Use the following self-assessment tool to ensure that you have key processes covered ("yes" is the preferred response for each process). Then, check your performance measures against the better-practice target levels in the performance indicator section.
Health Information Management (HIM)
1. Health information management staff report to the Chief Revenue Officer.
2. Use on-line DRG and APC groupers.
3. Use an on-line, bar-code enabled chart location system.
4. Use an on-line, scanning-enabled HIM records imaging system.
5. Use an on-line or voice-recognition transcription system.
6. Use an on-line clinical abstracting system.
7. Enable physicians to view and e-sign records outside the hospital.
8. Ensure the storage, retrieval, and release of records is HIPAA-compliant.
9. Use an on-line, up-to-date coding compliance system.
10. All coding is done by employees who report to the HIM director.
11. All coding is done by certified coders who are retrained at least semi-annually.
12. All certified coders maintain their certification and CPEs.
13. All coding done is in descending balance order, not first in/first out.
14. All coding done when information is sufficient, not 100% complete.
15. HIM staff receive and discuss denials information provided by PFS or others.
16. HIM staff provide and discuss denials and delinquency information with physicians.
17. Establish an effective tracking system to locate missing records.
18. Have appropriate staffing levels to prevent processing backlogs.
19. Consistently monitor and control Discharged-Not-Final-Billed A/R due to HIM.
20. Perform internal quality-control audits at least quarterly.
21. Have external quality-control audits done at least annually.
Key Performance Indicators
1. Inpatient charts coded, per coder per day
23 - 26
2. Observation charts coded, per coder per day
36 - 40
3. Ambulatory surgery charts coded, per coder per day
36 - 40
4. Outpatient charts coded, per coder per day
150 - 230
5. Emergency room charts coded, per coder per day
190 - 250
6. Chart delinquency greater than 30 days
7. Total chart delinquency
8. HIM "DRG development" D-N-F-B A/R days greater than the late charge hold
≤ 2 A/R days
9. Time to make copies of medical records pursuant to payers' requests
≤ 2 work days
10. Transcription rate per line
8¢ - 12¢
11. Transcription backlog
≤ 1 work day
12. Chart retrieval time pursuant to physicians' requests
≤ 90 minutes
13. Master patient index (MPI) duplicates as a percentage of total registrations
This checklist was based on HFMA's February 2004 audio webcast, "Developing Key Performance Indicators for the Revenue Cycle," by David Hammer, Vice President, Revenue Cycle Management Services, McKesson Information Solutions, and Roland Funsten, Assistant Vice President, Revenue Cycle Operations, St. Vincent Hospital, Indianapolis, IN. Questions or comments may be directed to email@example.com or firstname.lastname@example.org
Publication Date: Tuesday, August 03, 2010