: Coding Compliance Policies and Plans ..67 Coding Compliance Policy ..68 Coding Compliance Plan ..68 Coding Audits ..75 Implementing the Plan ..78 Selecting the Audit Sample ..82 Calculating Accuracy ..84 Chapter 6: ICD-10 and Its Impact on Productivity.

8 91 Transitioning to ICD-10 ..91 Addressing the Productivity Loss ..96 Challenges to Coding Within the 'Hold' Period ..97 Using Benchmarks ..98 Collecting Data From Your Team ..98 Communicating the Expectation ..102 What Are Other Organizations Seeing? ..103 Fair Distribution of Work ..105 Chapter 7: Physician Documentation ..107At the Office ..108 Helping the Physician Help Us ..108 Clinical Documentation Improvement Programs ..110 JustCoding s Practical Guide to Coding management | v Table of Contents 2016 HCProCan Technology Help?

9 114Is This Fraud? ..114 CDIP Effectiveness ..115 Summary ..117 Chapter 8: Unique Challenges and Uses of Coded Data ..119 Hospital and Healthcare Organization Quality Measures ..119 Patient Safety Initiatives ..121 Registry Reporting .. 123 ICD-11 ..126 Chapter 9: Coding s Role in the Revenue Cycle ..129 Coding Connects the Cycle ..130 Coverage Approvals (Precertification vs. Preauthorization) ..131 Patient Access ..132 Case management ..133 Patient Care ..134 Patient Financial Services ..134 Health Information management .

10 135 Denial management ..136 Decision Support ..138 Managed Care Contracting ..139 Finance ..139 Credentialing ..139 Summary ..139 Chapter 10: Summarizing Important Points ..141 JustCoding s Practical Guide to Coding management | vii 2016 HCProAbout the AuthorRose T. Dunn, MBA, RHIA, CPA, FACHE, FHFMARose T. Dunn, MBA, RHIA, CPA, FACHE, FHFMA, is a past president of the American Health Information management Association (AHIMA) and recipient of its 1997 Distinguished Member and 2008 Legacy Awards. In 2011, Dunn served as the interim chief executive officer of AHIMA and received a Distinguished Service Award from the board of directors.